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Predicting Persistent Pregnancy-Related Low Back Pain

Gutke, Annelie, PhD*; Östgaard, Hans Christian, MD, PhD; Öberg, Birgitta, PhD*

doi: 10.1097/BRS.0b013e31817331a4
Health Services Research

Study Design. A cohort study.

Objective. To examine the course of subtypes of low back pain (LBP) experienced [no LBP, pelvic girdle pain (PGP), lumbar pain, and combined PGP and lumbar pain (combined pain)] during gestational weeks 12 to 18 and 3 months postpartum, and to explore potential predictors for persistent PGP or combined pain postpartum.

Summary of Background Data. LBP is more prevalent in pregnant women (25%) than in the general population (6.3%). Persistent LBP postpartum (16%) is usually studied as a single entity. However, only one subgroup of LBP, pelvic girdle pain (PGP), is associated with pregnancy. Several studies have suggested an association between muscular dysfunction and pregnancy-related LBP, however, muscle dysfunction has not been evaluated as potential predictor of persistent LBP postpartum. Possible subgroup differences in the course and predictors of persistent LBP are unknown.

Methods. Pregnant women (n = 308) were classified into LBP subgroups by mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. Trunk muscle endurance, hip muscle strength (dynamometer) and gait speed were evaluated. Multiple logistic regression was used to identify predictors from self-reports and clinical examination.

Results. Women with combined pain recovered to a lower degree 33% (17 of 51) than those with PGP 66% (56 of 85) or lumbar pain 72% (21 of 29). Predictors for having persistent PGP or combined pain after delivery were low endurance of back flexors, older age, combined pain in early pregnancy and work dissatisfaction (explained variance 30%).

Conclusion. Women with combined pain were identified to be a target group since they had the most unfavorable course and since the classification of combined pain was found to be a predictor for persistent pain postpartum. Identification of women at risk for persistent pain postpartum seems possible in early pregnancy and requires physical examination and self-reports. Pregnancy had low impact on the course of lumbar pain.

Predictors for persistent pregnancy-related low back pain postpartum were work dissatisfaction, combined pelvic girdle and lumbar pain in early pregnancy, older age, and low endurance of back flexors. Early identification of women with combined pelvic girdle and lumbar pain, at risk for the most unfavorable course, seems possible.

From the *Department of Medicine and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden; †Department of Orthopedic Surgery, Sahlgrenska University Hospital, Mölndal, Sweden.

Acknowledgment date: July 11, 2007. First revision date: October 31, 2007. Second revision date: January 19, 2008. Acceptance date: January 21, 2008.

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

Institutional and Foundation funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

This study was supported by grants from The Swedish research council, The Vardal Foundation, Foundation of the Region Västra Götaland, Trygg Hansa Research Foundation, The Rehabilitation and Medical Research Foundation.

The Regional Research Ethics Committee approved the study (Ö 414-00).

Address correspondence and reprint requests to Annelie Gutke, PhD, Department of Medicine and Health Sciences, Division of Physiotherapy, Linköping University, SE-581 83 Linköping, Sweden; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.