Back Pain During Pregnancy

Kristiansson, Per; Svärdsudd, Kurt; Schoultz, Bo von

doi:10.1097/00007632-199603150-00008

Cited by 307 publications

(339 citation statements)

References 12 publications

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“…These tests are also used in the present study, though they are named Palpation of the long dorsal ligaments and Pointing to the joint. Of the nine pain provocation tests Kristiansson et al [9] performed on the sacroiliac joints, the two most sensitive ones were Palpation of the symphysis and Painful femoral compression -in this study called Posterior pelvic pain provocation test. This 165 concords with the present study, where these two tests were among the five most sensitive.…”

Section: Discussionmentioning

confidence: 86%

“…This 165 concords with the present study, where these two tests were among the five most sensitive. Pain provoking tests had a better inter-examiner reliability than that of topograpic/palpation tests, but as Kristiansson et al [9] showed, they also have a better specificity. This is also confirmed in the present study, which shows an almost identical specificity in the compression and separation tests.…”

Section: Discussionmentioning

confidence: 97%

“…The spectrum runs from asking a woman to point out the source of pain on a drawing of the body [14], to subjecting her to a complex and large-scale physical examination comprising more than 40 objective tests [22]. Kristiansson et al [9] classified the pelvic pain suffered by pregnant women in their study into four different groups: pain in the symphysis, pain in the symphysis and sacral area, pain in the symphysis, sacral and lumbar area, and pain in the trochanteric area.…”

Section: Hanne Albert Mona Godskesen Jes Westergaardmentioning

confidence: 99%

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Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain

Albert

Godskesen

Westergaard

2000

European Spine Journal

175

148

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IntroductionPelvic joint pain and low back pain must be considered a major problem for pregnant women, with reported incidences varying from 4 to 78% [1,7,13,14]. The disparity between these figures suggests the need for consistent classification criteria. It also suggests a certain level of diagnostic confusion, which increases the likelihood of inappropriate treatment.Previous investigations, as well as clinical experience, reveal that symptom complexes in those suffering pain from the pelvic joints differ sharply from symptom complexes related to pain coming from the lower back [5,14,16,19]. The therapy differs too [7,8,19].Abstract Pain in the pelvic joints and lower back, a major problem for pregnant women, has proved resistant to precise measurement and quantification. To develop a classification system, the clinical tests used must be able to separate pelvic from low back pain; they must also have a high inter-examiner reliability, sensitivity and specificity, and preferably be easy to perform. The aim of this study was to describe a standardised way of performing tests for examining the pelvis, and to evaluate interexaminer reliability, and establish the sensitivity and specificity of 15 clinical tests. It was designed as a longitudinal, prospective, epidemiological cohort study. First, 34 pregnant women were examined by blinded examiners to establish inter-examiner reliability. Second, a cohort of 2269 consecutive pregnant women, each responded to a questionnaire and underwent a thorough and highly standardised physical examination (15 tests with 48 possible responses) of the pelvic joints and surrounding areas. The 535 women who reported daily pain from the pelvic joints and had objective findings from the joints were divided, according to symptoms, into four classification groups and one miscellaneous group. The results of the study showed inter-examiner agreement of the tests was high, calculated in percentage terms, at between 88 and 100%. Using the Kappa coefficient, most tests kept the high agreement: six tests had an inter-examiner agreement of between 0.81 and 1.00, three between 0.61 and 0.80, and two between 0.60 and 0.41. Five tests showed superior sensitivity. The specificity of the tests was between 0.98 and 1.00, except the value for pelvic topography, which was 0.79. These results show that it is possible to standardise examination and interpretation of clinical tests of the pelvic joints, resulting in a high degree of sensitivity, specificity and inter-examiner reliability.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 97%

Section: Hanne Albert Mona Godskesen Jes Westergaardmentioning

confidence: 99%

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Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain

Albert

Godskesen

Westergaard

2000

European Spine Journal

175

148

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“…46 Additionally, patients with both LBP and PGP have been found to be at greatest risk of persistent pain postpartum 47 and to experience greater disability. 48 Although back pain spontaneously resolves postpartum for most, 49 those with persistent pain were more likely to have had back pain prior to pregnancy, present with early onset of symptoms, and exhibit higher pain severity during pregnancy. 50,51 Existing guidance on occupational lifting…”

Section: Occupational Lifting and Fetal-maternal Health Outcomesmentioning

confidence: 99%

Clinical guidelines for occupational lifting in pregnancy: evidence summary and provisional recommendations

MacDonald

Waters

Napolitano

et al. 2013

American Journal of Obstetrics and Gynecology

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Empirically based lifting criteria established by the National Institute for Occupational Safety and Health (NIOSH) to reduce the risk of overexertion injuries in the general US working population were evaluated for application to pregnant workers. This report proposes criteria to guide decisions by medical providers about permissible weights for lifting tasks performed at work over the course of an uncomplicated pregnancy. Our evaluation included an extensive review of the literature linking occupational lifting to maternal and fetal health. Although it has been 29 years since the American Medical Association's Council on Scientific Affairs published its report on the Effects of Pregnancy on Work Performance, these guidelines continue to influence clinical decisions and workplace policies. Provisional clinical guidelines derived from the NIOSH lifting criteria that account for recent evidence for maternal and fetal health are presented and aim to improve the standard of care for pregnant workers. Keywordslifting; occupational hazard; pregnancy; recommendations Clinicians play an important role in decisions concerning work activity restrictions during pregnancy. This role is underscored in the United States where federal regulations for occupational lifting are lacking and limited opportunities for paid antenatal leave are available. 1,2 Findings from a recent survey show that recommendations to pregnant workers in physically demanding jobs vary widely, possibly because of limited clinician training in occupational health 3 and the absence of current authoritative guidelines. 4 The views expressed herein are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health or the official policy or position of the Department of the Army, the Department of the Navy, the Department of Defense, or the United States Government.The authors report no conflict of interest.Reprints not available from the authors. HHS Public AccessAuthor manuscript Am J Obstet Gynecol. Author manuscript; available in PMC 2015 August 28. Author Manuscript Author Manuscript Author Manuscript Author ManuscriptTo address the need for updated empirically based recommendations that can be uniformly applied, this paper presents provisional clinical guidelines for occupational lifting in pregnancy based on an extensive review of the literature linking occupational lifting to maternal and fetal health and application of the National Institute for Occupational Safety and Health (NIOSH) lifting equation. Literature review criteriaAn extensive review of the literature linking occupational lifting to maternal and fetal health was conducted to inform the application of the NIOSH lifting equation to pregnant workers. Using the PubMed MESH Thesaurus terms, pregnancy, lifting, occupational diseases, preeclampsia, hypertension, pregnancy complications, pelvis, sacroiliac joint, pubic symphysis, range of motion articular, joint instability, relaxin, estradiol, biomechanics, stress mechanic...

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“…Back pain is reported by as many as 50-76% of all pregnant women, generally as a musculoskeletal response to the shifting centre of gravity, weight gain and hormonal factors responsible for ligamentous relaxation and changes in the pelvic joints [99,165,170].…”

Section: Sciatica In Pregnancymentioning

confidence: 99%

Sciatica in the female patient: anatomical considerations, aetiology and review of the literature

2006

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Back Pain During Pregnancy

Cited by 307 publications

References 12 publications

Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain

Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain

Clinical guidelines for occupational lifting in pregnancy: evidence summary and provisional recommendations

Sciatica in the female patient: anatomical considerations, aetiology and review of the literature

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