Reliability and Validity of the Active Straight Leg Raise Test in Posterior Pelvic Pain Since Pregnancy
SPINE Volume 26, Number 10, pp 1167–1171 ©2001, Lippincott Williams & Wilkins, Inc.
Reliability and Validity of the Active Straight Leg Raise Test in Posterior Pelvic Pain Since Pregnancy
Jan M. A. Mens, MD,*† Andry Vleeming, PhD,* Chris J. Snijders, PhD,‡ Bart W. Koes, PhD,§ and Henk J. Stam, MD, PhD†
Pregnancy is frequently complicated by the occurrence of lumbopelvic pain; the reported cumulative 9-month incidence ranges from 48%-56%.2,4,8,12 Posterior pelvic pain since pregnancy (PPPP) is often described as a distinct category.7,12,13,17 It remains questionable whether PPPP is a specific syndrome or just nonspecific lumbopelvic pain with an onset during pregnancy or delivery. Regardless of the answer, detailed study on the characteristics of PPPP could provide better understanding of lumbopelvic pain in general. To discriminate patients with PPPP from healthy subjects, various instruments have been investigated. Mobility of the pelvic joints assessed by the Chamberlain method showed a range of motion between the pubic bones of 5.9 3.3 mm in puerperal women with pelvic pain since pregnancy and 1.9 2.2 mm in a group of puerperal women without pelvic pain.1,3 As far as is known, the specificity of this method was never studied in PPPP with a disease duration exceeding 6 months. In two studies in pregnant women the posterior pelvic pain provocation test (PPPP test) scored high both on sensitivity (0.69 – 0.81) and specificity (0.80 – 0.90). 7,13 ‘‘Catching’’ of the leg (the phenomenon whereby a patient feels difficulty in moving one or both legs forward when walking) is described as a diagnostic sign in PPPP.17 The specificity of this sign was similar to that of the PPPP test, but its sensitivity was much lower; the reliability of this sign has, as far as we know, never been investigated. The setting provides the opportunity to examine a large group of patients with PPPP. It was noticed that in most patients active raising of one or both legs in the supine position
Reliability and Validity of the Active Straight Leg Raise Test in Posterior Pelvic Pain Since Pregnancy
Jan M. A. Mens, MD,*† Andry Vleeming, PhD,* Chris J. Snijders, PhD,‡ Bart W. Koes, PhD,§ and Henk J. Stam, MD, PhD†
Pregnancy is frequently complicated by the occurrence of lumbopelvic pain; the reported cumulative 9-month incidence ranges from 48%-56%.2,4,8,12 Posterior pelvic pain since pregnancy (PPPP) is often described as a distinct category.7,12,13,17 It remains questionable whether PPPP is a specific syndrome or just nonspecific lumbopelvic pain with an onset during pregnancy or delivery. Regardless of the answer, detailed study on the characteristics of PPPP could provide better understanding of lumbopelvic pain in general. To discriminate patients with PPPP from healthy subjects, various instruments have been investigated. Mobility of the pelvic joints assessed by the Chamberlain method showed a range of motion between the pubic bones of 5.9 3.3 mm in puerperal women with pelvic pain since pregnancy and 1.9 2.2 mm in a group of puerperal women without pelvic pain.1,3 As far as is known, the specificity of this method was never studied in PPPP with a disease duration exceeding 6 months. In two studies in pregnant women the posterior pelvic pain provocation test (PPPP test) scored high both on sensitivity (0.69 – 0.81) and specificity (0.80 – 0.90). 7,13 ‘‘Catching’’ of the leg (the phenomenon whereby a patient feels difficulty in moving one or both legs forward when walking) is described as a diagnostic sign in PPPP.17 The specificity of this sign was similar to that of the PPPP test, but its sensitivity was much lower; the reliability of this sign has, as far as we know, never been investigated. The setting provides the opportunity to examine a large group of patients with PPPP. It was noticed that in most patients active raising of one or both legs in the supine position
References: 1. Berezin D. Pelvic insufficiency during pregnancy and after parturition. Acta Obstet Gynecol Scand 1954;23(3):1–130. 2. Berg G, Hammar M, Moller-Nielsen J, et al. Low back pain during pregnancy. ¨ Obstet Gynecol 1988;71:71–5. 3. Chamberlain WE. The symphysis pubis in the roentgen examination of the sacro- iliac joint. Am J Roentgenol Rad Ther 1930;24:621–5. 4. Fast A, Shapiro D, Ducommun EJ, et al. Low back pain in pregnancy. Spine 1987;12:368 –71. 5. Genell S. Studies on insufficientia pelvis (gravidarum et puerpartum). Acta Obstet Gynecol Scand 1949;28:1–33. 6. Kopec JA, Esdaile JM, Abrahamowicz M, et al. The Quebec back pain dis´ ability scale. Spine 1995;20:341–52. 7. Kristiansson P, Svardsudd K. Discriminatory power of tests applied in back ¨ pain during pregnancy. Spine 1996;21:2337– 44. 8. Mantle MJ, Greenwood RM, Currey HLF. Backache in pregnancy. Rheumatol Rehabil 1977;16:95–101. 9. McCombe PF, Fairbank JCT, Cockersole BC, et al. Reproducibility of physical signs in low back pain. Spine 1989;14:908 –17. Reliability and Validity of the ASLR Test • Mens et al 1171 10. Mens JMA, Vleeming A, Stoeckart R, Stam HJ, Snijders CJ. Understanding peripartum pelvic pain: Implications of a patient survey. Spine 1996;21: 1363–70. 11. Mens JMA, Vleeming A, Snijders CJ, et al. The active straight leg raising test and mobility of the pelvic joints. Eur Spine J 1999;8:468 –73. 12. Ostgaard HC, Andersson GBJ, Karlsson K. Prevalence of back pain in pregnancy. Spine 1991;16:549 –52. 13. Ostgaard HC, Zetherstrom GBJ, Roos-Hansson E. The posterior pelvic pain ¨ provocation test in pregnant women. Eur Spine J 1994;3:258 – 60. 14. Schoppink LEM, Tulder MW van, Koes BW, et al. Reliability and validity of the Dutch adaptation of the Quebec Back Pain Disability Scale. Phys Ther ´ 1996;76:268 –75. 15. Snijders CJ, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs. Part I: Biomechanics of self-bracing of the sacro-iliac joints and its significance for treatment and exercise. Clin Biomech 1993;8:285–94. 16. Strender LE, Sjoblom A, Sundell K, et al. Interexaminer reliability in physical ¨ examination of patients with low back pain. Spine 1997;15:814 –20. 17. Sturesson B, Uden G, Uden A. Pain pattern in pregnancy and ‘‘catching’’ of the leg in pregnant women with posterior pelvic pain. Spine 1997;22: 1880 –3. 18. Taimela S, Kankaanpaa M, Luoto S. The effect of lumbar fatigue on the ability to sense a change in lumbar position. Spine 1999;24:1322–7. 19. Thomas E, Silman AJ, Papageorgiou AC, et al. Association between measures of spinal mobility and low back pain. An analysis of new attenders in primary care. Spine 1998;23:343–7. 20. van Tulder MW, Assendelft WJ, Koes BW, et al. Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies. Spine 1997;22:427–34. 21. Waddell G, Somerville D, Henderson L, et al. Objective clinical evaluation of physical impairment in chronic low back pain. Spine 1992;17:617–28. Address reprint requests to J.M.A. Mens Spine & Joint Centre Westerlaan 10 3016 CK Rotterdam, The Netherlands E-mail: sjceco@wxs.nl