Exercises for Women with Persistent Pelvic and Low Back Pain after Pregnancy

Monica Unsgaard-Tøndel, Ottar Vasseljen, Astrid Woodhouse, Siv Morkved, Monica Unsgaard-Tøndel, Ottar Vasseljen, Astrid Woodhouse, Siv Morkved

Abstract

Background: Specific stabilizing exercises activating deep local muscles in coordination with global muscles are recommended in the treatment of pregnancy-related lumbopelvic pain. Some studies have suggested that recruitment of the deepest abdominal muscle, transversus abdominis, is crucial in the development and improvement of lumbopelvic pain.

Objective: This exploratory study aimed to describe the development of pain, disability and transversus abdominis recruitment before, during and after an individually designed intervention including an exercise program for women with persisting lumbopelvic pain after delivery.

Design: A multiple-baseline, single-subject experimental design was applied.

Methods: Sixteen women with lumbopelvic pain after delivery were included and received tailored exercise therapy, including ultrasound-guided activation of deep muscles, strengthening and stretching exercises and advice. Pain, disability and ultrasound-recorded activation of transversus abdominis was registered weekly. Treatment and testing was performed in a primary care setting in Trondheim, Norway.

Results: All sixteen included women reported reduced pain and decreased disability over the intervention period. The magnitude of transversus abdominis activation varied substantially between individuals and tests. While there was a statistically significant correlation between change in pain and change in disability, no correlation was observed between change in transversus abdominis activation and change in symptoms.

Limitations: This is an exploratory study and results cannot be generalized without replication in controlled studies.

Conclusions: Pain and disability due to persistent low back and pelvic pain after delivery were reduced after specific, individual adapted exercise including deep and superficial lumbopelvic muscles. Changes in pain and disability were not associated with changes in transversus abdominis activation.

Conflict of interest statement

The authors declare that there is no conflict of interests regarding the publication of this paper.

Figures

Figure 1
Figure 1
Ultrasound recordings procedure
Figure 2
Figure 2
Pain and disability before and after exercise Pain and disability reported before (top of red columns) and after (top of green columns) treatment. Average score for each of the 16 participants over first baseline period (weeks 1-4) and second baseline period, the treatment withdrawal phase (weeks 21-24). The red columns represent the symptom reduction for each individual participant over the treatment period.
Figure 3
Figure 3
Pain, disability, and deep abdominal muscle activation for participants 1-4, week for week Pain and disability intensity measured in centimeters from zero on the 0-100 mm visual analogue scale. Transversus abdominis slide was also measured in centimeters.
Figure 4
Figure 4
Pain, disability, and deep abdominal muscle activation for participants 5-8, week for week Pain and disability intensity measured in centimeters from zero on the 0-100 mm visual analogue scale. Transversus abdominis slide was also measured in centimeters.
Figure 5
Figure 5
Pain, disability, and deep abdominal muscle activation for participants 9-12, week for week Pain and disability intensity measured in centimeters from zero on the 0-100 mm visual analogue scale. Transversus abdominis slide was also measured in centimeters.
Figure 6
Figure 6
Pain, disability, and deep abdominal muscle activation for participants 13-16, week for week Pain and disability intensity measured in centimeters from zero on the 0-100 mm visual analogue scale. Transversus abdominis slide was also measured in centimeters.
Figure 7
Figure 7
The figure illustrates weekly pain intensity with celeration line for participant 4 Pain intensity was measured in centimeters from zero on the 0-100 mm visual analogue scale.

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