Predicting persistent pregnancy related low back pain
Predicting persistent pregnancy related low back pain
From: Spine. 2008 May 20;33(12):E386-93
A cohort study to examine the course of subtypes of low back pain experienced [no low back pain, pelvic girdle pain, lumbar pain, and combined pelvic girdle pain and lumbar pain (combined pain)] during gestational weeks 12 to 18 and 3 months postpartum, and to explore potential predictors for persistent pelvic girdle pain or pelvic girdle pain and lumbar pain postpartum.
Low back pain is more prevalent in pregnant women (25%) than in the general population (6.3%). Persistent low back pain postpartum (16%) is usually studied as a single entity. However, only one subgroup of low back pain, pelvic girdle pain, is associated with pregnancy. Several studies have suggested an association between muscular dysfunction and pregnancy-related low back pain, however, muscle dysfunction has not been evaluated as potential predictor of persistent low back pain postpartum. Possible subgroup differences in the course and predictors of persistent low back pain are unknown.
Pregnant women (n = 308) were classified into low back pain subgroups by mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. Trunk muscle endurance, hip muscle strength (dynamometer) and gait speed were evaluated. Multiple logistic regression was used to identify predictors from self-reports and clinical examination. RESULTS: Women with combined pain recovered to a lower degree 33% (17 of 51) than those with pelvic girdle pain 66% (56 of 85) or lumbar pain 72% (21 of 29). Predictors for having persistent pelvic girdle pain or combined pain after delivery were low endurance of back flexors, older age, combined pain in early pregnancy and work dissatisfaction (explained variance 30%).
Women with pelvic girdle pain and lumbar pain were identified to be a target group since they had the most unfavorable course and since the classification of pelvic girdle pain and lumbar pain pain was found to be a predictor for persistent pain postpartum. Identification of women at risk for persistent pain postpartum seems possible in early pregnancy and requires physical examination and self-reports. Pregnancy had low impact on the course of lumbar pain.
