Issn Print: 0362-2436

Publication Date: 1997/08/15


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Point of View: Pain Pattern in Pregnancy and "Catching" of the Leg in Pregnant Women With Posterior Pelvic Pain

H. C. Östgaard

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Excerpt

More than one of every two pregnant women experiences some kind of back pain for some period. In earlier studies, it was indicated that back pain in pregnancy should be separated into at least two different types of pain pattern-namely lumbar back pain and posterior pelvic pain-and treated accordingly. If this is not done, treatment will fail,1,2 because back muscle strengthening exercise will make posterior pelvic pain worse. Lumbar back pain is abundant throughout life, but may increase in incidence and intensity during pregnancy, whereas posterior pelvic pain is present almost exclusively in close connection with pregnancy. Approximately 10% of pregnant women will experience both pain types, and there is no simple way to differentiate between the two types of pain pattern. Plain radiographs, computed tomography, and magnetic resonance imaging are of no use, nor is any known blood test. Differentiation between the two pain patterns is based, therefore, on a clinical examination and a careful history. Posterior pelvic pain should be attended to first because it has a tendency to initiate a chronic pelvic muscle pain, so it is important to identify women with this pain type in the group of pregnant women with unspecified back pain. The clinical examination includes the posterior pelvic pain test, which will identify approximately 80% of women with posterior pelvic pain, and the history taking includes questions about catching of the leg during walking, but this phenomenon, typical as it is for pregnant women with posterior pelvic pain, has not been assessed in a scientific way earlier.
The article by Sturesson et al is unique because it presents statistics that show that catching of the leg during pregnancy was present only among women with a positive posterior pelvic pain test, and therefore has provided us with another important tool when identifying women with posterior pelvic pain in pregnancy. There is no known explanation for catching of the leg, and although the increase in movement in the sacroiliac joints during pregnancy may be very small, it could be painful for some women, and cause a pain-induced short paralysis of the pelvic muscles, explaining the catching feeling these women experience. A parallel situation is when a loose body is impinged in the elbow or the knee. However, it is interesting that the observations in this article concur with the theory that posterior pelvic pain as well as catching of the leg and persisting pain in the back and pelvis long after pregnancy may be caused by a malfunction of the complicated coordination between the sacroiliac joints and the muscles and ligaments of the pelvic girdle. It seems that even a small, pregnancy-induced decrease in pelvic stability may be inconsistent with normal walking for some women. Much research is needed before we understand what impact pregnancy has on the biomechanics of the human pelvis in its unique bipedal situation.

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