Abstract
Objective
To describe the management of groin pain occurring during pregnancy using a comprehensive conservative approach.
Clinical Features
A 32-year-old woman 20 weeks into her pregnancy experienced difficulty standing and moving due to groin pain. She also had pain with forward bending and a positive long dorsal ligament test. She had a Quebec Task and Force Disability Scale questionnaire score of 122 and rated her pain as an 8/10 on a visual analog scale.
Intervention and Outcome
Active Release Technique, home relaxation exercises, patient education, and ergo-nomic training were provided over approximately 3 weeks (3 treatments). Her Quebec score was 62 and she had no pain after treatment.
Conclusion
A comprehensive treatment plan of soft tissue release, patient education and home exercises appeared to help minimize this patient's groin pain associated with pregnancy.
Key Indexing Terms: Chiropractic, Pregnancy, Groin
Footnotes
Sources of Support: No funds were received for the preparation of this manuscript.
References
- 1.Ostgaard HC, Andersson GBJ, Karlsson K. Prevalence of back pain in pregnancy. Spine. 1991;16:549–552. doi: 10.1097/00007632-199105000-00011. [DOI] [PubMed] [Google Scholar]
- 2.Kristiansson P, Svarsudd K, Von Schoultz B. Back pain during pregnancy: a prospective study. Spine. 1996;21:702–709. doi: 10.1097/00007632-199603150-00008. [DOI] [PubMed] [Google Scholar]
- 3.Orvieto R, Achiron A, Ben-Rafael Z, Gelernter I, Achiron R. Low-back pain of pregnancy. Acta Obstet Gynecol Scand. 1994;73:209–214. doi: 10.3109/00016349409023441. [DOI] [PubMed] [Google Scholar]
- 4.Berg G, Hammar M, Moller-Nielsen J, Linden U, Thorblad J. Low back pain during pregnancy. Obstet Gynecol. 1988;71:71–75. [PubMed] [Google Scholar]
- 5.Albert H, Godskesen M, Westergaard J. Prognosis in four syndromes of pregnancy-related pelvic pain. Acta Obstet Gynecol Scand. 2001;80:505–510. [PubMed] [Google Scholar]
- 6.Bjorklund K, Nordstrom M, Bergstrom S. Sonographic assessment of symphyseal joint distention during pregnancy and post partum with special reference to pelvic pain. Acta Obstet Gynecol Scand. 1999;78:125–130. doi: 10.1080/j.1600-0412.1999.780210.x. [DOI] [PubMed] [Google Scholar]
- 7.Owens K, Pearson A, Mason G. Symphysis pubis dysfunction—a cause of significant obstetric morbidity. Eur J Obstet Gynecol Reprod Biol. 2002;105:143–146. doi: 10.1016/s0301-2115(02)00192-6. [DOI] [PubMed] [Google Scholar]
- 8.Daly JM, Frame PS, Rapoza PA. Sacroiliac subluxation: a common, treatable cause of low-back pain in pregnancy. Fam Pract Res J. 1991;22:149–159. [PubMed] [Google Scholar]
- 9.Stuge BM, Kirkesola G. The efficacy of a specific stabilization exercise program in the treatment of patients with peripartum pelvic pain after pregnancy: a randomized controlled trial. Proceedings of the 4thInterdisciplinary World Congress on Low Back and Pelvic Pain; 2001 Nov 8–10; Montreal, Canada. Montreal: World Congress on Low Back and Pelvic Pain; 2001.
- 10.Skaggs CD, Gross G, Ducar D, Thompson PA, Nelson DM. A comprehensive musculoskeletal management program reduces pain and disability in pregnancy. Proceedings of the 5th Interdisciplinary World Congress on Low Back and Pelvic Pain. 2004 Nov 10–13; Melbourne, Australia. Melbourne: World Congress on Low Back and Pelvic Pain; 2004.
- 11.Vleeming A, Devries HJ, Mens JMA, Van Wingerden JP. Possible role of the long dorsal sacroiliac ligament in women with peripartum pelvic pain. Acta Obstet Gynecol Scand. 2002;81:430–436. doi: 10.1034/j.1600-0412.2002.810510.x. [DOI] [PubMed] [Google Scholar]
- 12.Goeken LN. Instrumental straight-leg raising: results in patients. Arch Phys Med Rehabil. 1994;75:470–477. doi: 10.1016/0003-9993(94)90174-0. [DOI] [PubMed] [Google Scholar]
- 13.McCombe PF, Fairband JCT, Cockersole BC, Pynsent PB. Reproducibility of physical signs in low-back pain. Spine. 1989;14:908–918. doi: 10.1097/00007632-198909000-00002. [DOI] [PubMed] [Google Scholar]
- 14.Mens JMA, Vleeming A, Snijders CJ, Stam HJ, Ginai AZ. The active straight leg raising test and mobility of the pelvic joints. Eur Spine J. 1999;8:468–473. doi: 10.1007/s005860050206. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Mens JMA, Vleeming A, Snijders CJ, Koes BW, Stam HJ. Validity of the active straight leg raise test for measuring disease severity in patients with posterior pelvic pain after pregnancy. Spine. 2002;27:196–200. doi: 10.1097/00007632-200201150-00015. [DOI] [PubMed] [Google Scholar]
- 16.Ostgaard HC, Zetherstrom G, Roos-Hansson E, Svanberg B. Reduction of back and posterior pelvic pain in pregnancy. Spine. 1994;19:894–900. doi: 10.1097/00007632-199404150-00005. [DOI] [PubMed] [Google Scholar]
- 17.Albert HB, Godskesen M, Westergaard JG. Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain. Eur Spine J. 2000;9:161–166. doi: 10.1007/s005860050228. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Mens JMA, Vleeming A, Snijders CJ, Ronchetti I, Ginai AZ, Stam HJ. Responsiveness of outcome measurements in rehabilitation of patients with posterior pelvic pain since pregnancy. Spine. 2002;27:1110–1115. doi: 10.1097/00007632-200205150-00019. [DOI] [PubMed] [Google Scholar]
- 19.Leahy PM. Active Release Techniques: soft tissue management system. Colorado Springs, CO; 1999. [Google Scholar]
- 20.McGill S. Ultimate back fitness and performance. Wabuno Publ; Waterloo, Ontario: 2004. [Google Scholar]
- 21.Friedrich M, Cermak T, Maderbacher P. The effect of brochure use versus therapist teaching on patients performing therapeutic exercise and on changes in impairment status. Phys Ther. 1996;76:1082–1088. doi: 10.1093/ptj/76.10.1082. [DOI] [PubMed] [Google Scholar]
- 22.Mens JMA, Vleeming A, Stoeckart R, Stam HJ, Snijders CJ. Understanding peripartum pelvic pain: implications of a patient survey. Spine. 1996;21:1363–1370. doi: 10.1097/00007632-199606010-00017. [DOI] [PubMed] [Google Scholar]
- 23.Briggs CG, Freman R, Sumney YJ. Drugs in pregnancy and lactation. Williams and Wilkins; Baltimore, MD: 1994. [Google Scholar]
- 24.Gabbe SG, Neibyl J, Simpson JL. Obstetrics: normal and problem pregnancies. Churchill Livingstone; New York: 1991. [Google Scholar]
- 25.Brynhildsen J, Hansson A, Persson A, Hammard M. Follow-up of patients with low back pain during pregnancy. Obstet Gynecol. 1998;91:182–186. doi: 10.1016/s0029-7844(97)00630-3. [DOI] [PubMed] [Google Scholar]
