Predictive Value of the Active Straight Leg Raise on the Efficacy of a SJB in Posterior PGP During Pregnancy
Condition: Pelvic Girdle Pain
MeSH terms: Pelvic Girdle Pain
Study type: Interventional

Summary: 
      During pregnancy, women often experience musculoskeletal pain, specifically in their low back
      and/or pelvic girdle. Pelvic girdle pain (PGP) is defined as pain between the posterior iliac
      crest and gluteal fold, particularly in the region of the sacroiliac joint (SIJ)1. Although
      it is often referred to as "sciatica". PGP in pregnancy is common with prevalence estimates
      of 45%2. Previous studies have found that one third of patients will rate their PGP intensity
      as severe, leading to functional impairments. Functional disabilities include sitting,
      walking, and standing; thus, significantly impacting the ability of patients to perform
      routine daily activities. This pain has been reported to develop as early as 17-19 weeks'
      gestation, lasting up to 3 months postpartum; with a peak incidence of 24-36 weeks.

      The etiology of PGP in pregnant women is still not fully understood, largely due to the
      complex interactions between bone, ligaments, fascia, and muscles in the pelvic joints3. Some
      studies suggest the increased mobility of the joints in the pelvic girdle during pregnancy
      due to relaxing cause a lack of stabilization in the sacroiliac region, which results in
      pain4. Thus, it is hypothesized that providing stabilization of the joints with an external
      force, such as a maternity or SIJ belt, will improve pain.
    

Detailed description: 
      During pregnancy, women often experience musculoskeletal pain, specifically in their low back
      and/or pelvic girdle. Pelvic girdle pain (PGP) is defined as pain between the posterior iliac
      crest and gluteal fold, particularly in the region of the sacroiliac joint (SIJ)1. Although
      it is often referred to as "sciatica". PGP in pregnancy is common with prevalence estimates
      of 45%2. Previous studies have found that one third of patients will rate their PGP intensity
      as severe, leading to functional impairments. Functional disabilities include sitting,
      walking, and standing; thus, significantly impacting the ability of patients to perform
      routine daily activities. This pain has been reported to develop as early as 17-19 weeks'
      gestation, lasting up to 3 months postpartum; with a peak incidence of 24-36 weeks.

      The etiology of PGP in pregnant women is still not fully understood, largely due to the
      complex interactions between bone, ligaments, fascia, and muscles in the pelvic joints3. Some
      studies suggest the increased mobility of the joints in the pelvic girdle during pregnancy
      due to relaxing cause a lack of stabilization in the sacroiliac region, which results in
      pain4. Thus, it is hypothesized that providing stabilization of the joints with an external
      force, such as a maternity or SIJ belt, will improve pain.

      Clinically, pelvic belts are often used as a part of a multimodal approach to reduce PGP
      alongside other conservative treatments such as analgesics and physical therapy, or more
      alternative treatments such as acupuncture5. This makes it difficult to determine their
      individual effect on pain reduction. Further confounding this issue are variations in
      physician counseling, physical therapy regimens, and analgesic usage. Moreover, several
      support belts have been designed that vary in padding size, flexibility, and site of
      application5-7. Among these belts, it has not yet been identified which belt is most
      beneficial regarding pain reduction and patient tolerance5. Previous studies have found
      benefit in short term use (3-6 weeks) of maternity belts, providing women with improved pain
      and function compared to exercise or no intervention7. Pelvic belts are a cost-effective
      option to treating PGP, and more specifically SIJ pain, yet studies are limited regarding the
      effect they have on SIJ mobility and pain reduction8 and more specifically determining what
      clinically predicts those who will benefit most from an SIJ belt.

      The active straight leg raise test originally described by Mens is an examination maneuver
      that measures functional mobility and has been correlated with pregnancy related PGP (cite).
      Anecdotally, our clinical team has observed that women who benefit from compression during
      the second part of the test, seem to benefit most from the use of an SIJ belt. Having a
      simple test for obstetric providers to perform in pregnant women with pain would be
      informative in determining who might benefit most from an SIJ belt. Hence our study seeks to
      investigate the following aims:
    

Intervention name(s): SIJ Belt
Intervention type(s): Device
Intervention description(s): Support Belts
Intervention model: Single Group Assignment
Intervention model description: All patients receive an SIJ belt.
Masking: None (Open Label)
Primary purpose: Treatment