The effectiveness of craniosacral therapy compared to standard treatment for pelvic girdle pain during pregnancy: A quasi experimental study

Introduction and Aim: Pelvic girdle pain is one of major pregnancy discomforts affecting about 50% of pregnant women. There is no evidence that standard treatment is completely effective for pelvic girdle pain in pregnant women. Hence there is a requirement for newer safer therapies such as craniosacral therapy. The aim of this study is to evaluate effectiveness of craniosacral therapy in reducing pain and improving daily life activities which is restricted in pregnant women with pelvic girdle pain. Materials and Methods: In this quasi-experimental study, we recruited 30 pregnant women who were clinically diagnosed with pelvic girdle pain using convenient sampling technique. They were divided into control and craniosacral therapy treated group. Using NPRS and PGQ, their pain intensity and disability values were recorded and compared pre and post treatment using mean and standard deviation. The paired ‘t’ test was used for statistical analysis. Results: Group A post treatment NPRS value range was mean = 3.00, SD = 0.85 and PGQ post treatment was mean = 36.87, SD = 4.91. Group B post treatment NPRS value mean = 1.87, SD = 0.83 and PGQ post treatment value was mean = 26.53, SD = 4.42. Since between group significant difference was p<0.0001 it was statistically significant. Conclusion: Craniosacral therapy was found to be effective than standard treatment for pelvic girdle pain during pregnancy

Variations in shoulder and pelvic girdle alignment in patients with stroke: A Cross sectional study

ABSTRACT Background: Shoulder and pelvic girdle plays an important role in day to activities of life. In patients with Stroke, one side affection of these girdles pose a major challenge in rehabilitation. However, there is scanty literature about the variations in alignment of girdles in patients with stroke. Aim: This study is aimed to analyse the abnormal changes in the Scapular, Acromion, Mastoid, Pelvis alignment in patients with stroke, as a baseline data. Methodology: An observational study of Scapular, Acromion, Mastoid, Pelvis alignment in stroke survivors was conducted in a Tertiary care hospital. Stroke survivors were recruited from the Physiotherapy unit of VPMH hospital, Ahmednagar. Patients were included between the age group 30 to 70 yrs., Patients with unilateral stroke, patients with acute, subacute & chronic stroke and able to stand with or without support. A palpation meter is used to measure the Scapular, Acromion, Mastoid, Pelvis alignment in stroke survivors. Results: When measured scapular protraction, people after stroke showed more protracted scapulae than the healthy individuals (mean 1.28> 0.42, P= <0.0001). Scapular height discrepancy (mean 1.50>0.55 P= 0.0003), PSIS alignment (mean 0.52>0.07 P= <0.0001) and Acromioclavicular joint alignment (mean 2.28>0.45 P= <0.0001) shows more significant difference found in stroke survivors group than the Healthy individuals Conclusion: Our results indicate that people after stroke, in comparison with age-matched healthy comparison subjects, have altered Scapular, Acromioclavicular and pelvic alignment as evaluated by palpation meter. Keywords: Stroke, Shoulder alignment, Pelvic alignment, Palpation Meter

Effectiveness of motor control exercises versus other musculoskeletal therapies in patients with pelvic girdle pain of sacroiliac joint origin: A systematic review with meta-analysis of randomized controlled trials

BACKGROUND: Pelvic girdle pain represents a group of musculoskeletal pain disorders associated with the sacroiliac joint and/or the surrounding musculoskeletal and ligamentous structures. Its physical management is still a serious challenge as it has been considered the primary cause of low back pain. OBJECTIVE: This review sought to determine the effectiveness of motor control exercises for two clinicallyrelevant measures; i.e., pain and disability, on patients with pelvic girdle pain of sacroiliac joint origin. METHODS: This review covered only randomized controlled studies. Online databases, such as PubMed, Embase, Scopus, and Cochrane Library, were searched from January 1, 1990, to December 31, 2019. PEDro scale was used to assess the methodological quality of included studies, while Review Manager was employed to synthesize data in view of meta-analysis. The PRISMA guidelines were applied for this review. RESULTS: Twelve randomized controlled trials of moderate-to-high quality were included in this review. The studies involved 1407 patients with a mean age ranging from 25.5 to 42.1 years as well as intervention and follow-up durations from 1 week to 2 years. Motor control exercises alone for pelvic girdle pain of sacroiliac joint origin were not effective in terms of pain reduction (SMD = 0.29 [-0.64,1.22]) compared to control interventions whereas they were slightly effective in terms of disability reduction (SMD =-0.07 [-0.67, 0.53]) at short-term. The combination of motor control exercises with other musculoskeletal therapies, however, revealed to be more effective than control interventions in terms of pain reduction (SMD =-1.78 [-2.49, -1.07]; 95%CI) and lessened disability (SMD =-1.80 [-3.03, -0.56]; 95%CI) at short-term. CONCLUSION: Motor control exercises alone were not found to be effective in reducing pain at short-term. However, their combination with other musculoskeletal therapies revealed a significant and clinically-relevant decrease in pain and disability at short-term, especially in peripartum period.

Redescription of Conniella apterygia Allen and its reassignment in the genus Cirrhilabrus Temminck and Schlegel (Teleostei: Labridae), with comments on cirrhilabrin pelvic morphology

Conniella apterygia is redescribed from re-examination of the holotype, two paratypes, and six additional specimens. The genus is closely allied to Cirrhilabrus, sharing similarities in general morphological and meristic details, but is separated from Cirrhilabrus and most other labrid fishes in lacking pelvic fins and a pelvic girdle. Recent molecular phylogenetic studies have provided strong evidence for the deep nesting of Conniella within Cirrhilabrus, contradicting its generic validity and suggesting that the loss of pelvic elements is autapomorphic. Consequently, the species is redescribed and assigned to the genus Cirrhilabrus, as Cirrhilabrus apterygia new combination. The pelvic morphologies of related cirrhilabrin labrids are discussed, and a new synapomorphy is identified for Paracheilinus.

Conceptual model of patho- and sanogenesis of the sacroiliac joint osteoarthritis

Objective. To develop a conceptual model of patho- and sanogene­sis of the sacroiliac joint (SIJ) osteoarthritis on base of the known data about the SIJ, the results of our own biomechanical studies of this joint, its ligaments and stabilizing muscles by finite element modelling, data of clinical verification of these results. Methods. The object of the model is the SIJ as a link, which connects the spine and pelvis. The proposed conceptual model is based on the M. Panjabi hypothesis of chronic lumbar pain in the case of partial dama­ge to ligaments, which leads to muscle dysfunction. Results. A new conceptual model of SIJ osteoarthritis was developed. In this model we tried to take into account the limitations of the existing SIJ stability hypotheses and models of the appearance of the pelvic girdle pain, SIJ dysfunction and SIJ arthrosis. The model is based on the results of our own research. It was proved, that patients with SIJ osteoarthritis have an asymmetry of the width of the joint slits, the inclination of the sacrum and pelvis, sacral rotation, hyperlordosis in the LV–SI segment. These factors lead to a shift of the horizontal axis of sacral rotational mobility relative to the pelvic bones. This horizontal axis shift leads to the instabili­ty of the SIJ on one side of the joint, and to the functional block on another side. The results of these functional changes were damage of the SIJ ligaments-stabilizers, dysfunction of the SIJ muscles-stabilizers, degenerative changes of SIJ elements and pain. The deve­loped model allows to explain the distortion of muscular response pattern in patients with improper SIJ biomechanics in conditions of SIJ osteoarthritis. The increase of the SIJ biomechanics changes enlarges the the muscle response pattern distortion. Conclusions. The developed conceptual model explains many clinical manifestations of the SIJ osteoarthritis and will help to understand better the mechanics of the pelvic girdle pain in such conditions, will improve the results of diagnosis and treatment.

Maintenance of physical activity level, functioning and health after non-pharmacological treatment of pelvic girdle pain with either transcutaneous electrical nerve stimulation or acupuncture: a randomised controlled trial

ObjectiveTo investigate if there are differences between acupuncture and transcutaneous electrical nerve stimulation (TENS) as treatment for pelvic girdle pain (PGP) in pregnancy in order to manage pain and thus maintain health and functioning in daily activities and physical activity (PA).DesignRandomised controlled trial.Setting and participantsPregnant women (n=113) with clinically verified PGP in gestational weeks 12–28, recruited from maternity healthcare centres, randomised (1:1) into two groups. Exclusion criteria: any obstetrical complication, systemic disease or previous disorder that could contradict tests or treatment.InterventionsThe intervention consisted of either 10 acupuncture sessions (two sessions per week) provided by a physiotherapist or daily home-based TENS during 5 weeks.Primary outcome variablesDisability (Oswestry Disability Index), functioning (Patient Specific Functional Scale), work ability (Work Ability Index) and PA-level according to general recommendations.Secondary outcome variablesFunctioning related to PGP (Pelvic Girdle Questionnaire), evening pain intensity (Numeric Rating Scale, NRS), concern about pain (NRS), health (EuroQoL 5-dimension), symptoms of depression/catastrophising (Edinburgh Postnatal Depression Scale/Coping Strategies Questionnaire).ResultsNo mean differences were detected between the groups. Both groups managed to preserve their functioning and PA level at follow-up. This may be due to significantly (p<0.05) reduced within groups evening pain intensity; acupuncture −0.96 (95% CI −1.91 to −0.01; p=0.049), TENS −1.29 (95% CI −2.13 to −0.44; p=0.003) and concern about pain; acupuncture −1.44 (95% CI −2.31 to −0.57; p=0.0012), TENS −1.99 (95% CI −2.81 to −1.17; p<0.0001). The acupuncture group showed an improvement in functioning at follow-up; 0.82 (95% CI 0.01 to 1.63; p=0.048)ConclusionTreating PGP with acupuncture or TENS resulted in maintenance of functioning and physical activity and also less pain and concern about pain. Either intervention could be recommended as a non-pharmacological alternative for pain relief and may enable pregnant women to stay active.Trial registration number12726. https://www.researchweb.org/is/sverige/project/127261

Characteristics of bodily injuries of the pelvic girdle and lower extremities in car trauma

Background. Fractures of the pelvic girdle and lower extremities as a result of a road traffic accident are the most frequent localization of injuries in victims, however, the structure of pedestrian and intra-salon injuries has not been sufficiently studied. Objective - to study the nature of injuries in victims of a car injury to the pelvic girdle and lower extremities. Methods. Research material - 170 acts of primary forensic medical examinations of victims with fractures of the pelvic bones and long bones of the lower extremities, received as a result of a non-lethal automobile injury. An expert assessment of the nature of bodily injuries was carried out at the Kharkiv Regional Bureau of Forensic Medicine (KRBSFM) within a period of no more than 1 month after injury. Acts of primary forensic medical examinations were selected at random for the period February - June 2018. Research methods - retrospective analysis, descriptive statistics. Results. Among the injured as a result of a car injury - 129 (75.9%) pedestrians, 23 (13.5%) drivers, 14 (8.2%) front seat passengers and 4 (2.4%) rear seat passengers. Thus, pedestrians and car drivers are the most vulnerable to road traffic injuries; the most protected rear seat passengers. Men predominated among the drivers; in the remaining groups of victims, the gender distribution was generally even. Among the participants in the accident were mainly people of working age. Injuries to the chest (26.5%), head (25.9%), abdomen (16.5%) prevailed among the associated injuries. Conclusion. A distinctive feature of injuries sustained as a result of a collision of a pedestrian or a car with another car with a relatively low speed of movement was an isolated injury to the bones of the pelvic girdle or lower extremities, both during pedestrian and intra-salon trauma. All the victims had injuries of the integumentary system of various localization in the form of subcutaneous hematomas and abrasions (158; 92.9%), bruised lacerations (96; 56.5%), stamp injuries (62; 36.5%). The main mechanism of pedestrian injury is the direct impact of the traumatic force with the formation of primary injuries in the form of bumper fractures of the shin bones (35.9%), hip (22.4%) and pelvis (10%).