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European guidelines for the diagnosis and treatment of pelvic girdle pain

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Abstract

A guideline on pelvic girdle pain (PGP) was developed by “Working Group 4” within the framework of the COST ACTION B13 “Low back pain: guidelines for its management”, issued by the European Commission, Research Directorate-General, Department of Policy, Coordination and Strategy. To ensure an evidence-based approach, three subgroups were formed to explore: (a) basic information, (b) diagnostics and epidemiology, and (c) therapeutical interventions. The progress of the subgroups was discussed at each meeting and the final report is based on group consensus. A grading system was used to denote the strength of the evidence, based on the AHCPR Guidelines (1994) and levels of evidence recommended in the method guidelines of the Cochrane Back Review group. It is concluded that PGP is a specific form of low back pain (LBP) that can occur separately or in conjunction with LBP. PGP generally arises in relation to pregnancy, trauma, arthritis and/or osteoarthritis. Uniform definitions are proposed for PGP as well as for joint stability. The point prevalence of pregnant women suffering from PGP is about 20%. Risk factors for developing PGP during pregnancy are most probably a history of previous LBP, and previous trauma to the pelvis. There is agreement that non risk factors are: contraceptive pills, time interval since last pregnancy, height, weight, smoking, and most probably age. PGP can be diagnosed by pain provocation tests (P4/thigh thrust, Patrick’s Faber, Gaenslen’s test, and modified Trendelenburg’s test) and pain palpation tests (long dorsal ligament test and palpation of the symphysis). As a functional test, the active straight leg raise (ASLR) test is recommended. Mobility (palpation) tests, X-rays, CT, scintigraphy, diagnostic injections and diagnostic external pelvic fixation are not recommended. MRI may be used to exclude ankylosing spondylitis and in the case of positive red flags. The recommended treatment includes adequate information and reassurance of the patient, individualized exercises for pregnant women and an individualized multifactorial treatment program for other patients. We recommend medication (excluding pregnant women), if necessary, for pain relief. Recommendations are made for future research on PGP.

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References

  1. Albert H, Godskesen M, Westergaard JG, Chard T, Gunn L (1997) Circulating levels of relaxin are normal in pregnant women with pelvic pain. Eur J Obstet Gynecol Reprod Biol 74:19–22

    PubMed CAS  Google Scholar 

  2. Albert H, Godskesen M, Westergaard J (2000) Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain. Eur Spine J 9:161–166

    PubMed CAS  Google Scholar 

  3. Albert H, Godskesen M, Westergaard J (2001) Prognosis in four syndromes of pregnancy-related pelvic pain. Acta Obstet Gynecol Scand 80:505–510

    PubMed CAS  Google Scholar 

  4. Albert HB, Godskesen M, Westergaard JG (2002) Incidence of four syndromes of pregnancy-related pelvic joint pain. Spine 27:2831–2834

    PubMed  Google Scholar 

  5. Albert H, Godskesen M, Korsholm L, Westergaard JG (2006) Risk factors in pregnancy-related pelvic joint pain. Acta Obstet Gynecol Scand 85(5):539–544

    PubMed  Google Scholar 

  6. Ansari N, Keyhani S, Jalaie S (2003) Low back pain during pregnancy, incidence and risk factors. WCPT congress Barcelona, Abstract

  7. Arrindell WA, Janssen ICM, Akkerman A (2006) Invariance of SCL-90-R dimensions of symptom distress in patients with peripartum pelvic pain (pppp) syndrome. Br J Clin Psychol 45:377–391

    PubMed CAS  Google Scholar 

  8. Beaton DE (2000) Understanding the relevance of measured change through studies of responsiveness. Spine 25:3192–3199

    PubMed CAS  Google Scholar 

  9. Belanger TA, Dall BE (2001) Sacroiliac arthrodesis using a posterior midline fascial splitting approach and pedicle screw instrumentation: a new technique. J Spinal Disord 14:118–124

    PubMed CAS  Google Scholar 

  10. Berg G, Hammar M, Möller-Jensen J, Linden U, Thorblad J (1988) Low back pain during pregnancy. Obstet Gynecol 1:71–75

    Google Scholar 

  11. Berthelot JM, Gouin F, Glemarec J, Maugars Y, Prost A (2001) Possible use of arthrodesis for intractable sacroiliitis in spondylarthropathy: report of two cases. Spine 26:2297–2299

    PubMed CAS  Google Scholar 

  12. Bigos S, Bowyer O, Braen G (1994) Acute low back problems in adults. Clinical Practice Guideline no. 14. AHCPR Publication No. 95-0642. Agency for Health Care Policy and Research, Public Health Service, U.S., Department of Health and Human Services, Rockville

  13. Bjorklund K, Lindgren PG, Bergstrom S, Ulmsten U (1997) Sonographic assessment of symphyseal joint distention intra partum. Acta Obstet Gynecol Scand 76:227–232

    PubMed CAS  Google Scholar 

  14. Braun J, Sieper J, Bollow M (2000) Imaging of sacroiliitis. Clin Rheumatol 19:51–57

    PubMed CAS  Google Scholar 

  15. Broadhurst NA, Bond MJ (1998) Pain provocation tests for the assessment of sacroiliac joint dysfunction. J Spinal Disord 11:341–345

    PubMed CAS  Google Scholar 

  16. Carmichael JP (1987) Inter- and intra-examiner reliability of palpation for sacroiliac joint dysfunction. J Manip Physiol Ther 10:164–171

    CAS  Google Scholar 

  17. Carr CA (2003) Use of a maternity support binder for relief of pregnancy-related back pain. J Obstet Gynecol Neonatal Nurs 32:495–502

    PubMed  Google Scholar 

  18. Cibulka MT, Koldehoff R (1999) Clinical usefulness of a cluster of sacroiliac joint tests in patients with and without low back pain. J Orthop Sports Phys Ther 29:83–92

    PubMed CAS  Google Scholar 

  19. Clarke M, Oxman AD (1999), Cochrane Reviewers Handbook 4.0, Oxford, England: The Cochrane Collaboration. In: Review Manager (RevMan) (Computer program). Version 4

  20. Dagfinrud H, Hagen KB (2002) Physiotherapy interventions for ankylosing spondylitis (Cochrane review) In: The cochrane Library, Issue 2. Oxford: updated software

  21. Daly J, Frame PS, Rapoza PA (1991) Sacroiliac subluxation: a common treatable cause of low-back pain in pregnancy. Fam Pract Res J 11:149–159

    PubMed CAS  Google Scholar 

  22. Damen L Buyruk HM, Guler-Uysal F, Lotgering FK, Snijders CJ, Stam HJ (2001) Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints. Acta Obstet Gynecol Scand 80:1019–1024

    Google Scholar 

  23. Damen L, Spoor CW, Snijders CJ, Stam H J (2002) Does a pelvic belt influence sacroiliac laxity? Clin Biomech 17:495–448

    Google Scholar 

  24. Damen L, Buyruk HM, Guler Uysal F, Lotgering FK, Snijders CJ, Stam HJ (2002) The prognostic value of asymmetric laxity of the sacroiliac joint in pregnancy related pelvic pain. Spine 27:2820–2824

    PubMed  Google Scholar 

  25. Damen l (2002) Laxity measurements of sacroiliac joints in women with pregnancy-related pelvic pain. thesis, Erasmus University Rotterdam, The Netherlands

  26. Dequeker J, Goddeeris T, Walravens M, De Roo M (1978) Evaluation of sacro-iliitis: comparison of radiological and radionuclide techniques. Radiology 128:687–689

    PubMed CAS  Google Scholar 

  27. Deursen van LLJM, Patijn J, Ockhuysen A, Vortman BJ (1990) The value of some clinical tests of the sacroiliac joint. J Man Med 5:96–99

    Google Scholar 

  28. Diakow PR, Gadsby TA, Gadsby JB, Gleddie JG, Leprich DJ, Scales AM (1991) Back pain during pregnancy and labor. J Manip Physiol Ther 14:116–118

    CAS  Google Scholar 

  29. Dijkstra PF, Vleeming A, Stoeckart R (1989) Complex motion tomography of the sacroiliac joint: an anatomical and roentgenological study. Fortschr Geb Rontgenstr Nuklearmed 150:635–642

    CAS  Google Scholar 

  30. Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N (1996) The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine 21:2594–2602

    PubMed CAS  Google Scholar 

  31. Dumas GA, Reid JG, Wolfe LA, Griffin MP, McGrath MJ (1995) Exercise, posture, and back pain during pregnancy. Part 2. Exercise and back pain. Clin Biomech 10:104–109

    Google Scholar 

  32. Dussault RG, Kaplan PA, Anderson MW (2000) Fluoroscopy-guided sacroiliac joint injections. Radiology 214:273–277

    PubMed CAS  Google Scholar 

  33. Elden H, Ladfors L, Olsèn MF, Östgaard HC, Hagberg H (2005) Effects of acupuncture and stabilizing exercises among women with pregnancy-related pelvic pain: a randomised single blind controlled trial. BMJ 330(7494):761

    PubMed  Google Scholar 

  34. Elgafy H, Semaan HB, Ebraheim NA, Coombs RJ (2001) Computed tomography findings in patients with sacroiliac pain. Clin Orthop 382:112–118

    PubMed  Google Scholar 

  35. Endresen EH (1995) Pelvic pain and low back pain in pregnant women—an epidemiological study. Scand J Rheumatol 24:135–141

    PubMed CAS  Google Scholar 

  36. European guidelines for the management of low back pain (2006) Eur Spine J Suppl 2

  37. Fairbank JCT, Davies JB, Couper J, O`Brien JP (1980) The oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    PubMed CAS  Google Scholar 

  38. Fast A, Weiss L, Ducommun EJ, Medina E, Butler JG (1990) Low back pain in pregnancy. Spine 1:28–30

    Google Scholar 

  39. Ferrante FM, King LF, Roche EA, Kim PS, Aranda M, Delaney LR, Mardini IA, Mannes AJ (2001) Radiofrequency sacroiliac joint denervation for sacroiliac syndrome. Reg Anesth Pain Med 26:137–142

    PubMed CAS  Google Scholar 

  40. Field T, Hernandez-Reif M, Hart S, Theakston H, Schanberg S, Kuhn C (1999) Pregnant women benefit from massage therapy. J Psychosom Obstet Gynecol 20:31–38

    Article CAS  Google Scholar 

  41. Fortin JD, Dwyer AP, West S, Pier J (1994) Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part I: Asymptomatic volunteers. Spine 19:1475–1482

    PubMed CAS  Google Scholar 

  42. Fortin JD, Aprill CN, Ponthieux B, Pier J (1994) Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part II: Clinical evaluation. Spine 19:1483–1489

    PubMed CAS  Google Scholar 

  43. Gaenslen FJ (1927) Sacro-iliac arthrodesis. J Am Med Assoc 89:2031–2035

    Google Scholar 

  44. Gevargez A, Groenemeyer D, Schirp S, Braun M (1992) CT-guided percutaneous radiofrequency denervation of the sacroiliac joint. Eur Radiol 12:1360–1365

    Google Scholar 

  45. Giannikas KA, Khan AM, Karski MT, Maxwell HA (2004) Sacroiliac joint fusion for chronic pain: a simple technique avoiding the use of metalwork. Eur Spine J 13:253–256

    PubMed CAS  Google Scholar 

  46. Golighty R (1982) Pelvic arthropathy in pregnancy and the puerperium. Physiotherapy 68:216–220

    PubMed CAS  Google Scholar 

  47. Guerreiro S, Nakamura M, Cordeiro J, Kulay L (2004) Acupuncture for low back pain in pregnancy—a prospective, quasi-randomised, controlled study. Acupunc Med 22:60–67

    Google Scholar 

  48. Gugliemi G, De Serio A, Leone A, Cammisa M (2000) Imaging of sacroiliac joints. Rays 25:63–74

    Google Scholar 

  49. Hagen KB, Hilde G, Jamtvedt G, Winnem MF (2000) The Cochrane review of bed rest for acute low back pain and sciatica. Spine 25:2932–2939

    PubMed CAS  Google Scholar 

  50. Hagen R (1974) Pelvic girdle relaxation from an orthopaedic point of view. Acta Orthop Scand 45:550–563

    PubMed CAS  Google Scholar 

  51. Hansen A, Jensen DV, Larsen E, Wilken-Jensen C, Pedersen LK (1996) Relaxin is not related to symptom-giving pelvic girdle relaxation in pregnant women. Acta Obstet Gynecol Scand 75:245–249

    PubMed CAS  Google Scholar 

  52. Hansen A, Jensen DV, Wormslev M, MInck H, Johansen S, Larsen EC, Wilke-Jansen C, Davidsen M, Hansen TM (1999) Symptom-giving pelvic girdle relaxation in pregnacy. Acta Obstet Gynecol Scand 78:111–115

    PubMed CAS  Google Scholar 

  53. Herzog W Read LJ, Conway PJ, Shaw LD, McEwen MC (1989) Reliability of motion palpation procedures to detect sacroiliac joint fixations. J Manipulative Physiol Ther 12:86–92

    Google Scholar 

  54. Ho G Jr, Sadovnikoff N, Malhotra CM, Claunch BC (1979) Quantitative sacroiliac joint scintigraphy. A critical assessment. Arthritis Rheum 22:837–844

    PubMed  Google Scholar 

  55. Hodge JC, Bessette B (1999) The incidence of sacroiliac joint disease in patients with low-back pain. Can Assoc Radiol J 50:321–323

    PubMed CAS  Google Scholar 

  56. Julkunen H, Rokkanen P (1969) Ankylosing spondylitis and osteitis condensans ilii. Acta Rheumatol Scand 15:224–231

    PubMed CAS  Google Scholar 

  57. Keating JG, Avillar MD, Price M (1997) Sacroiliac joint arthrodesis in selected patients with low back pain. In: Movement, stability & low back pain. Churchill Livingstone, London, pp 573–586

  58. Kendall NAS, Linton SJ, Main CJ (1997) Guide to assessing psychosocial yellow flags in acute low back pain: risk factors for long-term disability and work loss. Accident Rehabilitation & Compensation Insurance Corporation of New Zealand and the National Health Committee. Wellington, New Zealand

  59. Kihlstrand M, Stenman B, Nilsson S, Axelsson O (1999) Water-gymnastics reduced the intensity of back/low back pain in pregnant women. Acta Obstet Gynecol Scand 78:180–185

    PubMed CAS  Google Scholar 

  60. Kogstad O (1988) Bækkenløsning - en kontroversiel diagnose. Tidsskr Nor Lægeforen 14:1115–1119

    Google Scholar 

  61. Kokmeyer DJ, van der Wurff P, Aufdemkampe G, Fickensher TCM (2002) The realibility of multiregimens wiht sacroiliac pain provocation tests. J Manip Physiol Ther 25:42–48

    Google Scholar 

  62. Kopec JA, Esdaile JM, Abrahamowicz M, Abenhaim L, Wood-Dauphinee S, Lamping DL, Williams JI (1995) The Quebec back pain disability scale. Measurement properties. Spine 20:341–352

    PubMed CAS  Google Scholar 

  63. Kraag G, Stokes B, Groh J, Helewa A, Goldsmith C (1990) The effects of comprehensive home physiotherapy and supervision on patients with ankylosing spondylitis—a randomised controlled trial. J Rheumatol 17:228–233

    PubMed CAS  Google Scholar 

  64. Kristiansson P, Svärdsudd K, von Schoultz B (1996) Back pain during pregnancy. Spine 6:702–709

    Google Scholar 

  65. Kristiansson P, Svärdsudd K (1996) Discriminatory power of tests applied in back pain during pregnancy. Spine 20:2337–2344

    Google Scholar 

  66. Kristiansson P, Svärdsudd K, von Schoultz B (1996c) Serum relaxin, symphyseal pain and back pain during pregnancy. Am J Obstet Gynecol 5:1342–1347

    Google Scholar 

  67. Kvorning N, Holmberg C, Grennert L, Aberg A, Akeson J (2004) Acupuncture relieves pelvic and low-back pain in late pregnancy. Acta Obstet Gynecol Scand 83:246–250

    PubMed  Google Scholar 

  68. Larsen EC, Wilken-Jensen C, Hansen A, Jensen DV, Johansen S, Minck H, Wormslev M, Davidsen M, Hansen TM (1999) Symptom-giving pelvic girdle relaxation in pregnancy. I: Prevalence and risk factors. Acta Obstet Gynecol Scand 78:105–110

    PubMed CAS  Google Scholar 

  69. Laslett M, Williams M (1994) The reliability of selected pain provocation tests for sacroiliac joint pathology. Spine 19:1243–1249

    PubMed CAS  Google Scholar 

  70. Luukkainen RK, Wennerstrand PV, Kautiainen HH, Sanila MT, Asikainen EL (2002) Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint. Clin Exp Rheumatol 20:52–54

    PubMed CAS  Google Scholar 

  71. MacLennan A, Nicolson R, Green R, Bath M (1986) Serum relaxin and pelvic pain of pregnancy. Lancet 2:243–244

    PubMed CAS  Google Scholar 

  72. Maigne JY, Aivaliklis A, Pfefer F (1996) Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine 21:1889–1892

    PubMed CAS  Google Scholar 

  73. Maigne JY, Boulahdour H, Chatellier G (1998) Value of quantitative radionuclide bone scanning in the diagnosis of sacroiliac joint syndrome in 32 patients with low back pain. Eur Spine J 7:328–331

    PubMed CAS  Google Scholar 

  74. Mantle MJ, Holmis J, Currey HL (1981) Backache in pregnancy II. Prophylactic influence of back care classes Rheumatol Rehabil 20:227–232

    Article PubMed CAS  Google Scholar 

  75. Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A (1996) Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study. Br J Rheumatol 35:767–770

    PubMed CAS  Google Scholar 

  76. McCombe PF, Fairbank JC, Cockersole BC, Pynsent PB (1989) 1989 Volvo award in clinical sciences. Reproducibility of physical signs in low-back pain. Spine 14:908–918

    PubMed CAS  Google Scholar 

  77. McIntyre IN, Broadhurst NA (1996) Effective treatment of low back pain in pregnancy. Aust Fam Phys 25:65–67

    Google Scholar 

  78. Mens JM, Vleeming A, Snijders CJ, Stam HJ, Ginai AZ (1999) The active straight leg raising test and mobility of the pelvic joints. Eur Spine J 8:468–473

    PubMed CAS  Google Scholar 

  79. Mens JM, Snijders CJ, Stam HJ (2000) Diagonal trunk muscle exercises in peripartum pelvic pain: a randomized clinical trial. Phys Ther 80:1164–1173

    PubMed CAS  Google Scholar 

  80. Mens JM, Vleeming A, Snijders CJ, Koes BW, Stam HJ (2001) Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy. Spine 26:1167–1171

    PubMed CAS  Google Scholar 

  81. Mens JM, Vleeming A, Snijders CJ, Koes BW, Stam HJ (2002) Validity of the active straight leg raise test for measuring disease severity with posterior pelvic pain after pregnancy. Spine 27:196–200

    PubMed  Google Scholar 

  82. Mens JM, Vleeming A, Snijders CH, Stam HJ (2002) Responsiveness of outcome measurements in rehabilitation of patients with posterior pelvic pain since pregnancy. Spine 27:1110–1115

    PubMed  Google Scholar 

  83. Moon WN, Kin MY, Oh HJ (2000) Incidence and risk factors of pelvic pain in pregnancy. J Korean Spine Surg 7:259–263

    Google Scholar 

  84. Moore MR (1997) Surgical treatment of chronic painful sacroiliac joint dysfunction. In: Vleeming A et al (eds) Movement, stability & low back pain. Churchill Livingstone, London, pp 563–572

  85. Mousavi SJ (2003) Low back pain and posterior pelvic pain during pregnancy in a middle East population. WCPT congress Barcelona, Abstract

  86. Nilsson-Wikmar L, Holm K, Oijerstedt R, Harms-Ringdahl K (2003) Effect of three different physical therapy treatments on pain and functional activities in pregnant women with pelvic girdle pain: A randomised clinical trial with 3, 6, and 12 months’ follow-up postpartum. PhD Thesis Karolinska Institute, Stockholm

  87. Njoo KH (1993) Non specific low back pain in general practice: a delicate point. PhD Thesis, Erasmus University Rotterdam, The Netherlands

  88. Noren L, Östgaard S, Nielsen TF, Östgaard HC (1997) Reduction of sick leave for lumbar back and posterior pelvic pain in pregnancy. Spine 22:2157–2160

    PubMed CAS  Google Scholar 

  89. Ohen AS, McNeill JM, Calkins E, Sharp JT, Schubart A (1967) The “normal” sacroiliac joint. Analysis of 88 sacroiliac roentgenograms. Am J Roentgenol Radium Ther Nucl Med 100:559–563

    PubMed CAS  Google Scholar 

  90. Olerud S, Walheim GG (1984) Symphysiodesis with a new compression plate. Acta Orthop Scand 55:315–313

    PubMed CAS  Google Scholar 

  91. Oostveen JC, van de Laar MA (2000) Magnetic resonance imaging in rheumatic disorders of the spine and sacroiliac joints. Semin Arthritis Rheum 30:52–69

    PubMed CAS  Google Scholar 

  92. O’Sullivan PB, Beales DJ, Beetham JA, Cripps J, Graf F, Lin IB, Tucker B, Avery A (2002) Altered motor control strategies in subjects with sacroiliac pain during the active straight leg raise test. Spine 27:E1–8

    PubMed  Google Scholar 

  93. Östgaard HC, Andersson GBJ (1992) Post partum low back pain. Spine 17:53–55

    PubMed  Google Scholar 

  94. Östgaard HC, Andersson GJ (1991) Previous back pain and risk of developing back pain in future pregnancy. Spine 16:432–436

    PubMed  Google Scholar 

  95. Östgaard HC, Andersson GJ, Karlsson K (1991) Prevalence of back pain in pregnancy. Spine 16:549–552

    PubMed  Google Scholar 

  96. Östgaard HC, Zetherström G, Roos-Hansen E, Svanberg G (1994) The posterior pelvic pain provocation test I pregnant women. Eur Spine J 3:258–260

    PubMed  Google Scholar 

  97. Östgaard HC, Zetherström G, Roos-Hansson E, Svanberg B (1994) Reduction of back and posterior pelvic pain in pregnancy. Spine 19:894–900

    PubMed  Google Scholar 

  98. Östgaard HC, Zetherström G, Roos-Hansson E (1996) Regression of back and posterior pelvic pain after pregnancy. Spine 21:2777–2780

    PubMed  Google Scholar 

  99. Panjabi MM (1992) The stabilizing system of the spine. Part I: Function, dysfunction, adaptation, and enhancement. J Spinal Dis 5:383–389

    CAS  Google Scholar 

  100. Petersen T, Olsen S, Laslett M, Thorsen H, Manniche C, Ekdahl C, Jacobsen S (2004) Inter-tester reliability of a new diagnostic classification system for patients with non-specific low back pain. Aust J Physiother 50:85–94

    PubMed  Google Scholar 

  101. Potter NA, Rothstein JM (1985) Intertester reliability for selected clinical tests of the sacroiliac joint. Phys Ther 65:1671–1675

    PubMed CAS  Google Scholar 

  102. Puhakka KB, Jurik AG, Egund N, Schiottz-Christensen B, Stengaard-Pedersen K, van Overeem Hansen G, Christiansen JV (2003) Imaging of sacroiliitis in early seronegative spondylarthropathy. Assessment of abnormalities by MR in comparison with radiography and CT. Acta Radiol 44:218–229

    PubMed  Google Scholar 

  103. Pulisetti D, Ebraheim NA (1999) CT-guided sacroiliac joint injections. J Spinal Disord 14:310–312

    Google Scholar 

  104. Riddle DL, Freburger JK (2002) Evaluation of the presence of sacroiliac joint dysfunction using a combination of tests: A multicenter intertester reliability study. Phys Ther 82:772–781

    PubMed  Google Scholar 

  105. Rojko A, Farkas K (1959) Osteitis condensans ossia ilii. Acta Orthop Scand 29:108–120

    PubMed CAS  Google Scholar 

  106. Rosenberg JM, Quint DJ, de Rosayro AM (2000) Computer tomographic localization of clinically—guided sacroiliac joint injections. Clin J Pain 16:18–21

    PubMed CAS  Google Scholar 

  107. Royal College of General Practitioners (1996/1999) Clinical Guidelines for the Management of Acute Low Back Pain. London, Royal College of General Practitioners

  108. Salèn BA, Spangfort EV, Nygren ÅL, Nordemar R (1994) The disability rating index: an instrument for the assessment of disability in clinical settings. J Clin Epidemiol 47:1423–1434

    PubMed  Google Scholar 

  109. Schauberger CW, Rooney BL, Goldsmith L, Shenton D, Silva P, Schaper A (1996) Peripheral joint laxity increases in pregnancy but does not correlate with serum relaxin. Am J Obstet Gynecol 174:667–671

    PubMed CAS  Google Scholar 

  110. Schwarzer AC, Aprill CN, Bogduk N (1995) The sacroiliac joint in chronic low back pain. Spine 20:31–37

    PubMed CAS  Google Scholar 

  111. Shibata Y, Shirai Y, Miyamoto M (2002) The aging process in the sacroiliac joint: helical computed tomography analysis. J Orthop Sci 7:12–18

    PubMed  Google Scholar 

  112. Slätis P, Eskola A (1989) External fixation of the pelvic girdle as a test for assessing instability of the sacro-iliac joint. Ann Med 21:369–372

    PubMed  Google Scholar 

  113. Slätis P, Karaharju EO (1975) External fixation of the pelvic girdle with a trapezoid compression frame. Injury 7:53–56

    PubMed  Google Scholar 

  114. Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E (1996) The value of radionuclide imaging in the diagnosis of sacroiliac joint syndrome. Spine 21:2251–2254

    PubMed CAS  Google Scholar 

  115. Smith-Petersen MN, Rogers WA (1926) End-result study of arthrodesis of the sacroiliac joint for arthritis—traumatic and nontraumatic. J Bone Joint Surg 8:118–136

    Google Scholar 

  116. Snijders CJ, Vleeming A, Stoeckart R (1993) Transfer of lumbosacral load to iliac bones and legs. 1: Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clin Biomech 8:285–294

    Google Scholar 

  117. Snijders CJ, Vleeming A, Stoeckart R (1993) Transfer of lumbosacral load to iliac bones and legs. 2: Loading of the sacroiliac joints when lifting in a stooped posture. Clin Biomech 8:295–301

    Google Scholar 

  118. Soucy JC Jr, Pitts WH Jr, Soucy JC Sr, Smyth CJ (1969) Osteitis condensans ilii. JAMA 207:1145–1147

    PubMed  Google Scholar 

  119. Stewart TD (1984) Pathologic changes in aging sacroiliac joints. Clin Orthop 183:188–196

    PubMed  Google Scholar 

  120. Strender LE, Sjoblom A, Sundell K, Ludwig R, Taube A (1997) Interexaminer reliability in physical examination of patients with low back pain. Spine 22:814–820

    PubMed CAS  Google Scholar 

  121. Stuge B, Hilde G, Vollestad N (2003) Physical therapy for pregnancy-related low back and pelvic pain: a systematic review. Acta Obstetet Gynecol Scand 82:983–990

    Google Scholar 

  122. Stuge B, Lærum E, Kirkesola G, Vøllestad N (2004) The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy. A randomized controlled trial. Spine 29:351–359

    PubMed  Google Scholar 

  123. Stuge B, Veierød MB, Lærum E, Vøllestad N (2004) The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy. A two-year follow-up of a randomized clinical trial. Spine 29:E197–E203

    PubMed  Google Scholar 

  124. Sturesson B, Selvik G, Udén A (1989) Movements of the sacroiliac joints. A roentgen stereophotogrammetric analysis. Spine 14:162–165

    PubMed CAS  Google Scholar 

  125. Sturesson B, Udén G, Udén A (1997) Pain pattern in pregnancy and “Catching” of the leg in pregnant women with posterior pelvic pain. Spine 22:1880–1891

    PubMed CAS  Google Scholar 

  126. Sturesson B, Udén A, Önsten I (1999) Can an external frame fixation reduce the movements of the sacroiliac joint? A radiostereometric analysis. Acta Orthop Scand 70:37–41

    Google Scholar 

  127. Suputtitada A, Wacharapreechanont T, Chaisayan P (2002) Effect of the “sitting pelvic tilt exercise” during the third trimester in primigravidas on back pain. J Med Assoc Thai 85:S170–S179

    PubMed  Google Scholar 

  128. Thomas IL, Nicklin J, Pollock H, Faulkner K (1989) Evaluation of a maternity cushion (Ozzlo Pillow) for backache and insomnia in late pregnancy. Aust NZ J Obstet Gynaecol 29:133–138

    CAS  Google Scholar 

  129. Toussaint R, Gawlik CS, Rehder U, Rüther W (1999) Sacroiliac joint diagnostics in the Hamburg construction workers study. J Manip Physiol Ther 22:139–143

    CAS  Google Scholar 

  130. Tullberg T, Blomberg S, Branth B, Johnnson R (1998) Manipulation does not alter the position of the sacroiliac joint. A Roentgen stereophotogrammetric analysis. Spine 23:1124–1128

    PubMed CAS  Google Scholar 

  131. van Dongen PW, de Boer M, Lemmens WA, Theron GB (1999) Hypermobility and peripartum pelvic pain syndrome in pregnant South African women. Eur J Obstet Gynecol Reprod Biol 84:77–82

    PubMed  Google Scholar 

  132. van Tubergen A, Boonen A, Landewe R, Rutten-van Molken M, van der Heijde D, Hidding A, Van der Linden S (2002) Cost effectiveness of combined spa-exercise therapy in ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum 47(5):459–467

    PubMed  Google Scholar 

  133. van Tulder MW, Tuut M, Pennick V, Bombardier C, Assendelft WJJ (2004) Quality of primary care guidelines for acute low back pain. Spine 29:E357–E362

    PubMed  Google Scholar 

  134. van der Wurff P Hagmeijer RHM, Kuhlmann P (1996) Het sacroiliacaal gewricht getest. Nederlands Tijdschrift voor Fysiotherapie 106:178–184

    Google Scholar 

  135. van der Wurff P, Hagmeijer RHM, Meyne W (2000) Clinical tests of the sacroiliac joint. A systematic methodological review. Part 1: Reliability. Man Ther 5:30–36

    PubMed  Google Scholar 

  136. van der Wurff P, Hagmeijer RHM, Meyne W (2000) Clinical tests of the sacroiliac joint. A systematic methodological review. Part 2: Validity. Man Ther 5:89–96

    PubMed  Google Scholar 

  137. van Zwienen CM, van den Bosch EW, Snijders CJ, van Vugt AB (2004) Triple pelvic ring fixation in patients with severe pregnancy-related low back and pelvic pain. Spine 29:478–484

    PubMed  Google Scholar 

  138. Vincent-Smith B, Gibbons S (1999) Inter-examiner and intra-examiner reliability of the standing flexion test. Man Ther 4:87–93

    PubMed CAS  Google Scholar 

  139. Vleeming A, Stoeckart R, Volkers ACW, Snijders CJ (1990) Relation between form and function in the sacroiliac joint. 1. Clinical anatomical aspects. Spine 15:130–132

    PubMed CAS  Google Scholar 

  140. Vleeming A, Volkers ACW, Snijders CJ, Stoeckart R (1990) Relation between form and function in the sacroiliac joint. 2. Biomechanical aspects. Spine 15:133–136

    PubMed CAS  Google Scholar 

  141. Vleeming A, Buyruk HM, Stoeckart R, Karamursel S, Snijders CJ (1992) An integrated therapy for peripartum pelvic instability: a study of the biomechanical effects of pelvic belts. Am J Obstet Gynecol 166:1243–1247

    PubMed CAS  Google Scholar 

  142. Vleeming A, Pool-Goudzwaard A, Hammudoghlu D, Stoeckart R, Snijders CJ, Mens JM (1996) The function of the long dorsal sacroiliac ligament: its implication for understanding low back pain. Spine 21:556–562

    PubMed CAS  Google Scholar 

  143. Vleeming A, de Vries HJ, Mens JM, van Wingerden JP (2002) Possible role of the long dorsal sacroiliac ligament in women with peripartum pelvic pain. Acta Obstet Gynecol Scand 81:430–436

    PubMed  Google Scholar 

  144. Vleeming A, Albert H B, van der Helm F C T, Lee D, Östgaard HC, Stuge B, Sturesson B (2004) A definition of joint stability. In: European guidelines on the diagnosis and treatment of pelvic girdle pain. Cost Action B13; Low back pain: guidelines for its management. Working group 4 (this report)

  145. Walheim GG (1984) Stabilization of the pelvis with the Hoffman frame. An aid in diagnosing pelvic instability. Acta Orthop Scand 55:319–324

    Article PubMed CAS  Google Scholar 

  146. Waisbrod H, Krainick JU, Gerbershagen HU (1987) Sacroiliac joint arthrodesis for chronic lower back pain. Arch Orthop Trauma Surg 106:238–240

    PubMed CAS  Google Scholar 

  147. Walde J (1962) Obstetrical and gynaecological back and pelvic pains, especially those contracted during pregnancy. Acta Obstet Gynecol Scand 2(Suppl):1–52

    Google Scholar 

  148. Wedenberg K, Moen B, Norling A (2000) A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy. Acta Obstet Gynecol Scand 79:331–335

    PubMed CAS  Google Scholar 

  149. Wiles M (1980) Reproducibility and inter-examiner correlations of motion palpation findings of the sacroiliac joints. J Can Chiro Ass 24:59–69

    Google Scholar 

  150. Withrington RH, Sturge RA, Mitchell N (1985) Osteitis condensans ilii or sacro-iliitis? Scand J Rheumatol 14:163–166

    PubMed CAS  Google Scholar 

  151. Wormslev M, Juul AM, Marques B, Minck H, Bentzen L, Hansen TM (1994) Clinical examination of pelvic Insufficiency during pregnancy. Scand J Rheumatol 23:96–102

    PubMed CAS  Google Scholar 

  152. Wu W, Meijer OG, Uegaki K, Mens JA, van Dieën JH, Wuisman PIJM, Östgaard HC (2004) Pregnancy-related pelvic girdle pain I. Eur Spine J 13(7):575–589

    PubMed CAS  Google Scholar 

  153. Wurdinger S, Humbsch K, Reichenbach JR, Peiker G, Seewald HJ, Kaiser WA (2002) MRI of the pelvic ring joints postpartum: normal and pathological findings. J Magn Reson Imaging 15:324–329

    PubMed  Google Scholar 

  154. Yelland MJ, Glasziou PP, Bogduk N, Schluter PJ, McKernon M (2004) Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine 29:9–16

    PubMed  Google Scholar 

  155. Yildiz A, Gungor F, Tuncer T, Karayalcin B (2001) The evaluation of sacroiliitis using 99mTc-nanocolloid and 99mTc-MDP scintigraphy. Nucl Med Commun 22:785–794

    PubMed CAS  Google Scholar 

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Acknowledgments

The authors are grateful for the contributions made by Prof. Dr. F.C.T van der Helm, Diane Lee and Prof. Dr. M. Parnianpour to the basic part of this manuscript; especially in relation to discussing the definition of joint stability.

Author information

Authors and Affiliations

  1. Spine and Joint Centre, Westerlaan 10, 3016 CK, Rotterdam, The Netherlands

    Andry Vleeming

  2. The Back Research Centre, Part of Clinical Locomotion Science, University of Southern Denmark, Odense, Denmark

    Hanne B. Albert

  3. Department of Orthopaedics, The Sahlgrenska Academy, Molndal Hospital, 431 80, Molndal, Sweden

    Hans Christian Östgaard

  4. Department of Orthopaedics, Spine Unit, Ängelholm Hospital, 26262, Angelholm, Sweden

    Bengt Sturesson

  5. Centre for Clinical Research, Ullevål University Hospital, Oslo, Norway

    Britt Stuge

Authors
  1. Andry Vleeming

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  2. Hanne B. Albert

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  3. Hans Christian Östgaard

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  4. Bengt Sturesson

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  5. Britt Stuge

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Corresponding author

Correspondence toAndry Vleeming.

Additional information

A guideline on pelvic girdle pain was developed by “Working Group 4” within the framework of the COST ACTION B13 “Low back pain: guidelines for its management”, issued by the European Commission, Research Directorate-General, Department of Policy, Coordination and Strategy.

Advisors for definitions: Prof. Dr. M. Parnianpour (Iran), Prof. Dr. FCT van der Helm (Netherlands), D. Lee (Canada).

Appendices

Appendix 1: Grading system based on the original ratings of the AHCPR Guidelines (1994)12and levels of evidence used in systematic (Cochrane)19reviews on low back pain

Level of evidence

  1. 1.

    Therapy and prevention

    • Level A: Generally consistent findings provided by (a systematic review of) multiple high quality randomised controlled trials (RCTs).

    • Level B: Generally consistent findings provided by (a systematic review of) multiple low quality RCTs or non-randomised controlled clinical trials (CCTs).

    • Level C: One RCT (either high or low quality) or inconsistent findings from (a systematic review of) multiple RCTs or CCTs.

    • Level D: No RCTs or CCTs.

Systematic review: systematic methods of selection and inclusion of studies, methodological quality assessment, data extraction and analysis.

  1. 2.

    Prognosis

    • Level A: Generally consistent findings provided by (a systematic review of) multiple high quality prospective cohort studies.

    • Level B: Generally consistent findings provided by (a systematic review of) multiple low quality prospective cohort studies or other low quality prognostic studies.

    • Level C: One prognostic study (either high or low quality) or inconsistent findings from (a systematic review of) multiple prognostic studies.

    • Level D: No evidence: no prognostic studies.

High quality prognostic studies: prospective cohort studies

Low quality prognostic studies: retrospective cohort studies, follow-up of untreated control patients in a RCT, case series

  1. 3.

    Diagnosis

    • Level A: Generally consistent findings provided by (a systematic review of) multiple high quality diagnostic studies.

    • Level B: Generally consistent findings provided by (a systematic review of) multiple low quality diagnostic studies.

    • Level C: One diagnostic study (either high or low quality) or inconsistent findings from (a systematic review of) multiple diagnostic studies.

    • Level D: No evidence: no diagnostic studies.

High quality diagnostic study: Independent blind comparison of patients from an appropriate spectrum of patients, all of whom have undergone both the diagnostic test and the reference standard. An appropriate spectrum is a cohort of patients who would normally be tested for the target disorder. An inappropriate spectrum compares patients already known to have the target disorder with patients diagnosed with another condition.

Low quality diagnostic study: Study performed in a set of non-consecutive patients, or confined to a narrow spectrum of study individuals (or both) all of whom have undergone both the diagnostic test and the reference standard, or if the reference standard was unobjective, unblinded or not independent, or if positive and negative tests were verified using separate reference standards, or if the study was performed in an inappropriate spectrum of patients, or if the reference standard was not applied to all study patient.

Checklist for methodological quality of therapy/prevention studies

Items

  1. 1.

    Adequate method of randomisation

  2. 2.

    Concealment of treatment allocation

  3. 3.

    Withdrawal/dropout rate described and acceptable

  4. 4.

    Co-interventions avoided or equal

  5. 5.

    Blinding of patients

  6. 6.

    Blinding of observer

  7. 7.

    Blinding of care provider

  8. 8.

    Intention-to-treat analysis

  9. 9.

    Compliance

  10. 10.

    Similarity of baseline characteristics

Checklist for methodological quality of prognosis (observational) studies

Items

  1. 1.

    Adequate selection of study population

  2. 2.

    Description of inclusion and exclusion criteria

  3. 3.

    Description of potential prognostic factors

  4. 4.

    Prospective study design

  5. 5.

    Adequate study size (>100 patient-years)

  6. 6.

    Adequate follow-up (>12 months)

  7. 7.

    Adequate loss to follow-up (<20%)

  8. 8.

    Relevant outcome measures

  9. 9.

    Appropriate statistical analysis

Checklist for methodological quality of diagnostic studies

Items

  1. 1.

    Was at least one valid reference test used?

  2. 2.

    Was the reference test applied in a standardised manner?

  3. 3.

    Was each patient submitted to at least one valid reference test?

  4. 4.

    Were the interpretations of the index test and reference test performed independently of each other?

  5. 5.

    Was the choice of patients who were assessed by the reference test independent of the results of the index test?

  6. 6.

    When different index tests are compared in the study: were the index tests compared in a valid design?

  7. 7.

    Was the study design prospective?

  8. 8.

    Was a description included regarding missing data?

  9. 9.

    Were data adequately presented in enough detail to calculate test characteristics (sensitivity and specificity)?

Appendix 2: Description of pelvic girdle pain tests

Active straight leg raise test

The patient lies supine with straight legs and the feet 20 cm apart. The test is performed after the instruction: “Try to raise your legs, one after the other, above the couch for 20 cm without bending the knee”. The patient is asked to score any feeling of impairment (on both sides separately) on a 6-point scale: not difficult at all = 0; minimally difficult = 1; somewhat difficult = 2; fairly difficult = 3; very difficult = 4; unable to do = 5. The scores on both sides are added so that the sum score can range from 0 to 10 [80].

Gaenslen’s test

The patient, lying supine, flexes the hip/knee and draws it towards the chest by clasping the flexed knee with both hands. The patient is then shifted to the side of the examination table so that the opposite leg extends over the edge while the other leg remains flexed. The examiner uses this manoeuvre to gently stress both sacroiliac joints simultaneously. The test is positive if the patient experiences pain (either local or referred) on the provoked side [43].

Long dorsal sacroiliac ligament (LDL) test

The LDL test in postpartum women

The patient lies prone and is tested for tenderness on bilateral palpation of the LDL directly under the caudal part of the posterior superior iliac spine. A skilled examiner scores the pain as positive or negative on a 4-point scale: no pain = 0; mild = 1; moderate = 2; unbearable = 3. The scores on both sides are added so that the sum score can range from 0–6. [143].

The LDL test in pregnant women

The patient lies on her side with slight flexion in both hip and knee joints. If the palpation causes pain that persists for more than 5 seconds after removal of the examiner’s hand it is recorded as pain. If the pain disappears within 5 seconds it is recorded as tenderness [2].

Pain provocation of the symphysis by Modified Trendelenburg’s test

The patient stands on one leg and flexes the hip and knee at 90 degrees. If pain is experienced in the symphysis the test is considered positive [2].

Patrick’s Faber test

The patient lies supine: one leg is flexed, abducted, and externally rotated so that the heel rests on the opposite knee. The examiner presses gently on the superior aspect of the tested knee joint. If pain is felt in the sacroiliac joints or in the symphysis the test is considered positive [2,15,151].

Posterior pelvic pain provocation test

The test is performed supine and the patient’s hip flexed to an angle of 90 degrees on the side to be examined: light manual pressure is applied to the patient’s flexed knee along the longitudinal axis of the femur while the pelvis is stabilized by the examiner’s other hand resting on the patients contralateral superior anterior iliac spine. The test is positive when the patient feels a familiar well localized pain deep in the gluteal area on the provoked side [96].

A similar test is described as the posterior shear or “thigh thrust” test [69].

Symphysis pain palpation test

The patient lies supine. The entire front side of the pubic symphysis is palpated gently. If the palpation causes pain that persists more than 5 s after removal of the examiner’s hand, it is recorded as pain. If the pain disappears within 5 s it is recorded as tenderness [2].

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Vleeming, A., Albert, H.B., Östgaard, H.C.et al. European guidelines for the diagnosis and treatment of pelvic girdle pain.Eur Spine J17, 794–819 (2008). https://doi.org/10.1007/s00586-008-0602-4

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