Acroiliac Joint or Pelvic Girdle Pain Treatment in Pregnant Women - Assignment Example

Acroiliac Joint/Pelvic Girdle Pain Introduction Sacroiliac joint (SIJ)/Pelvic Girdle Pain (PGP) is the pain that arisesfrom the SIJ joint structures. SIJ dysfunction commonly refers to abnormal movement of SIJ structures or position that may or not end in pain. PGP is a definite appearance of low back pain (LBP) that can arise disjointedly or in combination with the LBP. Approximately 77% of pregnant women report LBP at some point and about 22% of women experience PGP at some stage in pregnancy. This paper will explain these clinical models and present path physiology, clinical examinations and diagnosis and physical therapy treatment of SIJ disorders. Path physiology The fundamental things that lead to the the development of PGP during pregnancy, are uncertain. Literature in fact presents diverse, etiologic theories like hormonal, metabolic, degenerative factors, mechanical and traumatic factors. Both biomechanical and hormonal factors appear to be the most reliable hypothesis that can clarify the development of pregnancy associated PGP. The maximum pelvis stabilization is entirely essential; this is because the pelvis functions as an avenue to convey the load to the legs from the trunk. Firstly, the stabilization is of significant concern as it determines if the load will be efficiently transmitted. Secondly, maximum pelvis stability ensures that the shear forces will be reduced transversely across the joints. The stabilization is acquired by three explicit anatomic features, is mostly required at the sacroiliac joints. Ridges and grooves in the articular surfaces of the sacro-iliac form the first part of stabilization. Secondly, the sacrum, which is has a wedge shaped, allows it to articulate and fit firmly between the ilia. Lastly, fascia and ligaments are attached to the pelvis and work across the sacro-iliac joints to provide stability to the joints. During pregnancy, women produce increased amounts Relaxin (polypeptide hormone). As a result, there is more laxity in the ligament, particularly in the pelvis joints by relaxing the connective tissue. In this case of pregnant women, it results to the separation and widening of the symphysis pubis. The greater motion of the pelvic joints leads to negative outcomes that include; the diminishing of effectiveness of load transmission. Moreover the motion increase will increase the shear forces across the joints. It is a likelihood that increase in shear forces is liable for the pain experienced by pregnant women with PGP. Patients who experience PGP can be divided into subgroups depending on symptoms. 1. Pelvic girdle syndrome (PGS) : This syndrome includes anterior and posterior pelvic girdle symptoms and bilateral joints and symphysis pubis 2. Symphysiolysis : This includes the pubic symphysis and anterior pelvic girdle symptoms 3. Sacroiliac syndrome (SS): This includes both a one sided and double sided syndrome that includes unilateral sacroiliac joint and the posterior pelvic girdle symptoms 4. Miscellaneous: This includes incoherent results of the pelvic girdle. The risk causes for the development of PGP pregnant related include: An earlier history record of low back pain An earlier trauma history to the pelvis History of PGP Too much work over load or exhaustive work like bending and twisting of the back area many times per hour. Other factors that do not encourage the possibility for the occurrence of PGP include : Age and Height of the person The utilization of contraceptive pills Time period since last pregnancy Smoking Use of spinal anesthetic Bone solidity/density Weight of the Foetus Number of preceding pregnancies  Maternal customs (Albert, Godskesen, Korsholm, Westergaard 539) Clinical examinations and diagnosis Clinical examination The clinical appearance of a PGP pregnancy related is described by a broad difference of symptoms. These symptoms can range from mild to serious. It is characterized by a stabbing and burning pain which commonly starts approximately in the 17th week but can also begin after the delivery of the baby (Vermani and Mittal 60). During pregnancy, PGP will commonly reach climax intensity between the 25th and 37th week. The pain often disappears within 4 months. But 8-9% has both persisting and chronic pain. The pain intensity based on a visual analogue scale (VAS) is generally around 45-60 mm. Victims of PGP often experience difficulty during: Quick walking: alternating gait pattern (slower walking velocity) During sleep especially when turning in bed During errands in the house Sitting and standing Activities with children Climbing stairs Clinical diagnosis In diagnosis of PGP the following clinical tests are used. 1. PGP: Posterior pelvic pain provocation test (P4) which involves a palpation of the long dorsal SIJ ligament 2. Symphysis: This involves a Palpation of the symphysis girdle. 3. Diagnostic imaging Physical therapy treatment The following physical therapy treatments are recommended 1. Through application physical therapy in pregnancy (Stuge and Bergland 557) 2. Inclusion of individualized treatment program, like particular stabilizing exercises (Stuge, Laerum, Kirkesola, Vollestad 351) 3. By using sing water exercises like swimming during pregnancy 4. By using acupuncture techniques during pregnancy. 5. By using therapeutic intra-articular SIJ injections (Vleeming, Albert, Ostgaard, Sturesson, Stuge 794) Physical Therapy Management 1. Physical therapy for PGP during pregnancy. Exercises are recommended during pregnancy. These exercises should focus on enough advice relating to daily activities and to evade maladaptive movement patterns. 2. Physical therapy for PGP after pregnancy The most important part of the PGP therapy after pregnancy is the focus on precise stabilizing activities and exercises. It has been established that these types of exercises have a constructive outcome on pain, health and functional status to related quality of life. The treatment program includes numerous significant factors like: Notifying the patient about ergonomic advice in real life situations as well as body awareness. These conditions can be actually definite like carrying a child. Body massage, Relaxation, stretching and joint mobilization Training of the abdominal muscles, which are crossways slanted and twisted. This is carried out with activation of the lumbar multifidus located at the lumbosacral region (Gutke, Kjellby, Wendt, Oberg 13) The quadrates lumborum, latissimus dorsi, gluteus maximus, erector spinae, muscles are trained. A systematic overview/meta-analysis of the therapeutic exercises on pregnancy- related PGP and LBP This article will provide an overview and evaluate if the appliance of the specific therapeutic exercises affects the process and result of pregnancy-related LBP and PGP in a positive way. Physical therapies for LBP and PGP treatment include use of pelvic belt, acupuncture, aquatic therapy, ergonomic advice and use of exercise therapy. A review was used to update information of the accessible evidence for exercise therapy interventions in LBP and PGP pregnancy in contrast with other treatments or non- treatment. The secondary purpose is to reflect on essential basics for clinical execution of exercises and future research. Methods A broad database search was conducted within PubMed with the aim of finding RCTs on exercise effects for pregnancy-related LBP and PGP. Addition criteria were defined using population, intervention, control/comparison and outcome (PICO model) 1. Population: Pregnant women 2. Intervention: All exercise category therapy on both aquatic and land exercise therapy 3. Control/comparison: RCTs 4. Outcomes/Results: Pain and disability questionnaires, VAS, days of sick leave Two articles met the criteria and included 3230 participants. The most commonly reviewed outcomes were disability and pain but the outcomes, measurement, number of measurements, time and methods of outcome varied through articles. A meta-analysis could not be carried out and outcome size could not be computed because of the participant’s heterogeneity and the measurement of the results. (Wedenberg , Moen , Norling 331) used a randomized controlled trial to contrast 10 sessions of multimodal physiotherapy to 10 sessions of acupuncture program which incorporated pelvic belt, posture correction, education and exercises both on land and water 2 times/week in 6-8 weeks. The research had 60 expectant women prior to the 32nd week of gestation. The measured results were pain (VAS) and disability (Disability Rating Index). The Mean VAS values lessened after acupuncture therapy following physiotherapy in the morning (P=0.02, 3.7 to 2.3 to 3.4 to 0.9, respectively), and in the evening (p Read More