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The Association of Variations in Hip and Pelvic Geometry With Pregnancy-Related Sacroiliac Joint Pain Based on a Longitudinal Analysis

Ji, Xiang, MSc; Morino, Saori, MSc; Iijima, Hirotaka, PhD; Ishihara, Mika, BSc; Kawagoe, Mirei, BSc; Umezaki, Fumiko, RM§; Hatanaka, Yoko, RM§; Yamashita, Mamoru, MD; Tsuboyama, Tadao, MD, PhD; Aoyama, Tomoki, MD, PhD

doi: 10.1097/BRS.0000000000002774

Study Design. Cross-sectional study using radiological measurements and longitudinal data analysis.

Objective. We aim to explore hip/pelvic geometry on anteroposterior radiographs and examine if such parameters are associated with clinical symptoms.

Summary of Background Data. Pregnancy-related sacroiliac joint pain is a common disease and is responsible to the disability of daily activities. The etiology is likely to be correlated with the biomechanical factors which are determined by trunk load and hip/pelvic geometry. Previous studies have already found the association between symptoms and weight increase during pregnancy. However, the relationship between bony anatomy and pregnancy-related sacroiliac joint pain remains unknown.

Methods. In total, 72 women were included in the final analysis. In pregnant women with self-reported sacroiliac joint pain, pain scores at 12, 24, 30, and 36 weeks of pregnancy were recorded and included in a mixed-effect linear regression model as dependent variables. The radiological measurements were included as independent variables. Furthermore, to investigate the relationship between hip/pelvic geometry and the activity-specific nociceptive phenomenon, the radiological measurements between patients with and without activity-induced pain were compared using a binominal logistic regression model.

Results. The relative bilateral is chial tuberosity distance (betta coefficient: 0.078; P = 0.015) and the relative bilateral femoral head length (betta coefficient: 0.011; P = 0.028) showed significant interactions with the slope of pain scores. Moreover, women whose pain exacerbate during prolonged walking had a higher odds in hip/pelvic geometry of the bilateral ischial tuberosity distance (odds ratio [OR]: 1.12; P = 0.050) and the bilateral femoral head length (OR: 1.16; P = 0.076) with approximately significant P-value.

Conclusion. These data indicate hip/pelvic anatomical variations are associated with the degree of pain increasing and the activity-specific pain during pregnancy, which may help to have further understanding on the biomechanical factor in developing pregnancy-related sacroiliac joint pain.

Level of Evidence: 3

The current study determined that variations of hip and pelvic anatomy among women can be associated with different degrees of both generalized, and activity-specific, sacroiliac joint pains that are often experienced during pregnancy.

Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto

School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa

Pilates Studio Wohl

§Kishokai Medical Corporation, Aichi, Japan.

Address correspondence and reprint requests to Tomoki Aoyama, MD, PhD, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; E-mail:

Received 14 March, 2018

Revised 7 June, 2018

Accepted 11 June, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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