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Predicting persistent pregnancy-related low back pain.

Annelie Gutke¹, Hans Christian Ostgaard, Birgitta Oberg

¹Department of Medicine and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden. annelie.gutke@ihs.liu.se

|May 23, 2008

Summary

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Women with combined pelvic girdle pain (PGP) and lumbar pain (LBP) during pregnancy have the most unfavorable recovery. Early identification of at-risk pregnant individuals is possible through physical exams and self-reports.

Area of Science:

Obstetrics and Gynecology
Musculoskeletal Disorders
Pain Management

Background:

Low back pain (LBP) affects 25% of pregnant women, significantly higher than the general population.
Persistent postpartum LBP (16%) is often treated as a single entity, overlooking specific subtypes like pelvic girdle pain (PGP).
The role of muscular dysfunction as a predictor for persistent postpartum LBP remains under-evaluated, with potential subgroup differences unknown.

Purpose of the Study:

To analyze the progression of distinct low back pain (LBP) subtypes during pregnancy and postpartum.
To identify potential predictors for persistent pelvic girdle pain (PGP) or combined PGP and lumbar pain (combined pain) postpartum.
To investigate the course of LBP subtypes from gestational weeks 12-18 through 3 months postpartum.

Main Methods:

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A cohort study involving 308 pregnant women classified into LBP subgroups.
Mechanical assessment of the lumbar spine, pelvic pain provocation tests, and pain drawings were used for classification.
Trunk muscle endurance, hip muscle strength, and gait speed were evaluated, with logistic regression identifying predictors.

Main Results:

Women with combined pain showed lower recovery rates (33%) compared to PGP (66%) or lumbar pain (72%) alone.
Predictors for persistent PGP or combined pain postpartum included low back flexor endurance, older age, early pregnancy combined pain, and work dissatisfaction.
These predictors explained 30% of the variance in persistent postpartum pain.

Conclusions:

Combined pain during pregnancy represents a high-risk group with the least favorable recovery trajectory.
Classification of combined pain is a significant predictor for persistent postpartum pain.
Early identification of pregnant individuals at risk for persistent postpartum pain is feasible using physical examination and self-report data in early pregnancy.