Quali tipologie di esercizio di controllo motorio sono maggiormente utilizzate per modificare il dolore nel breve termine nei pazienti con pelvic girdle pain: una revisione narrativa

Types of Motor Control Exercises Most Effective for Short-Term Pain Relief in Patients with Pelvic Girdle Pain: A Narrative Review

Autori

Alessandro Mantia, University of Rome La Sapienza Department of Human Neuroscience, Rome,Italy

Mirko Zitti, University of Rome La Sapienza Department of Human Neuroscience, Rome,Italy

Lorenzo Storari, University of Rome La Sapienza Department of Human Neuroscience, Rome,Italy

Fabiola Garzonio, University of Rome La Sapienza Department of Human Neuroscience, Rome,Italy

Graziano Raffaele, University of Rome La Sapienza Department of Human Neuroscience, Rome,Italy

Fabio Fiorentino, University of Rome La Sapienza Department of Human Neuroscience, Rome,Italy

Rebecca Andreutto, University of Rome La Sapienza Department of Human Neuroscience, Rome,Italy

Filippo Maselli, University of Rome La Sapienza Department of Human Neuroscience, Rome,Italy

Introduction

Pelvic girdle pain (PGP) is described in the literature as a subset of low back pain (LBP) characterized by pain perceived between the posterior iliac crest and the gluteal fold, particularly near the sacroiliac joints. This condition can present in a nonspecific form: during pregnancy or postpartum (pregnancy-related PGP), which is also the most prevalent form; as a result of mechanical alterations due to trauma or microtrauma (non-pregnancy-related PGP); or in a specific form following fractures, infections, or arthritis. There are different intervention modalities available in the literature and for years, researchers have been investigating and studying the best approach for managing this condition and the associated biopsychosocial impairments.The aim of this study focused on the effectiveness of motor control (MC) exercises in reducing pain in the short term, and whether these really have the characteristics to stimulate MC.

Methods

The narrative review was carried out by searching various medical-rehabilitation databases (Pubmed, Cochrane, PEDro database, Scopus, EMBASE, Web Of Science) and was done following the methodology described by Gasparyan et al. The research was carried out taking into consideration different study designs (i.e. systematic reviews and RCTs) published between 2013 and 2023 only in english language. The research included all studies that considered patients with PGP or sacroiliac dysfunctions and involved interventions consisting of MC exercises or lumbopelvic stabilization exercises. Excluded from the review were articles that lacked an experimental or control group or did not exclusively involve motor control exercise interventions, pediactric population and papers not in english language.

Results

A total of 3151 studies were identified, from these five studies were included (including 4 RCTs and 1 systematic review).The primary outcome investigated was pain reduction. It was observed that these exercises were ineffective in reducing pain in the short term when implemented alone. The qualitative analysis underscored that the exercises utilized to date lack specificity and structure, not following the dictates proposed by the various motor control theories

Discussion and Conclusion

From the analysis conducted, it has been highlighted that the exercises currently utilized are generally lacking in specificity and structure, not adhering to the principles proposed by various motor control theories. Based on the available data and the structure of these exercises, it is therefore not possible to definitively state whether MC exercises are more or less effective in reducing short-term pain in patients with both pregnancy-related and non-pregnancy-related PGP.Future studies are warranted to enhance understanding, within the rehabilitation field ,regarding the structuring of MC exercises. This will enable better programming and evaluation of the effects of a alone motor control exercise approach in managing PGP and its short-term pain reduction.

REFERENCES

Stuge B. Evidence of stabilizing exercises for low back- and pelvic girdle pain – a critical review. Brazilian J Phys Ther [Internet]. 2019;23(2):181–6. Available from: https://doi.org/10.1016/j.bjpt.2018.11.006

Weis CA, Pohlman K, Draper C, Stuber K, Hawk C. Chiropractic Care for Adults With Pregnancy-Related Low Back , Pelvic Girdle Pain , or Combination Pain : A Systematic Review. :15–8.

Pousette S, Gutke A, Betten C, Ar KD. Treatments for pregnancy-related lumbopelvic pain : a systematic review of physiotherapy modalities. 2015;94:1156–67.

Kennedy DJ, Engel A, Kreiner DS, Nampiaparampil D. Review Article Fluoroscopically Guided Diagnostic and Therapeutic Intra-Articular Sacroiliac Joint Injections : A Systematic Review. 2015;1500–18.

O’Sullivan PB, Beales DJ. Diagnosis and classification of pelvic girdle pain disorders-Part 1: A mechanism based approach within a biopsychosocial framework. Man Ther. 2007;12(2):86–97.

Mapinduzi J, Ndacayisaba G, Mahaudens P, Hidalgo B. Effectiveness of motor control exercises versus other musculoskeletal therapies in patients with pelvic girdle pain of sacroiliac joint origin: A systematic review with meta-analysis of randomized controlled trials. J Back Musculoskelet Rehabil. 2022;35(4):713–28.

Motor Control Translating Research Into Clinical Practice 5th 2017.

Yuri A, Lilit G, Blackmore H, Kitas GD. Writing a narrative biomedical review : considerations for authors , peer reviewers , and editors. 2011;1409–17.