The active straight leg raising test and mobility of the pelvic joints

Abstract

Objective signs to assess impairment in patients who are disabled by peripartum pelvic girdle pain hardly exist. The purpose of this study was to develop a clinical test to quantify and qualify disability in these patients. The study examined the relationship between impaired active straight leg raising (ASLR) and mobility of pelvic joints in patients with peripartum pelvic girdle pain, focusing on (1) the reduction of impairment of ASLR when the patient was wearing a pelvic belt, and (2) motions between the pubic bones measured by X-ray examination when the patient was standing on one leg, alternating left and right. Twenty-one non-pregnant patients with peripartum pelvic girdle pain in whom pain and impairment of ASLR were mainly located on one side were selected. ASLR was performed in the supine position, first without a pelvic belt and then with a belt. The influence of the belt on the ability to actively raise the leg was assessed by the patient. Mobility of the pelvic joints was radiographically visualized by means of the Chamberlain method. Assessment was blinded. Ability to perform ASLR was improved by a pelvic belt in 20 of the 21 patients (binomial two-tailed P = 0.0000). When the patient was standing on one leg, alternating the symptomatic side and the reference side, a significant difference between the two sides was observed with respect to the size of the radiographically visualized steps between the pubic bones (binomial two-tailed P = 0.01). The step at the symptomatic side was on average larger when the leg at that side was hanging down than when the patient was standing on the leg at that side. Impairment of ASLR correlates strongly with mobility of the pelvic joints in patients with peripartum pelvic girdle pain. The ASLR test could be a suitable instrument to quantify and qualify disability in diseases related to mobility of the pelvic joints. Further studies are needed to assess the relationship with clinical parameters, sensitivity, specificity and responsiveness in various categories of patients. In contrast with the opinion of Chamberlain, that a radiographically visualized step between the pubic bones is caused by cranial shift of the pubic bone at the side of the standing leg, it is concluded that the step is caused by caudal shift of the pubic bone at the side of the leg hanging down. The caudal shift is caused by an anterior rotation of the hip bone about a horizontal axis near the sacroiliac joint.

Prognostic factors for recovery from postpartum pelvic girdle pain

“…Using the scoring system for the ASLR test as in the present study, it is previously shown that ASLR score can assess disease severity for patients with PGP [18]. Moreover, Mens and co-workers [19] demonstrated a relation between the ASLR test and mobility of the pelvic joints. Yet, none of these studies explains the mechanisms for how ASLR is associated to functioning or improvement.…”

“…Less than 5% of healthy subjects scores one or more on the test [17], and hence our cut-off of 4 or above must reflect a marked dysfunction. ASLR is stated to reflect functioning as for instance in transfer of load from the legs to the trunk [19], indicating that the test results are related to the neuromuscular activation patterns. On the other hand, to what extent the effect is limited to the specific task and muscles involved or a more general effect is not known.…”

“…Physical assessment at baseline included ASLR, P4 and LDL tests. The ASLR test is believed to assess the ability to transfer load from the legs to the trunk [19] and to assess disease severity in patients with pregnancy-related PGP [18]. The test was performed according to the description, and impairment in raising one leg was scored on a six-point scale from 0 to 5.…”

Muscle Strength During Active Straight Leg Raising Correlates with Walking Capacity in Patients with Lumbar Spinal Canal Stenosis with Neurogenic Intermittent Claudication

“…ASLR is known to be primarily achieved by the rectus femoris (RF) 23) which originates in the anteroinferior iliac spine. Mens et al 24) conducted a dynamic analysis of pelvic motion during ASLR by X-ray examination. According to their results, the iliac in the elevated leg side rotated forward (pelvic nutation) at the center near the sacroiliac joint, and the iliolumbar ligament on the same side pulled the transverse processes of L4 and L5.…”

Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? A systematic review

“…Pelvic instability, in this context, refers to a failure in the pelvic load transfer mechanism causing excessive pelvic joint movement, which has been verified by observing the displacement between the pubic bones on two-dimensional radiographs [21]. Ideally, the load transfer is supported by well coordinated neuromuscular and articular systems [22].…”