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Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000139
Original Article: PDF Only

Experimental Pelvic Pain Impairs the Performance During the Active Straight Leg Raise Test and Causes Excessive Muscle Stabilization.

Palsson, Thorvaldur Skuli MMT; Hirata, Rogerio Pessoto Ph.D; Graven-Nielsen, Thomas PhD, DMSc

Published Ahead-of-Print
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Objectives: The Active Straight Leg Raise (ASLR) test is widely used clinically to assess severity of lumbopelvic pain due to decreased stability of the sacroiliac joint (SIJ). This study aimed to bypass the influence of decreased SIJ stability on the ASLR test by investigating the effect of experimental pelvic pain and hyperalgesia on the outcome of the ASLR test.

Methods: Thirty-four healthy subjects participated in this randomized crossover study. Pelvic pain was induced by injecting hypertonic saline into the long posterior sacroiliac ligament. Isotonic saline was injected on the contralateral side as control. Pain intensity was assessed on an electronic visual analogue scale (VAS). The Likert scores of difficulty performing the ASLR test and simultaneous electromyography (EMG) of trunk and thigh muscles were recorded before, during and post-pain. Pressure pain thresholds (PPTs) were assessed bilaterally in the pelvic area and lower limb.

Results: Compared with the control condition and baseline, hypertonic saline injections caused (P<0.05): (1) Higher VAS scores of the pain intensity. (2) Reduced PPTs at the injection site and lateral to S2. (3) Increased difficulty in performing the ASLR rated on the Likert scale. (4) Bilateral increase in the EMG activity of stabilizing trunk and thigh muscles during pain.

Discussion: These data demonstrate that pain and hyperalgesia in conditions unaffected by biomechanical SIJ impairments change the outcome of the ASLR test towards what is seen in clinical lumbopelvic pain. This may implicate pain-related changes in motor control strategies potentially relevant for the transition from acute into chronic pain.

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