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An exploratory analysis of gait biomechanics and muscle activation in pregnant females with high and low scores for low back or pelvic girdle pain during and after pregnancy

      Highlights

      • The pain group had smaller hip contribution to work during second trimester gait.
      • The pain group had greater ankle contribution to work during second trimester gait.
      • Decreased hip utilization early in pregnancy could contribute to disability later.
      • Moments and work were greater during third trimester compared to other time points.
      • Gluteus maximus activation was greater during third trimester compared to second.

      Abstract

      Background

      The purpose of this study was to compare gait kinematics, kinetics, and muscle activation between pregnant females with high and low scores for low back and/or pelvic girdle pain during and after pregnancy.

      Methods

      Twenty participants tested during second trimester, third trimester, and again post-partum. At each session, motion capture, force plates, and surface electromyography data were captured during self-selected velocity over-ground walking. Participants completed the Quebec Back Pain Disability Scale (QBPDS) and were assigned to high (QBPDS ≥15) or low pain groups (QBPDS <15) based on third trimester scores. Two-way mixed model ANOVAs were used to compare high and low pain groups over time.

      Findings

      Nine participants met the high pain group criteria and 11 were low pain. During second trimester the high pain group compared to the low pain group demonstrated smaller peak hip flexor moments, total hip work, percent hip contribution to work, and larger percent ankle contribution to work. Pregnant females demonstrated greater hip, knee, and ankle moments, ankle work, and gluteus maximus muscle activation third trimester than second trimester.

      Interpretation

      Reduced hip and greater ankle contribution to work in the high pain group during second trimester could indicate decreased hip utilization early in pregnancy and may contribute to disability as pregnancy progresses. It is also possible kinetic differences during second trimester reflect an early strategy to reduce pain by avoiding hip joint loading. Increased moments and work during third trimester indicate a clinical imperative to better prepare pregnant females to accommodate increased joint loading and muscular demand.

      Keywords

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      References

        • Ansari B.
        • Bhati P.
        • Singla D.
        • Nazish N.
        • Hussain M.E.
        Lumbar muscle activation pattern during forward and backward walking in participants with and without chronic low back pain: an electromyographic study.
        J. Chiropr. Med. 2018; 17: 217-225
        • Bagwell J.J.
        • Reynolds N.
        • Walaszek M.
        • et al.
        Lower extremity kinetics and muscle activation during gait are significantly different during and after pregnancy compared to nulliparous females.
        Gait Posture. 2020; 81: 33-40
        • Berber M.A.
        • Satilmis I.G.
        Characteristics of low back pain in pregnancy, risk factors, and its effects on quality of life.
        Pain. Manag. Nurs. 2020; 21: 579-586
        • Bergstrom C.
        • Persson M.
        • Mogren I.
        Pregnancy-related low back pain and pelvic girdle pain approximately 14 months after pregnancy - pain status, self-rated health and family situation.
        BMC Pregnancy Childbirth. 2014; 14: 48
        • Calguneri M.
        • Bird H.A.
        • Wright V.
        Changes in joint laxity occurring during pregnancy.
        Ann. Rheum. Dis. 1982; 41: 126-128
        • Chen Y.
        • Ma G.
        • Hu Y.
        • et al.
        Effects of maternal exercise during pregnancy on perinatal growth and childhood obesity outcomes: a meta-analysis and meta-regression.
        Sports Med. 2021; 51: 2329-2347
        • Christensen L.
        • Veierod M.B.
        • Vollestad N.K.
        • et al.
        Kinematic and spatiotemporal gait characteristics in pregnant women with pelvic girdle pain, asymptomatic pregnant and non-pregnant women.
        Clin. Biomech. 2019; 68: 45-52
        • Clinton S.C.
        • Newell A.
        • Downey P.A.
        • Ferreira K.
        Pelvic girdle pain in the antepartum population: physical therapy clinical practice guidelines linked to the international classification of functioning, disability, and health from the section on Women’s health and the orthopaedic section of the American Physical Therapy Association.
        J. Womens Health Phys. Ther. 2017; 41: 102-125
        • Coll C.V.
        • Domingues M.R.
        • Goncalves H.
        • Bertoldi A.D.
        Perceived barriers to leisure-time physical activity during pregnancy: a literature review of quantitative and qualitative evidence.
        J. Sci. Med. Sport. 2017; 20: 17-25
        • Cooper N.A.
        • Scavo K.M.
        • Strickland K.J.
        • et al.
        Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls.
        Eur. Spine J. 2016; 25: 1258-1265
        • de Sousa C.S.
        • de Jesus F.L.A.
        • Machado M.B.
        • et al.
        Lower limb muscle strength in patients with low back pain: a systematic review and meta-analysis.
        J. Musculoskelet. Neuronal Interact. 2019; 19: 69-78
        • Demoulin C.
        • Ostelo R.
        • Knottnerus J.A.
        • Smeets R.J.
        Quebec back pain disability scale was responsive and showed reasonable interpretability after a multidisciplinary treatment.
        J. Clin. Epidemiol. 2010; 63: 1249-1255
        • Elden H.
        • Gutke A.
        • Kjellby-Wendt G.
        • Fagevik-Olsen M.
        • Ostgaard H.C.
        Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study.
        BMC Musculoskelet. Disord. 2016; 17: 276
        • Feeney D.F.
        • Capobianco R.A.
        • Montgomery J.R.
        • Morreale J.
        • Grabowski A.M.
        • Enoka R.M.
        Individuals with sacroiliac joint dysfunction display asymmetrical gait and a depressed synergy between muscles providing sacroiliac joint force closure when walking.
        J. Electromyogr. Kinesiol. 2018; 43: 95-103
        • Foti T.
        • Davids J.R.
        • Bagley A.
        A biomechanical analysis of gait during pregnancy.
        J. Bone Joint Surg. Am. 2000; 82: 625-632
        • Fritz C.O.
        • Morris P.E.
        • Richler J.J.
        Effect size estimates: current use, calculations, and interpretation.
        J. Exp. Psychol. Gen. 2012; 141: 2-18
        • Gutke A.
        • Josefsson A.
        • Oberg B.
        Pelvic girdle pain and lumbar pain in relation to postpartum depressive symptoms.
        Spine. 2007; 32: 1430-1436
        • Haakstad L.A.
        • Voldner N.
        • Bo K.
        Stages of change model for participation in physical activity during pregnancy.
        J. Pregnancy. 2013; 2013193170
        • Hermens H.J.
        • Freriks B.
        • Disselhorst-Klug C.
        • Rau G.
        Development of recommendations for SEMG sensors and sensor placement procedures.
        J. Electromyogr. Kinesiol. 2000; 10: 361-374
        • Hines M.G.
        • Tillin N.A.
        • Luo J.
        • Lee R.Y.W.
        Passive elastic contribution of hip extensors to joint moments during walking in people with low back pain.
        Clin. Biomech. 2018; 60: 134-140
        • Jensen R.K.
        • Doucet S.
        • Treitz T.
        Changes in segment mass and mass distribution during pregnancy.
        J. Biomech. 1996; 29: 251-256
        • Kang H.G.
        • Dingwell J.B.
        Dynamics and stability of muscle activations during walking in healthy young and older adults.
        J. Biomech. 2009; 42: 2231-2237
        • Marras W.S.
        • Davis K.G.
        • Ferguson S.A.
        • Lucas B.R.
        • Gupta P.
        Spine loading characteristics of patients with low back pain compared with asymptomatic individuals.
        Spine. 2001; 26: 2566-2574
        • Mens J.M.
        • Vleeming A.
        • Stoeckart R.
        • Stam H.J.
        • Snijders C.J.
        Understanding peripartum pelvic pain. Implications of a patient survey.
        Spine. 1996; 21 (discussion 1369-1370): 1363-1369
        • Mens J.M.
        • Pool-Goudzwaard A.
        • Stam H.J.
        Mobility of the pelvic joints in pregnancy-related lumbopelvic pain: a systematic review.
        Obstet. Gynecol. Surv. 2009; 64: 200-208
        • Moyer C.
        • Reoyo O.R.
        • May L.
        The influence of prenatal exercise on offspring health: a review.
        Clin. Med. Insights Womens Health. 2016; 9: 37-42
        • Ng B.K.
        • Kipli M.
        • Abdul Karim A.K.
        • Shohaimi S.
        • Abdul Ghani N.A.
        • Lim P.S.
        Back pain in pregnancy among office workers: risk factors and its impact on quality of life.
        Horm. Mol. Biol. Clin. Invest. 2017; 32
        • Robinson P.S.
        • Balasundaram A.P.
        • Vollestad N.K.
        • Robinson H.S.
        The association between pregnancy, pelvic girdle pain and health-related quality of life - a comparison of two instruments.
        J. Patient Rep. Outcomes. 2018; 2: 45
        • Shiavi R.
        • Frigo C.
        • Pedotti A.
        Electromyographic signals during gait: criteria for envelope filtering and number of strides.
        Med. Biol. Eng. Comput. 1998; 36: 171-178
      1. Smith J, Stabber, H, Bagwell, JJ, Teng, HL, Wade, V, Lee, SP Do people with low back pain walk differently? A systematic review and meta-analysis. J. Sports Med. Sci. (In press).

        • To W.W.
        • Wong M.W.
        Factors associated with back pain symptoms in pregnancy and the persistence of pain 2 years after pregnancy.
        Acta Obstet. Gynecol. Scand. 2003; 82: 1086-1091
        • Tudor-Locke C.
        • Bassett Jr., D.R.
        How many steps/day are enough? Preliminary pedometer indices for public health.
        Sports Med. 2004; 34: 1-8
        • van der Hulst M.
        • Vollenbroek-Hutten M.M.
        • Rietman J.S.
        • Schaake L.
        • Groothuis-Oudshoorn K.G.
        • Hermens H.J.
        Back muscle activation patterns in chronic low back pain during walking: a “guarding” hypothesis.
        Clin. J. Pain. 2010; 26: 30-37
        • van Wingerden J.P.
        • Vleeming A.
        • Buyruk H.M.
        • Raissadat K.
        Stabilization of the sacroiliac joint in vivo: verification of muscular contribution to force closure of the pelvis.
        Eur. Spine J. 2004; 13: 199-205
        • Virgara R.
        • Maher C.
        • Van Kessel G.
        The comorbidity of low back pelvic pain and risk of depression and anxiety in pregnancy in primiparous women.
        BMC Pregnancy Childbirth. 2018; 18: 288
        • Vleeming A.
        • Schuenke M.
        Form and force closure of the sacroiliac joints.
        PM R. 2019; 11: S24-S31
        • Vogt L.
        • Pfeifer K.
        • Banzer W.
        Neuromuscular control of walking with chronic low-back pain.
        Man. Ther. 2003; 8: 21-28
        • Wang S.M.
        • Dezinno P.
        • Maranets I.
        • Berman M.R.
        • Caldwell-Andrews A.A.
        • Kain Z.N.
        Low back pain during pregnancy: prevalence, risk factors, and outcomes.
        Obstet. Gynecol. 2004; 104: 65-70
        • Wiezer M.
        • Hage-Fransen M.A.H.
        • Otto A.
        • et al.
        Risk factors for pelvic girdle pain postpartum and pregnancy related low back pain postpartum; a systematic review and meta-analysis.
        Musculoskelet Sci. Pract. 2020; 48102154
        • Winter D.A.
        Biomechanics of Human Movements.
        4th ed. Wiley, New York2009
        • Wu W.H.
        • Meijer O.G.
        • Uegaki K.
        • et al.
        Pregnancy-related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence.
        Eur. Spine J. 2004; 13: 575-589
        • Wu W.H.
        • Meijer O.G.
        • Bruijn S.M.
        • et al.
        Gait in pregnancy-related pelvic girdle pain: amplitudes, timing, and coordination of horizontal trunk rotations.
        Eur. Spine J. 2008; 17: 1160-1169
        • Wuytack F.
        • Begley C.
        • Daly D.
        Risk factors for pregnancy-related pelvic girdle pain: a scoping review.
        BMC Pregnancy Childbirth. 2020; 20: 739