Biomechanical Analysis of Reducing Sacroiliac Joint Shear Load by Optimization of Pelvic Muscle and Ligament Forces

Effective stabilization of the sacroiliac joints (SIJ) is essential, since spinal loading is transferred via the SIJ to the coxal bones, and further to the legs. We performed a biomechanical analysis of SIJ stability in terms of reduced SIJ shear force in standing posture using a validated static 3-D simulation model. This model contained 100 muscle elements, 8 ligaments, and 8 joints in trunk, pelvis, and upper legs. Initially, the model was set up to minimize the maximum muscle stress. In this situation, the trunk load was mainly balanced between the coxal bones by vertical SIJ shear force. An imposed reduction of the vertical SIJ shear by 20% resulted in 70% increase of SIJ compression force due to activation of hip flexors and counteracting hip extensors. Another 20% reduction of the vertical SIJ shear force resulted in further increase of SIJ compression force by 400%, due to activation of the transversely oriented M. transversus abdominis and pelvic floor muscles. The M. transversus abdominis crosses the SIJ and clamps the sacrum between the coxal bones. Moreover, the pelvic floor muscles oppose lateral movement of the coxal bones, which stabilizes the position of the sacrum between the coxal bones (the pelvic arc). Our results suggest that training of the M. transversus abdominis and the pelvic floor muscles could help to relieve SI-joint related pelvic pain

Low back pain in microgravity and bed rest studies

BACKGROUND: The prevalence of low back pain (LBP) for astronauts in space (68%) is higher than the 1-mo prevalence for the general population on Earth (39%). It is unclear whether differences occur between healthy subjects and astronauts with a history of LBP. Knowledge of this issue is important to assess whether a history of LBP could have an operational impact. METHODS: We evaluated LBP prospectively during short duration spaceflight (15 d; N=20) and compared this with similar data collected during two bed rest studies (N=40). Astronauts completed a questionnaire 5-10 d preflight, during each flight day, and 5-10 d postflight. RESULTS: All astronauts with a history of LBP also developed LBP in flight. These astronauts reported a significantly longer duration of LBP and a different pain location. LBP was most often experienced in the central area of the lower back during spaceflight with an incidence of 70% and a mean pain level of 3 (on a scale of 0-10). Pain resolved within 10 d of flight. No neurological signs were present. The most frequently reported countermeasure was assuming a "knees to chest (fetal tuck) position" combined with stretching. Greater LBP intensity was reported in spaceflight than bed rest with a trend indicating a greater number of days of pain during spaceflight. DISCUSSION: The current study represents a prospective study of LBP in spaceflight. The results indicate that LBP is self-limiting in spaceflight and should not pose an operational risk. Prior LBP on Earth appears to be a risk factor for LBP in spaceflight

Risk factors for pelvic girdle pain postpartum and pregnancy related low back pain postpartum:a systematic review and meta-analysis

Contains fulltext : 221001.pdf (Publisher’s version ) (Closed access)BACKGROUND: Although pelvic girdle pain postpartum and pregnancy related low back pain postpartum (combined and named PGPP in this study) have a natural favourable course, there is a subgroup of women who have persistent complaints. The objective of this study was to identify personal-, (pre)pregnancy-, obstetric-, and child related risk factors on PGPP by means of a systematic literature review and meta-analysis. METHODS: Literature searches of PubMed, EMBASE, CINAHL and Cochrane up to October 2018 were conducted. Prospective cohort studies in English or Dutch describing three or more risk factors for PGPP were included. We assessed articles for inclusion and risk of bias. Studies with high risk of bias were excluded from data extraction. Data was extracted and checked for accuracy confirming to the CHARMS-checklist. Homogeneous variables were pooled. RESULTS: Twelve full text studies were assessed. Seven studies were excluded due to high risk of bias. Data was extracted from five studies. Multivariate analysis was not possible due to heterogeneity in included risk factors as well as outcome measures on risk factor per study. Pooled univariate significant risk factors on PGPP were: a history of low back pain, pre-pregnancy body mass index >25, pelvic girdle pain in pregnancy, depression in pregnancy, and a heavy workload in pregnancy. No significant obstetric and child related risk factors were reported. CONCLUSIONS: Risk factors on PGPP have been identified. Since multivariate analysis was not possible the outcome should be treated with care, because interaction between risk factors could not be analysed

Pelvic floor muscle function in a general female population in relation with age and parity and the relation between voluntary and involuntary contractions of the pelvic floor musculature

Contains fulltext : 80525.pdf (publisher's version ) (Closed access

Vaginal noise: prevalence, bother and risk factors in a general female population aged 45–85 years

Item does not contain fulltextINTRODUCTION AND HYPOTHESIS: Vaginal noise (VN) is a symptom of pelvic floor (PF) dysfunction and has been described in a few studies. No other risk factors have been described besides parity and pelvic organ prolapse (POP). Underlying mechanisms of VN are unclear. Aims of this study were to describe prevalence, bother and relation between VN and PF (muscle)(dys)function. METHODS: A cross-sectional study was performed on a general population of 2,921 women (aged 45-85 years). Questionnaires were filled in by 1,397 women, and 800 were selected at random to undergo vaginal examination for POP Quantification and PF muscle function assessment. Chi-square tests, Student's t test and multivariate logistic regression were performed (P < 0.05). RESULTS: Response rate was 62.7%. Prevalence of VN was 12.8%; 72.1% reported only a little bother. Odds ratios for parity and solid stool were high. CONCLUSIONS: VN was strongly related to many symptoms of pelvic floor dysfunction, but it was only causing a little bother

Course and prognosis of recovery for chronic non-specific low back pain: design, therapy program and baseline data of a prospective cohort study

Background: There has been increasing focus on factors predicting the development of chronic musculoskeletal disorders. For patients already experiencing chronic non-specific low back pain it is also relevant to investigate which prognostic factors predict recovery. We present the design of a cohort study that aims to determine the course and prognostic factors for recovery in patients with chronic non-specific low back pain. Methods/Design. All participating patients were recruited (Jan 2003-Dec 2008) from the same rehabilitation centre and were evaluated by means of (postal) questionnaires and physical examinations at baseline, during the 2-month therapy program, and at 5 and 12 months after start of therapy. The therapy protocol at the rehabilitation centre used a bio-psychosocial approach to stimulate patients to adopt adequate (movement) behaviour aimed at physical and functional recovery. The program is part of regular care and consists of 16 sessions of 3 hours each, over an 8-week period (in total 48 hours), followed by a 3-month self-management program. The primary outcomes are low back pain intensity, disability, quality of life, patient's global perceived effect of recovery, and participation in work. Baseline characteristics include information on socio-demographics, low back pain, employment status, and additional clinical items status such as fatigue, duration of activities, and fear of kinesiophobia. Prognostic variables are determined for recovery at short-term (5 months) and long-term (12 months) follow-up after start of therapy. Discussion. In a routine clinical setting it is important to provide patients suffering from chronic non-specific low back pain with adequate information about the prognosis of their complaint

Pregnancy-related pelvic girdle pain: an update

A large number of scientists from a wide range of medical and surgical disciplines have reported on the existence and characteristics of the clinical syndrome of pelvic girdle pain during or after pregnancy. This syndrome refers to a musculoskeletal type of persistent pain localised at the anterior and/or posterior aspect of the pelvic ring. The pain may radiate across the hip joint and the thigh bones. The symptoms may begin either during the first trimester of pregnancy, at labour or even during the postpartum period. The physiological processes characterising this clinical entity remain obscure. In this review, the definition and epidemiology, as well as a proposed diagnostic algorithm and treatment options, are presented. Ongoing research is desirable to establish clear management strategies that are based on the pathophysiologic mechanisms responsible for the escalation of the syndrome's symptoms to a fraction of the population of pregnant women

Clinimetric properties of sacroiliac joint mobility tests: A systematic review

Background: Previous systematic reviews revealed poor reliability and validity for sacroiliac joint (SIJ) mobility tests. However, these reviews were published nearly 20 years ago and recent evidence has not yet been summarised. Objectives: To conduct an up-to-date systematic review to verify whether recommendations regarding the clinical use of SIJ mobility tests should be revised. Study design: Systematic review. Method: The literature was searched for relevant articles via 5 electronic databases. The review was conducted according to the PRISMA guidelines. COSMIN checklists were used to appraise the methodological quality. Studies were included if they had at least fair methodology and reported clinimetric properties of SIJ mobility tests performed in adult patients with non-specific low back pain, pelvic (girdle) pain and/or SIJ pain. Only tests that can be performed in a clinical setting were considered. Results: Twelve relevant articles were identified, of which three were of sufficient methodological quality. These three studies evaluated the reliability of eight SIJ mobility tests and one test cluster. For the majority of individual tests, the intertester reliability showed slight to fair agreement. Although some tests and one test cluster had higher reliability, the confidence intervals around most reliability estimates were large. Furthermore, there were no validity studies of sufficient methodological quality. Conclusion: Considering the low and/or imprecise reliability estimates, the absence of high-quality diagnostic accuracy studies, and the uncertainty regarding the construct these tests aim to measure, this review supports the previous recommendations that the use of SIJ mobility tests in clinical practice is problematic

Barriers and facilitators to ask for lower urinary tract symptoms in people with low back pain and pelvic girdle pain. A qualitative study

BACKGROUND: Lower urinary tract symptoms (LUTS) may be a relevant comorbidity when managing people with low back or pelvic girdle pain. It is unknown how often physiotherapists inquire about LUTS, and what the potential barriers and facilitators are to inquire about LUTS in this patient population. OBJECTIVE: To explore the frequency of inquiring about LUTS, and to identify the barriers and facilitators among physiotherapists with and without additional pelvic health training to ask for LUTS in people with low back or pelvic girdle pain. DESIGN: A qualitative study using thematic analysis. METHODS: Through purposeful sampling, 29 primary care physiotherapists were interviewed (16 physiotherapists and 13 physiotherapists with additional pelvic health training). Thematic analysis was performed to identify themes regarding facilitators and barriers. FINDINGS: The frequency of inquiring about LUTS was: 'never': 10%, 'sometimes': 38%, and 'always': 52%. Four barriers were identified: (1) lack of knowledge of the physiotherapist, (2) a standardised assessment approach which did not include LUTS, (3) patient expectations assumed by the physiotherapist, and (4) social, cultural and personal barriers. Three facilitators were identified: (1) communication skills and experience of the physiotherapist, (2) education and knowledge, and (3) interprofessional consultation and referral. CONCLUSION: The majority of physiotherapists surveyed in this study regularly asked for LUTS in people with low back or pelvic pain. For when not asked, the identified barriers seem modifiable with adequate training, knowledge and skill acquisition, and sound clinical reasoning