Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Evaluation of Lumbar Lordosis and Hip Extensor Strength in Postpartum Woman with Pelvic Girdle Pain - A Case Control Study


Affiliations
1 Department of Physiotherapy, Krupanidhi College of Physiotherapy, Bengaluru, Karnataka, India ., India
     

   Subscribe/Renew Journal


Background: Pelvic Girdle Pain (PGP) is a musculoskeletal pain that arises between the posterior iliac crest and gluteal fold, at the sacroiliac joint and also radiates posteriorly in the thigh. PGP give rise to very intense pain and disability than Low Back Ache (LBA). It is a common condition during pregnancy and post-delivery. Joint laxity increases pelvic rotation and lumbar lordosis which results in adaptive hip extensor muscle weakness. Hence the studies focus on identifying the lumbar lordosis and hip extensor strength of PGP. Aim of the Study: To identify the association between lumbar lordosis and PGP and to identify the association between hip extensor strength and PGP among post-partum women. Material and Methodology: Based on inclusion and exclusion criteria a total of 80 postpartum women were assessed based on the diagnostic criteria the women were divided into two groups. Group A consists of women with PGP and group B consists of women without PGP. Both groups were assessed for lumbar lordosis using flexicurve and hip extensor strength using a manual muscle tester. Data collected was analyzed using. Outcome Measure: Flexicurve to assess lumbar lordosis. Manual muscle tester to assess hip extensor strength. Result: The study showed that the mean lumbar lordosis was significantly higher in women with PGP than in women without PGP, p = 0.001. There was a 15.46° ± 6.91° higher angle observed in persons who had pelvic girdle pain compared to those who did not have pelvic girdle pain. The mean hip extensor strength for group ‘A’ (average of right and left side) was 12.74 ± 0.73kg, whereas it was significantly higher in group ‘B’. Conclusion: The study concludes that there is a positive association between lumbar lordosis and hip extensor weakness in pelvic girdle pain.

Keywords

ASLR Test, Flexicurve, Pelvic Girdle Pain (PGP), Posterior Pelvic Pain Provocation Test, Sacroiliac Joint (SIJ)
Subscription Login to verify subscription
User
Notifications
Font Size


  • Vleeming A, Albert HB, Östgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal. 2008; 17(6):794-819. https://doi.org/10.1007/s00586-008-0602-4 PMid:18259783 PMCid:PMC2518998
  • Wuytack F, Curtis E, Begley C. Experiences of first-time mothers with persistent pelvic girdle pain after childbirth: descriptive qualitative study. Physical Therapy. 2015 Oct 1; 95(10):1354-64. https://doi.org/10.2522/ptj.20150088 PMid:25929535
  • O’Sullivan PB, Beales DJ. Diagnosis and classification of pelvic girdle pain disorders- Part 1: A mechanism based approach within a biopsychosocial framework. Manual Therapy. 2007 May; 12(2):86-97 https://doi.org/10.1016/j.math.2007.02.001 PMid:17449432
  • Dufour S, Daniel S. Understanding clinical decision making: Pregnancy-related pelvic girdle pain. Journal of Women’s Health Physical Therapy. 2018 Sep; 42(3):120-7 https://doi.org/10.1097/JWH.0000000000000100
  • Aldabe D, Milosavljevic S, Bussey MD. Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? A systematic review. Eur Spine J. 2012 Sep; 21(9):1777-87. https://doi.org/10.1007/ s00586-012-2401-1 PMid:22718046 PMCid:PMC3459120
  • Casagrande D, Gugala Z, Clark SM, Lindsey RW. Low back pain and pelvic girdle pain in pregnancy. Journal of the American Academy of Orthopaedic Surgeons. 2015 Sep; 23(9):539-49. https://doi.org/10.5435/JAAOS-D-14-00248 PMid:26271756
  • Zahedpour F, Mohammadi M, Damavandi M, Agah J. The effect of core stability training on postpartum lumbar lordosis and low back pain in nulliparous women. The Iranian Journal of Obstetrics, Gynecology and Infertility, 2017; 20(3):89-97. doi: 10.22038/ijogi.2017.8876
  • Lue Y, Hsieh C, Liu M, Hsiao S, Chen S, Lin J, et al. Influence of testing position on the reliability of hip extensor strength measured by a handheld dynamometer. The Kaohsiung Journal of Medical Sciences. 2009 Mar; 25(3):126-32. https:// doi.org/10.1016/S1607-551X(09)70051-8 PMid:19419917
  • Smith JA, Popovich JM, Kulig K. The influence of hip strength on lower-limb, pelvis, and trunk kinematics and coordination patterns during walking and hopping in healthy women. J Orthop Sports Phys Ther. 2014 Jul; 44(7):525-31. https://doi.org/10.2519/jospt.2014.5028 PMid:24816500
  • Sjödahl J, Gutke A, Öberg B. Predictors for long-term disability in women with persistent postpartum pelvic girdle pain. Eur Spine J. 2013 Jul; 22(7):1665-73 https://doi. org/10.1007/s00586-013-2716-6 PMid:23430102 PMCid: PMC3698347
  • Gutke A, Östgaard H, Öberg B. Association between muscle function and low back pain in relation to pregnancy. J Rehabil Med. 2008; 40(4):304-11. https://doi.org/10.2340/16501977-0170 PMid:18382827
  • Morino S, Ishihara M, Umezaki F, Hatanaka H, Yamashita M, Aoyama T. Pelvic alignment changes during the perinatalperiod. PLoS ONE. 2019 Oct 10; 14(10):e0223776. https:// doi.org/10.1371/journal.pone.0223776 PMid:31600310 PMCid:PMC6799872
  • Ronchetti I, Vleeming A, van Wingerden JP. Physical characteristics of women with severe pelvic girdle pain after pregnancy. Spine. 2008 Mar; 33(5):E145-51. https://doi.org/10.1097/BRS.0b013e3181657f03 PMid:18317182
  • Robinson HS, Mengshoel AM, Bjelland EK, Vøllestad NK. Pelvic girdle pain, clinical tests and disability in late pregnancy. Manual Therapy. 2010 Jun; 15(3):280-5 https://doi.org/10.1016/j.math.2010.01.006 PMid:20117040
  • Mukkannavar P, Desai BR, Mohanty U, Kulkarni S, Parvatikar V, Daiwajna S. Pelvic girdle pain in Indian postpartum women: a cross-sectional study. Physiotherapy Theory and Practice. 2014 Feb; 30(2):123-30. https://doi.org/10.3109/09593985.2013.816399 PMid:23899351
  • Mens JMA, Vleeming A, Snijders CJ, Koes BW, Stam HJ. Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy. Spine. 2001 May; 26(10):1167-71. https://doi.org/10.1097/00007632200105150-00015 PMid:11413432
  • Gutke A, Hansson ER, Zetherström G, Östgaard HC.Posterior pelvic pain provocation test is negative in patients with lumbar herniated discs. Eur Spine J. 2009 Jul; 18(7):1008-12. https://doi.org/10.1007/s00586-009-1003-z PMid:19390876 PMCid:PMC2899577
  • Ishøi L, Hölmich P, Thorborg K. Measures of hip muscle strength and rate of force development using a fixated handheld dynamometer: intra-tester intra-day reliability of a clinical set-up. Int J Sports Physther. 2019 Sep; 14(5):71523. https://doi.org/10.26603/ijspt20190715 PMid:31598409 PMCid:PMC6769277
  • Lin JT, Lutz GE. Postpartum sacral fracture presenting as lumbar radiculopathy: A case report. Archives of Physical Medicine and Rehabilitation. 2004 Aug; 85(8):1358-61. https://doi.org/10.1016/j.apmr.2003.09.021 PMid:15295766
  • de Oliveira TS, Candotti CT, La Torre M, Pelinson PPT, Furlanetto TS, Kutchak FM, et al. Validity and reproducibility of the measurements obtained using the flexicurve instrument to evaluate the angles of thoracic and lumbar curvatures of the spine in the sagittal plane. Rehabilitation Research and Practice. 2012; 2012:1-9. https://doi. org/10.1155/2012/186156 PMid:22619723 PMCid:PMC3348664
  • Malmqvist S, Kjaermann I, Andersen K, Gausel AM,Økland I, Larsen JP, et al. Can a bothersome course of pelvic pain from mid-pregnancy to birth be predicted? A Norwegian prospective longitudinal SMS-Track study. BMJ Open. 2018 Jul; 8(7):e021378. https://doi.org/10.1136/ bmjopen-2017-021378 PMid:30049694 PMCid:PMC6067360
  • R. Rajabi. Which method is accurate when using the flexible ruler to measure the lumbar curvature angle? Deep pint or mid point of arch? World Applied Sciences Journal.2008; 4(6):849-52.
  • Verstraete EH, Vanderstraeten G, Parewijck W. Pelvic Girdle Pain during or after Pregnancy: a review of recent evidence and a clinical care path proposal. Facts Views Vis Obgyn. 2013; 5(1):33-43.
  • Thein-Nissenbaumjm, Thompsonef, Chumanov ES, Heiderscheit B. Low back and hip pain in a postpartum runner: Applying ultrasound imaging and running analysis. J Orthop Sports Physther. 2012 Jul; 42(7):615-24. https://doi.org/10.2519/jospt.2012.3941 PMid:22446476
  • Christophers M, Garcia AN, Snodgrasssj, Cook C. Common musculoskeletal impairments in postpartum
  • runners: An international delphi study. Arch Physiother. 2020 Dec;10(1). https://doi.org/10.1186/s40945-020- 00090-y PMid:33117595 PMCid:PMC7586674 .

Abstract Views: 265

PDF Views: 0




  • Evaluation of Lumbar Lordosis and Hip Extensor Strength in Postpartum Woman with Pelvic Girdle Pain - A Case Control Study

Abstract Views: 265  |  PDF Views: 0

Authors

Mani Mohanieshwari
Department of Physiotherapy, Krupanidhi College of Physiotherapy, Bengaluru, Karnataka, India ., India
Jincy Samuel
Department of Physiotherapy, Krupanidhi College of Physiotherapy, Bengaluru, Karnataka, India ., India

Abstract


Background: Pelvic Girdle Pain (PGP) is a musculoskeletal pain that arises between the posterior iliac crest and gluteal fold, at the sacroiliac joint and also radiates posteriorly in the thigh. PGP give rise to very intense pain and disability than Low Back Ache (LBA). It is a common condition during pregnancy and post-delivery. Joint laxity increases pelvic rotation and lumbar lordosis which results in adaptive hip extensor muscle weakness. Hence the studies focus on identifying the lumbar lordosis and hip extensor strength of PGP. Aim of the Study: To identify the association between lumbar lordosis and PGP and to identify the association between hip extensor strength and PGP among post-partum women. Material and Methodology: Based on inclusion and exclusion criteria a total of 80 postpartum women were assessed based on the diagnostic criteria the women were divided into two groups. Group A consists of women with PGP and group B consists of women without PGP. Both groups were assessed for lumbar lordosis using flexicurve and hip extensor strength using a manual muscle tester. Data collected was analyzed using. Outcome Measure: Flexicurve to assess lumbar lordosis. Manual muscle tester to assess hip extensor strength. Result: The study showed that the mean lumbar lordosis was significantly higher in women with PGP than in women without PGP, p = 0.001. There was a 15.46° ± 6.91° higher angle observed in persons who had pelvic girdle pain compared to those who did not have pelvic girdle pain. The mean hip extensor strength for group ‘A’ (average of right and left side) was 12.74 ± 0.73kg, whereas it was significantly higher in group ‘B’. Conclusion: The study concludes that there is a positive association between lumbar lordosis and hip extensor weakness in pelvic girdle pain.

Keywords


ASLR Test, Flexicurve, Pelvic Girdle Pain (PGP), Posterior Pelvic Pain Provocation Test, Sacroiliac Joint (SIJ)

References





DOI: https://doi.org/10.18519/jer%2F2023%2Fv27%2F222243