Finger joint laxity, number of previous pregnancies and pregnancy induced back pain in a cohort study

Abstract

BackgroundGeneral joint hypermobility is estimated to affect about 10% of the population and is a prerequisite of heritable connective tissue disorders where fragile connective tissue is a prominent feature. Pregnancy induced back pain is common whereas about 10% of women still have disabling pain several years after childbirth. The pathogenesis of the pain condition is uncertain, although several risk factors are suggested including general joint hypermobility. In the present study, the possible association of peripheral joint mobility in early pregnancy on the incidence of back pain with onset during pregnancy and persisting after childbirth was explored.MethodsA cohort of 200 pregnant women recruited from antenatal health care clinics was assessed by questionnaire and clinical examination, including measurement of passive abduction of the left fourth finger, throughout pregnancy and at 13 weeks postpartum. Comparisons were made between women with and without back pain. Statistical tests used were χ2-test, t-test, Spearman correlation and multiple logistic regression.ResultsIn the cohort, the mean passive abduction angle of the left fourth finger increased from 40.1° in early pregnancy to 41.8° at the postpartum appointment. At the postpartum appointment, women in the back pain group had a significantly larger mean passive abduction angle of the left fourth finger of 4.4°, twice as many previous pregnancies and deliveries, and more than twice as frequent back pain in previous pregnancy, as compared with women with no persistent back pain. A similar pattern was displayed in late pregnancy. In a multiple regression analysis, the passive abduction angle of the left fourth finger in early pregnancy and the number of previous pregnancies were positively, significantly and independently associated to the incidence of back pain in late pregnancy and postpartum.ConclusionsFinger joint laxity as a reflection of constitutional weakness of connective tissue and number of previous pregnancies were associated with the development of back pain induced in pregnancy and persisting after childbirth. These factors may provide a foundation for development of targeted prevention strategies, but this have to be confirmed in future research including measurement of general joint laxity.

Shoulder stiffness, back pain, and wrist pain: Are older primiparas more vulnerable?

“…Others have documented that first pregnancy, but not subsequent pregnancies, affects joint laxity yielding permanent changes of the foot (Segal et al, ). In addition, others have reported that increased joint laxity and number of previous pregnancies were also associated with the development of back pain (Lindgren & Kristiansson, ). Thus, further studies are warranted to examine hormonal changes of pregnancy related to joint laxity and development of joint pain.…”

Pregnancy-Related Hormonal Influences on the Musculoskeletal System, Lumbo-Pelvic Structures and Peripheral Joints: Some Practical Considerations for Manual Therapists

“…Though maternal hormonal changes serve to facilitate the parturition process, some alterations may predispose to the pathogenesis of degenerative disc disease, back pain, osteoporosis, DISH, musculoskeletal injury, or alter the course of preexisting conditions such as rheumatoid arthritis and joint hypermobility syndrome. [Li et al 2007, Sarli et al 2005, Sabino et al 2008, Lingren et al 2014 Though adverse outcomes of maternal manual treatment (high velocity low amplitude thrusts) is reportedly of rare occurrence, [Cassidy et al 2009, Oliphant et al 2004, it is worthwhile to consider hormonal influences of the musculoskeletal system, particularly when managing peripartum back pain and planning peripheral and spinal joint manipulation in pregnancy.…”

The Effect of Lower Extremity Asymmetries on Low Back and Lower Extremity Pain with Pregnancy

“…Pregnancy-related ligamentous laxity, caused by presence of the hormone Relaxin, has been reported to increase mobility of not only the pelvic joints, but peripheral joints as well (5,22,30,31). This laxity is related to alterations in foot and lower extremity alignment in pregnant women (18,32,37).…”

“…Franklin et al (14) reported no relationship between specific postural alignment changes occuring during pregnancy, such as lumbar lordosis and anterior pelvic tilt, with low back pain. However, recent studies have shown a relationship between joint laxity and low back pain (22). Lindgren and Kristiansson (22) found that finger laxity early in pregnancy, specifically of the fourth finger, was associated with low back pain later in pregnancy and post-partum.…”

“…Increased body mass specifically in the abdomen has been associated with increased lumbar lordosis (14). The hormone Relaxin has long been associated with joint laxity in the pelvic region (5); however, Relaxin has been shown to increase laxity of peripheral joints as well, including in the hands and feet (22,30,31).…”