Correlation Between Sacroiliitis and Piriformis, Quadratus Lumborum Muscle Tightness in Pregnant Women with Mechanical Low Back Pain
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Abstract
Background: Pregnancy-related mechanical low back pain is a common musculoskeletal complaint influenced by hormonal, biomechanical, postural, and neuromuscular changes. Altered pelvic loading, ligamentous laxity, increased lumbar lordosis, and compensatory muscle activation may contribute to sacroiliac joint dysfunction and tightness of the piriformis and quadratus lumborum muscles. Objective: To determine the association between clinically suspected sacroiliac joint dysfunction and piriformis and quadratus lumborum muscle tightness among pregnant women with mechanical low back pain. Methods: A cross-sectional observational correlational study was conducted among 88 pregnant women in the second and third trimesters presenting with mechanical low back pain. Pain intensity was assessed using the Numeric Pain Rating Scale, pelvic girdle disability using the Pelvic Girdle Questionnaire, and low back disability using the Modified Oswestry Disability Index. Sacroiliac joint dysfunction was assessed using a five-test provocation cluster, piriformis tightness using the FAIR test, and quadratus lumborum tightness using palpation and lumbar lateral flexion assessment. Chi-square and Spearman’s correlation tests were applied. Results: Mean age was 28.94 ± 4.11 years and mean gestational age was 26.64 ± 6.85 weeks. Sacroiliac joint provocation-test positivity was significantly associated with FAIR test status (χ² = 88.000, p < 0.001), but not with quadratus lumborum tightness (χ² = 0.169, p = 0.681). PGQ score showed a strong positive correlation with quadratus lumborum tightness (r = 0.864, p < 0.001), while NPRS was not significantly correlated with PGQ or MODI scores. Conclusion: Clinically suspected sacroiliac joint dysfunction was strongly associated with piriformis-related FAIR positivity, whereas quadratus lumborum tightness was more closely related to pelvic girdle disability. Comprehensive assessment of both joint-related and muscular contributors is recommended in pregnancy-related mechanical low back pain
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