Zusammenhang zwischen Beckengürtelschmerzen und Beckenmuskulatur[1]

Zusammenfassung

Beckengürtelschmerz ist eine in Europa häufig auftretende muskuloskelettale Störung. In der klinischen Praxis berichten die Betroffenen darüber hinaus oft auch von Harninkontinenzsymptomen.

Der Review untersuchte den Zusammenhang zwischen Beckengürtel und Funktionen der Beckenbodenmuskulatur sowie zwischen Beckengürtelschmerzen und Beckenbodendysfunktionen. Trotz unterschiedlicher Studientypen, Studienteilnehmer und Interventionen deuten die Ergebnisse auf eine Korrelation zwischen Beckengürtelschmerzen und veränderten Beckenbodenfunktionen hin.

Abstract

Pelvic girdle pain is a musculoskeletal disorder that often occurs in Europe. In clinical practice affected persons often also report urinary incontinence.

This review investigated the relationship between the pelvic girdle and pelvic floor muscles as well as between pelvic girdle pain and pelvic floor dysfunction. Despite varying study types, cohorts and interventions the results indicate a correlation between pelvic girdle pain and altered pelvic floor function.

Sakroiliakalgelenk - muskuloskelettal - Harninkontinenz - Beckenbodendysfunktionen

sacroiliac joint - musculoskeletal - urinary incontinence - pelvic floor dysfunction

Literatur

• 1 Abrams P, Cardozo L, Fall M. et al . The standardisation of terminology of lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society.  Neurourol Urodyn. 2002;  21 167-178
• 2 Bastiaenen C HG, Bie R A, Wolters M PJC. et al . Effectiveness of a tailor-made intervention for pregnancy-related pelvic girdle and/or low back pain after delivery: short term results of a randomized clinical trial.  BioMed Central Musculoskeletal Disorders. 2006;  7 1471-2474
• 3 Bø de K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength.  Physical Therapy. 2005;  85 269-282
• 4 Britnell S J, Cole C V, Isherwood L. et al . Postural Health in women: the role of physiotherapy.  Journal of Obstetrics and Gynaecoloy of Canada. 2005;  27 493-500
• 5 Buyruk H M, Snijders C J, Vleeming A. et al . The measurements of sacroiliac joint stiffness with doppler imaging: a study on healthy subjects.  European Journal of Radiology. 1995;  21 117-121
• 6 Cook C, Massa L, Ham-Emandes I. et al . Interrater reliability and diagnostic accuracy of pelvic girdle pain classification.  Journal of Manipulative and Physiological Therapeutics. 2007;  30 252-258
• 7 Damen L, Buyruk H M, Güler-Uysal F. et al . Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints.  Acta Obstetricia et Gynecologica Scandinavica. 2001;  80 1019-1024
• 8 Eliasson K, Elfving B, Nordgren B. et al . Urinary incontinence in women with low back pain.  Manual Therapy. 2006;  DOI: 10.1016 /j.math.2006.12.006
• 9 Hay-Smith E JC, Dumoulin C. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women.  Cochrane Database of Systematic Reviews. 2006;  Issue 1 DOI: 10.1002 / 14 651 858. CD 005 654
• 10 Hodges P W, Richardson C A. Delayed postural contraction of transverses abdominis in low back pain associated with movement of the lower limb.  Journal of Spinal Disorders. 1996;  11 46-56
• 11 Hodges P W, Richardson C A. Inefficient muscular stabilisation of the lumbar spine associated with low back pain.  Spine. 1996;  21 2640-2650
• 12 Hoek van Dijke G A, Snijders C J, Stoeckart R. et al . A biomechanical model on muscle forces in the transfer of spinal load to the pelvis and legs.  Journal of Biomechanics. 1999;  39 927-933
• 13 Hungerford B, Gilleard W, Hodges P. Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain.  Spine. 2003;  28 1593-1600
• 14 Kegel A H. Stress incontinence and genital relaxation.  Ciba Clin Symp. 1952;  2 35-51
• 15 Kokmeyer D J, Wurff van der P, Aufdemkampe G. et al . The reliability of multitest regiments with sacroiliac pain provocation tests.  Journal of Manual and Manipulative Therapeutics. 2002;  25 42-48
• 16 Mens J M, Vleeming A, Snijders C J. et al . The active straight leg raising test and mobility of the pelvic joints.  European Spine. 1999;  8 468-473
• 17 Mens J M, Vleeming A, Snijders C J. et al . Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy.  Spine. 2001;  26 1167-1171
• 18 Mens J M, Damen L, Snijders C J. et al . The mechanical effect of a pelvic belt in patients with pregnancy-related pelvic pain.  Clinical Biomechanics. 2006;  21 122-127
• 19 Mørkved S, Bø K, Salvesen K Å. Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial.  The American College of Obstetricians and Gynaecologists. 2003;  101 313-319
• 20 Mørkved S, Salvesen K Å, Bø K. et al . Pelvic floor muscle strength and thickness in continent and incontinent nulliparous pregnant women.  International Urogynecology Journal. 2004;  15 384-390
• 21 Mørkved S, Salvesen K A, Schei B. et al . Does group training during pregnancy prevent lumbopelvic pain? A randomized clinical trial.  Acta Obstetricia et Gynecologica Scandinavica. 2007;  86 276-282
• 22 O’Sullivan P B, Beales D J, Beetham J A. et al . Altered motor control strategies in subjects with sacroiliac joint pain during the active straight-leg-raise test.  Spine. 2002;  27 E1-E8
• 23 O’Sullivan P B, Beales D J. Changes in pelvic floor and diaphragm kinematics and respiratory patterns in subjects with sacroiliac joint pain following a motor learning intervention: a case series.  Manual Therapy. 2007;  12 209-218
• 24 O’Sullivan P B, Beales D J. Diagnosis and Classification of pelvic girdle pain disorders. Part 1: A mechanism based approach within a biopsychosocial framework.  Manual Therapy. 2007;  12 86-97
• 25 Painter E E, Ogle M D, Teyhen D S. Lumbopelvic dysfunction and stress urinary incontinence: a case report applying rehabilitative ultrasound imaging.  Journal of Orthopaedic & Sports Physical Therapy. 2007;  37 499-504
• 26 Pel J J, Spoor C W, Pool-Goudzwaard A L. et al . Biomechanical analysis of reducing sacroiliac joint shear load by optimization of pelvic muscle and ligament forces.  Annals of Biomedical Engineering. 2008;  36 415-424
• 27 Pennick V E, Young G. Interventions for preventing and treating pelvic and back pain in pregnancy.  Cochrane Database of Systematic Reviews. 2007;  Issue 2. CD 001 139 DOI: 10.1002 / 14 651858.CD 001 139.pub.2
• 28 Pool-Goudzwaard A, Vleeming A, Stoeckart R. et al . Insufficient lumbopelvic stability: a clinical, anatomical and biomechanical approach to ”a-specific” low back pain.  Manual Therapy. 1998;  3 12-20
• 29 Pool-Goudzwaard A, Dijke G H, Gurp van M. et al . Contribution of pelvic floor muscles to stiffness of the pelvic ring.  Clinical Biomechanics. 2004;  19 564-571
• 30 Pool-Goudzwaard van A L, Slieker ten Hove M C, Vierhout M E. et al . Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction.  International Urogynecology Journal. 2005;  16 468-474
• 31 Richardson C A, Snijders C J, Hides J A. et al . The relationship between the transversus abdominal muscle, sacroiliac joint mechanics and low back pain.  Spine. 2002;  27 399-405
• 32 Robinson H S, Brox J I, Robinson R. et al . The reliability of selected motion and pain provocation tests for the sacroiliac joint.  Manual Therapy. 2007;  12 72-79
• 33 Sapsford R R, Hodges P W. Contractions of the pelvic floor muscles during abdominal manoeuvre.  Archives of Physical Medicine and Rehabilitation. 2001;  82 1081-1088
• 34 Sapsford R R, Hodges P W, Richardson C A. et al . Co-activation of the abdominal and pelvic floor muscles during voluntary exercises.  Neurology and Urodynamics. 2001;  20 31-42
• 35 Schwarzer A C, Aprill C N, Bogduk N. The sacroiliac joint in chronic low back pain.  Spine. 1995;  20 31-37
• 36 Smith M D, Russell A, Hodges P W. Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity.  Australian Journal of Physiotherapy. 2006;  52 11-16
• 37 Smith M D, Coppieters M W, Hodges P W. Postural response of the pelvic floor and abdominal muscles in women with and without incontinence.  Neurology and Urodynamics. 2007;  26 377-385
• 38 Stuge B, Hilde G, Vøllestad N. Physical therapy for pregnancy-related low back and pelvic pain: a systematic review.  Acta Obstetricia et Gynecologica Scandinavica. 2003;  82 983-990
• 39 Stuge B, Lærum E, Kirkesola G. et al . The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy.  Spine. 2004;  29 351-359
• 40 Stuge B, Veierød M B, Laerum E. et al . The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a two-year follow-up of a randomized clinical trial.  Spine. 2004;  29 E197-E203
• 41 Stuge B, Mørkved S, Dahl H H. et al . Abdominal and pelvic floor muscle function in women with and without long lasting pelvic girdle pain.  Manual Therapy. 2006;  11 287-2969
• 42 Thompson J A, O’Sullivan P B. Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross-sectional study and review.  International Urogynecology Journal. 2003;  14 84-88
• 43 Thompson J A, O’Sullivan P B, Briffa N K. et al . Altered muscle activation patterns in symptomatic women during pelvic floor muscle contraction and Valsalva manoeuvre.  Neurology and Urodynamics. 2006;  25 268-276
• 44 Thompson J A, O’Sullivan P B, Briffa N K. et al . Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements.  International Urogynecology Journal. 2006;  17 624-630
• 45 Thompson J A, O’Sullivan P B, Briffa N K. et al . Differences in muscle activation patterns during pelvic floor muscle contraction and Valsalva manoeuvre.  Neurology and Urodynamics. 2006;  25 148-155
• 46 Van Wingerden J P, Vleeming A, Buyruk H M. et al . Stabilisation of the SIJ in vivo; verification of muscular contribution to force closure of the pelvis.  European Spine Journal. 2004;  13 199-205
• 47 Vleeming A, Albert H B, Östgaard H C. et al .European guidelines for the diagnosis and treatment of pelvic girdle pain. Concept version. 2008 www.backpaineurope.org/web/files/WG4_Guidelines.pdf
• 48 Whittaker J. Abdominal ultrasound imaging of pelvic floor muscle function in individuals with low back pain.  Journal of Manual and Manipulative Therapeutics. 2004;  12 44-49
• 49 Wu W H, Meijer O G, Uegaki K. et al . Pregnancy-related pelvic girdle pain (PPP), I: terminology, clinical presentation and prevalence.  European Spine Journal. 2004;  13 575-589

1 Die Arbeit wurde als Bestandteil der SVOMP-OMT-Ausbildung 2005 – 2008 verfasst.