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      Altered musculoskeletal mechanics as risk factors for postpartum pelvic girdle pain: a literature review

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          Abstract

          [Purpose] The aim of this literature review was to detect the factors associated with pelvic girdle pain persisting for over 3 months in the postpartum period. [Methods] We performed a broad literature search for eligible studies published before May 1, 2018 using electronic databases and processed the data using a review process. [Results] In the initial online search, we identified 12,174 potential studies. Finally, 22 studies met the specified criteria and were included for examination of risk factors for persistent pelvic girdle pain after delivery. Pain intensity and disability during pregnancy were risk factors for pelvic girdle pain persisting for over 6 months after delivery. The active straight leg raising test predicted the risk of persistent pelvic girdle pain after delivery. Dysfunction of the pelvic floor muscles was also a risk factor for persistent pelvic girdle pain. [Conclusion] Pain intensity and disability during pregnancy, positive provocation tests, active straight leg raising test, and musculoskeletal mechanics were positively associated with pelvic girdle pain persisting for over 3 months after delivery.

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          Most cited references 33

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          The levels of evidence and their role in evidence-based medicine.

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            Prognosis in four syndromes of pregnancy-related pelvic pain.

            The aim of the present study was to describe, on the basis of specific classification criteria and for a period of two years after delivery, the prognosis for women suffering from pregnancy-related pelvic joint pain, and to describe the characteristics influencing the prognosis. One thousand seven hundred and eighty-nine pregnant women who were booked for delivery at Odense University Hospital formed a cohort to investigate the prognosis. Women whose reported daily pain from pelvic joints could be objectively confirmed were divided, according to symptoms, into five subgroups (n=405) - four classification groups (pelvic girdle syndrome, symphysiolysis, one-sided sacroiliac syndrome and double-sided sacroiliac syndrome) and one miscellaneous. The women in the five subgroups were re-examined at regular intervals for two years after delivery or until disappearance of symptoms (whichever was less). Thre hundred and forty-one women from the 5 subgroups participated in the postpartum follow-up. The majority (62.5%) of women in the four classification groups experienced disappearance of pain within a month after delivery. Two years after parturition 8.6% were still suffering from pelvic joint pain (determined subjectively and objectively). Persistence of pain was found to vary significantly from one classification group to another. None of those initially classified as suffering from symphysiolysis had pain 6 months after delivery in comparison to the 21 percent of those with pelvic girdle syndrome who continued to have pain at the two-year mark. This study shows that pregnancy-related pelvic joint pain had an excellent postpartum prognosis (in general) in three out of four classification groups. The women with pelvic girdle syndrome (pain in all 3 pelvic joints) had a markedly worse prognosis than the women in the other three classification groups. High number of positive test and a low mobility index were identified as giving the highest relative risk for long term pain.
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              The sacroiliac joint: an overview of its anatomy, function and potential clinical implications.

              This article focuses on the (functional) anatomy and biomechanics of the pelvic girdle and specifically the sacroiliac joints (SIJs). The SIJs are essential for effective load transfer between the spine and legs. The sacrum, pelvis and spine, and the connections to the arms, legs and head, are functionally interrelated through muscular, fascial and ligamentous interconnections. A historical overview is presented on pelvic and especially SIJ research, followed by a general functional anatomical overview of the pelvis. In specific sections, the development and maturation of the SIJ is discussed, and a description of the bony anatomy and sexual morphism of the pelvis and SIJ is debated. The literature on the SIJ ligaments and innervation is discussed, followed by a section on the pathology of the SIJ. Pelvic movement studies are investigated and biomechanical models for SIJ stability analyzed, including examples of insufficient versus excessive sacroiliac force closure. © 2012 The Authors. Journal of Anatomy © 2012 Anatomical Society.
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                Author and article information

                Journal
                J Phys Ther Sci
                J Phys Ther Sci
                JPTS
                Journal of Physical Therapy Science
                The Society of Physical Therapy Science
                0915-5287
                2187-5626
                19 October 2019
                October 2019
                : 31
                : 10
                : 831-838
                Affiliations
                [1) ] Graduated School of Medical Technology and Health Welfare Sciences, Hiroshima International University: 555-36 Kurosegakuendai, Higashihirsoshima-shi, Hiroshima 739-2631, Japan
                [2) ] Faculty of Rehabilitation Sciences, Nishikyushu University, Japan
                Author notes
                [* ]Corresponding author. Kazuyoshi Gamada (E-mail: kazgamada@ 123456ortho-pt.com )
                Article
                jpts-2019-098
                10.1589/jpts.31.831
                6801337
                2019©by the Society of Physical Therapy Science. Published by IPEC Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. (CC-BY-NC-ND 4.0: https://creativecommons.org/licenses/by-nc-nd/4.0/ )

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