Mens, J.M.A.

Severity of signs and symptoms in lumbopelvic pain during pregnancy (Article)

2012-04-01T00:00:00Z

Data on the severity of signs and symptoms of lumbopelvic pain (LPP) during pregnancy are scarce. Therefore, this cross-sectional study examines the severity of LPP and pain-related signs and symptoms.Women with an uncomplicated pregnancy of 20-30 weeks were invited to participate. They rated their pain and fatigue on a numerical rating scale, and pain location was indicated on a drawing. Disability was scored on the Quebec Back Pain Disability Scale (QBPDS) and urine incontinence on a Likert scale. Physical examination consisted of the Active Straight Leg Raise (ASLR) test, the Posterior Pelvic Pain Provocation (PPPP) test and pain score, and force during isometric bilateral hip adduction.Of all 182 participants, 60.4% reported LPP. Mean pain level was 3.6 (SD 2.2); in 20.0% of the women the score was >5. The mean score on the QBPDS was 27 (SD 16); in 20.9% the score was >40. Compared to women without LPP, women with LPP more frequently suffered back pain in the past (p< 0.001), had a higher body mass index (p< 0.01), more often had urinary incontinence (p< 0.05), had less isometric hip adduction force (p< 0.001), had more pain on isometric hip adduction (p< 0.01), had a higher ASLR score (p< 0.001) and more had often a positive PPPP test (p< 0.001). Fatigue was not related to LPP during pregnancy.The main conclusion is that pain and disability of LPP during pregnancy can be interpreted as mild to moderate in most cases, and as severe in about 20%.

Corrigendum to "Short and mid-term results of a comprehensive treatment program for longstanding adductor-related groin pain in athletes: A case series" [Physical Therapy in Sport 11 (2010) 99-103] (Article)

2011-02-01T00:00:00Z

Short and mid-term results of a comprehensive treatment program for longstanding adductor-related groin pain in athletes: A case series (Article)

2010-08-01T00:00:00Z

Objective: To evaluate short and mid-term results of active physical therapy in athletes with longstanding groin pain. Design: Case series. Setting: Primary care physical therapy practice. Participants: A total of 44 athletes suffering longstanding adductor-related groin pain. Intervention: A combination of passive (joint mobilization) and active (exercises) physical therapy interventions. Main outcome measurements: Return to (the same level of) sports, restriction in sports, and recurrence. Results: Directly after treatment, return to the same level and type of sport was successful in 38 athletes (86%), and without symptoms in 34 athletes (77%). At 6.5-51 months follow up, 10/38 (26%) of those that returned to sports had experienced a relapse; 22 (50%) athletes were able to participate in sports without any restrictions at the mid-term follow-up. Conclusions: For athletes with longstanding groin pain, short term results of physical therapy seem positive, whereas mid-term results are moderately positive. The risk for recurrence is high.

The effect of experimental groin pain on abdominal muscle thickness (Article)

2010-05-01T00:00:00Z

It is not clear whether abnormal abdominal muscle behavior in athletes with longstanding groin pain is a risk factor for groin pain or is caused by groin pain itself. Therefore, this study investigated whether anticipation of experimental groin pain influences abdominal muscle behavior. METHODS: In 14 healthy athletes, abdominal muscle thickness was measured using ultrasound under conditions of anticipated groin pain and acute groin pain. Groin pain was induced using superficial electrical skin stimulation. Tasks evaluated were isometric hip adduction and active straight leg raise (ASLR) left. RESULTS: The m. transversus abdominis and m. obliquus internus showed a significant decrease in thickness during "anticipation of pain" compared with "no pain" and "pain" during both hip adduction and ASLR (P values <0.04). For m. obliquus externus, a significant increase in thickness was found only during "pain" compared with "no pain" and "anticipation of pain" for ASLR (P<0.004). DISCUSSION: If ASLR or hip adduction is associated with anticipated groin pain, abdominal muscle behavior is different from a pain-free situation and from a painful situation. These results suggest that abnormal abdominal muscle behavior found in athletes with longstanding groin pain may be caused by a pain anticipatory motor strategy. This may have implications for rehabilitation.

Resting thickness of transversus abdominis is decreased in athletes with longstanding adduction-related groin pain (Article)

2010-04-01T00:00:00Z

The purpose of the study was to compare thickness of the transversus abdominis (TA) and obliquus internus (OI) muscles between athletes with and without longstanding adduction-related groin pain (LAGP). Forty two athletes with LAGP and 23 controls were included. Thickness of TA and OI were measured with ultrasound imaging on the right side of the body during rest. Relative muscle thickness (compared to rest) was measured during the active straight leg raise (ASLR) left and right, and during isometric hip adduction. TA resting thickness was significantly smaller in injured subjects with left-sided (4.0 ± 0.82 mm; P < 0.001) or right-sided (4.3 ± 0.64 mm; P = 0.015) groin complaints compared with controls (4.9 ± 0.90 mm). No significant differences between patients and controls in TA or OI relative thickness during the ASLR and isometric hip adduction were found (all cases P ≥ 0.15). In conclusion, TA resting thickness is smaller in athletes with LAGP and may thus be a risk factor for (recurrent) groin injury. This may have implications for therapy and prevention of LAGP.

Relation between subjective and objective scores on the active straight leg raising test (Article)

2010-02-01T00:00:00Z

DESIGN.: Cross sectional. Objective: To fill a gap in the validation of the active straight leg raising (ASLR) test concerning the relation between a patient's subjective score on the ASLR test and the objective measured force. Summary of Background Data: The ASLR test is used to classify patients presenting with pain in the low back and/or pelvic girdle. Although its reliability and validity have been demonstrated, some details are still lacking. Methods: The ASLR test was performed by 21 parous women with various ASLR scores. Subjective weakness was scored by the patient both with and without a pelvic belt; moreover the isometric forces of leg raising were measured. Results: The correlation coefficients between the subjective ASLR score and objective measured force at 0 and 20 cm elevation were -0.58 (P < 0.01) and -0.52 (P < 0.05), respectively, at the left side; and -0.45 (P < 0.05) and -0.63 (P < 0.01), respectively, at the right side. When measured with a pelvic belt the correlations were, respectively, -0.51 and -0.48 at the left side, and -0.47 and -0.50 at the right side (all P < 0.05). After applying a pelvic belt the mean subjective ASLR score decreased with 0.38 point at the left side and 0.48 point at the right side (both P < 0.05). With the belt, the measured force at 0 cm elevation increased by 11.6% (P < 0.001) at the left side and by 8.6% (P < 0.05) at the right side; at 20 cm elevation the changes in measured force were negligible. No significant correlation was found between the subjective and the objective changes elicited by the pelvic belt.Conclusion: The subjective scores on the ASLR test correlate well with the objective measured forces; this supports the reliability of the ASLR test. The subjective influence of a pelvic belt on the ASLR score could not be objectified.

No relation between pelvic belt tests and abdominal muscle thickness behavior in athletes with long-standing groin pain. measurements with ultrasound (Article)

2010-01-01T00:00:00Z

Objective: To investigate whether abdominal muscle thickness in athletes with long-standing adduction-related groin pain (LAGP) differs between subgroups with a positive or no response to a pelvic belt. The response to a pelvic belt is defined positive in case of a decrease ≥1 on a Likert pain scale (0-10) during the squeeze test (SQT) or a decrease ≥1 on the active straight leg raise (ASLR) test score (0-10). DESIGN: Cross-sectional study. SETTING: Physical therapy practice. PATIENTS: Fifty athletes with LAGP. INDEPENDENT VARIABLES: Squeeze test and ASLR test. MAIN OUTCOME MEASURES: First, the effect of a pelvic belt on pain during the SQT and the ASLR test score was evaluated. Then, thickness of m. transversus abdominis (TA) and m. obliquus internus (OI) was measured using ultrasound during rest, ASLR left and right, and SQT. RESULTS: Of the 50 participants, 25 (50%) experienced a decrease in pain during the SQT when wearing a pelvic belt and 10 (20%) improved in ASLR performance with a pelvic belt. Thickness of TA and OI at rest (both cases P >.08) and relative thickness compared with rest during tasks (in all cases P >.12) revealed no significant difference when comparing the 2 subgroups based on the belt response during the SQT or ASLR. CONCLUSIONS: Using these methods, abdominal muscle thickness behavior in athletes with LAGP did not differ between the subgroups based on a positive or no response to a pelvic belt. However, the ultrasound method used may not have been sensitive enough to reveal differences between groups.

Mobility of the pelvic joints in pregnancy-related lumbopelvic pain: a systematic review. (Article)

2009-01-01T00:00:00Z

About 45% of all pregnant women and 25% of all women postpartum suffer from pelvic girdle pain and/or low back pain (PLPP). It has been suggested that increased motion of the three joints in the pelvic ring is one of the causes of PLPP. However, in spite of the availability of high technology the relation between enlarged motion of the pelvic joints and pain remains unclear. This article presents 14 studies on this topic, of which 8 are of sufficient quality to draw conclusions. The conclusion is that, during the last months of pregnancy and the first 3 weeks after delivery, motion of the pelvic girdle joints is 32-68% larger in patients with PLPP than in healthy controls. The overlap in the range of symphyseal motion between PLPP patients and healthy controls is too large to use motion as a diagnostic tool in individual cases. The findings support the idea that enlarged motion is one of the factors that causes PLPP and justifies treatment with measures to reduce this motion.

Pregnancy-Related Pelvic Girdle Pain: Intertester Reliability of 3 Tests to Determine Asymmetric Mobility of the Sacroiliac Joints (Article)

2008-02-01T00:00:00Z

Objective: Several tests have been developed to determine the extent of sacroiliac asymmetry during pregnancy-related pelvic girdle pain (PGP). This blinded control study investigated the intertester reliability of 3 such tests used in PGP. Methods: A total of 62 women (ages 20-40 years) were recruited from regional obstetric practices and subsequently divided into 3 groups: (1) 20 women without PGP who were pregnant for more than 20 weeks, (2) 22 women with PGP who were pregnant for more than 20 weeks, and (3) a control group of 20 women who were not pregnant and had no back pain or PGP. All tests were performed by 2 physiotherapists independently of each other and blinded to each other's results. The 3 tests were the thumb-posterior superior iliac spines test, the heel-bank test, and the abduction test. Results: To determine the level of agreement between the 2 testers, κ values were calculated. The overall κ is 0.30 (range, -0.22 to 0.83), which is considered as a poor agreement. The percentage agreement per test/category ranged from 45% to 95%. Conclusion: This study of 3 tests used to determine asymmetry of the sacroiliac joints in women with pregnancy-related PGP showed them to have a poor intertester reliability.

Pregnancy-Related Low Back Pain (Doctoral Thesis)

2000-11-22T00:00:00Z