Restricted accessResearch articleFirst published online 2019-9
Effect of segmental stabilizing exercises augmented by pelvic floor muscles training on women with postpartum pelvic girdle pain: A randomized controlled trial
Pelvic girdle pain (PGP) is a significant problem that affects daily living activities in postpartum women.
OBJECTIVE:
This study aimed to investigate the effect of stabilizing exercises with or without pelvic floor muscles (PFM) training on pain, functional disability, trunk range of motion (ROM) and PFM strength in women with PGP.
METHODS:
Forty postpartum women participated in the study. Their age ranged from 25–35 years and their body mass index (BMI) was 25–29.9 kg/m. They were randomly assigned into two groups equal in number. Group (A) received local stabilizing exercises, while group (B) received stabilizing exercises and PFM training. Pain, functional disability, trunk ROM and PFM strength have been evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI), Schober test and Kegel periniometer respectively.
RESULTS:
Both groups (A and B) revealed a significant decrease ( 0.001) in pain and functional disability and a significant increase ( 0.001) in trunk ROM and PFM strength. However, group (B) showed a significant decrease ( 0.001) in pain, and functional disability and a significant increase in PFM strength when compared with group (A).
CONCLUSIONS:
PFM training should be an essential part in rehabilitation programs of PGP postpartum.
BjorklundKBergstromS. Is pelvic pain in pregnancy a welfare complaint? Acta Obstet Gynecol Scand. 2000; 79(1): 24-30.
2.
OstgaardHCAnderssonGBKarlssonK. Prevalence of back pain in pregnancy. Spine. 1991; 16: 549-552.
3.
VleemingAAlbertHBOstgaardHCSturessonBStugeB. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008; 17(6): 794-819.
4.
BjellandEKStugeBEngdahlBEberhard-GranM. The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study. BJOG. 2013; 120(1): 32-40.
5.
RobinsonHSVøllestadaNKVeierødbMB. Clinical course of pelvic girdle pain postpartum-Impact of clinical findings in late pregnancy. Man Ther. 2014; 19(3): 19096.
6.
EngesetJStugeBFegranL. Pelvic girdle pain affects the whole life – a qualitative interview study in Norway on women’s experiences with pelvic girdle pain after delivery. BMC Research Notes. 2014; 7(1): 686.
7.
GutkeALundbergMOstgaardHCÖbergB. Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms. Eur Spine J. 2011; 20(3): 440-448.
8.
AldabeDRibeiroDCMilosavljevicSBusseyMD. Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. Eur Spine J. 2012; 21(9): 1769-1776.
9.
AldabeDMilosavljevicSBusseyMD. Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? A systematic review. Eur Spine J. 2012a; 21(9): 1777-1787.
10.
StugeBMorkvedSDahlHHVøllestadN. Abdominal and pelvic floor muscle function in women with and without long lasting pelvic girdle pain. Man Ther. 2006; 11(4): 287-296.
11.
StugeBSaetreKBraekkenIH. The association between pelvic floor muscle function and pelvic girdle pain – a matched case control 3D ultrasound study. Man Ther. 2012; 17(2): 150-156.
12.
DankaertsWO’SullivanPBurnettAStrakerL. Altered patterns of superficial trunk muscle activation during sitting in nonspecific chronic low back pain patients: importance of subclassification. Spine. 2006; 31(17): 2017-2023.
13.
SapsfordRRRichardsonCAStantonWR. Sitting posture affects pelvic floor muscle activity in parous women: an observational study. Aust J Physiother. 2006; 52(3): 219-222.
14.
StugeBLaerumEKirkesolaGVøllestadN. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine. 2004; 29(4): 351-359.
15.
StugeBVeierødMBLærumEVøllestadN. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: A Two-Year Follow-up of a Randomized Clinical Trial. Spine. 2004; 29(10): E197-E203.
16.
KiblerBWPressJSciasciaA. The role of core stability in athletic function. Sports Med. 2006; 36(3): 189-198.
17.
MensJMSnijdersCJStamHJ. Diagonal trunk muscle exercises in peripartum pelvic pain: a randomized clinical trial. Phys Ther. 2000; 80(12): 1164-1173.
18.
SjodahlJKvistJGutkeAÖbergB. The postural response of the pelvic floor muscles during limb movements: a methodological electromyography study in parous women without lumbopelvic pain. Clin Biomech (Bristol, Avon). 2009; 24(2): 183-189.
19.
ArabAMBehbahaniRBLorestaniLAzariA. Assessment of pelvic floor muscle function in women with and without low back pain using transabdominal ultrasound. Man Ther. 2010; 15(3): 235-239.
20.
LaslettMAprillCNMcDonaldBYoungSB. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther. 2005; 10(3): 207-218.
21.
OstgaardHCZetherströmGRoos-HanssonE. The posterior pelvic pain provocation test in pregnant women. Eur Spine J. 1994; 3(5): 258-260.
22.
MensJMAVleemingASnijdersAKoesBWStamHJ. Reliability and validity of the active straight leg raising test in posterior pelvic pain since pregnancy. Spine. 2001; 26(10): 1167-1171.
23.
ScrimashawSMaherC. Responsiveness of visual analogue scale and McGill pain scale measures. J Manipulative Physiol Ther. 2001; 24(8): 501-504.
24.
BijurPESilverWGallagherEJ. Reliability of visual analogue scale for measurement of acute pain. Acad Emerg Med. 2001; 8(12): 1153-1157.
25.
FairbankJCTPynsentPB. The oswestry disability index. Spine. 2000; 25(21): 2940-2953.
26.
FrawleyHCGaleaMPPhillipsBASherburnMBøK. Reliability of pelvic floor muscle strength assessment using different test positions and tools. Neurourol Urodyn. 2006; 25(3): 236-242.
27.
TousignantMPoulinLMarchandSViauAPlaceC. The Modified-Modified Schober Test for range of motion assessment of lumbar flexion in patients with low back pain: A study of criterion validity, intra- and inter-rater reliability and minimum metrically detectable change. Disabil Rehabil. 2005; 27(10): 553-559.
28.
WilliamsRBinkleyJBlochRGoldsmithCHMinukT. Reliability of the Modified-Modified Schober and double inclinometer methods for measuring lumbar flexion and extension. Phys Ther. 1993; 73(1): 26-37.
29.
RichardsonCAJullGA. Muscle control-pain control. What exercises would you prescribe? Man Ther. 1995; 1(1): 2-10.
30.
RichardsonCASnijdersCJHidesJADamenLPasMSStormJ. The relation between the trans-versus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine. 2002; 27(4): 399-405.
31.
NorrisCMMatthewsM. The role of an integrated back stability program in patients with chronic low back pain. Complement Ther Clin Pract. 2008; 14(4): 255-263.
32.
Santa MinaDAuDAlibhaiSMHJamnickyLFaghaniNHiltonWJ, et al. A pilot randomized trial of conventional versus advanced pelvic floor exercises to treat urinary incontinence after radical prostatectomy: a study protocol. BMC Urology. 2015; 15: 94.
33.
GutkeASjödahlJObergB. Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial. J Rehabil Med. 2010; 42(10): 929-935.
34.
DamenLBuyrukHMGuler-UysalFLotgeringFKSnijdersCJStamHJ. Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints. Acta Obstet Gynecol Scand. 2001; 80(11): 1019-24.
35.
VleemingASnijdersCJStoeckartR. Transfer of lumbosacral load to iliac bones and legs. Part 1: Biomechanics of self-bracing of the sacro-iliac joints and its significance for treatment and exercise. Clin Biomech. 1993; 8(6): 285-294.
36.
SelkowNMEckMRRivasS. Transversus abdominis activation and timing improves following core stability training: a randomized trial. Int J Sports Phys Ther. 2017; 12(7): 1048-1056.
37.
van WingerdenJPVleemingARonchettiI. Differences in standing and forward bending in women with chronic low back or pelvic girdle pain. Spine. 33(11): E334-E341.
38.
JavadianYBehtashHAkbariMTaghipour-DarziMZekavatH. Effects of stabilizing exercises on pain and disability of patients with lumbar segmental instability. J Back Musculoskelet Rehabil. 2012; 25(3): 149-155.
39.
ShahvarpourAHenrySMPreussRMecheriHLarivièreC. The effect of an 8-week stabilization exercise program on the lumbopelvic rhythm and flexion-relaxation phenomenon. Clin Biomech (Bristol, Avon). 2017; 48: 1-8.
40.
ZaleELLangeKLFieldsSADitreJW. The relation between pain-related fear and disability: A meta-analysis. J Pain. 2013; 14(10): 1019-1030.
41.
GeorgeSZFritzJMChildsJD. Investigation of elevated fear-avoidance beliefs for patients with low back pain: a secondary analysis involving patients enrolled in physical therapy clinical trials. J Orthop Sports Phys Ther. 2008; 38(2): 50-58.
42.
RichardsonCJullGHodgesPHidesJ. Therapeutic exercise for the spinal segmental stabilization in low back pain: scientific basis and clinical approach. Edinburgh: Churchill Livingstone; 1999.
43.
Cosio-LimaLMReynoldsKLWinterCPaoloneVJonesMT. Effect of physioball and conventional floor exercises on early phase adaptations in back and abdominal core stability and balance in women. J Strength Cond Res. 2003; 17(4): 721-725.
44.
DelittoAErhardREBowlingRW. A treatment based classification approach to low back syndrome: identifying and staging patients for conservative treatment. Phys Ther. 1995; 75(6): 470-489.
45.
MacdonaldDALorimerMGHodgesPW. The lumbar multifidus: Does the evidence support clinical beliefs? Man Ther. 2006; 11(4): 254-263.
46.
KovacsKMMarrasWSLitskyASGuptaPFergusonSA. Localized oxygen use of healthy and low back pain individuals during controlled trunk movements. J Spinal Disord. 2001; 14(2): 150-158.
47.
BiXZhaoJZhaoLLiuZZhangJSunD, et al. Pelvic floor muscle exercise for chronic low back pain. J Int Med Res. 2013; 41(1): 146-152.
48.
MadillSJMcLeanL. Intravaginal pressure generated during voluntary pelvic floor muscle contractions and during coughing. The effect of age and continence status. Neurourol Urodyn. 2010; 29(3): 437-442.
49.
HodgesPWSapsfordRPengelL. Feedforward activity of the pelvic floor muscles precedes rapid upper limb movements. Australian Physiotherapy Association Conference. Sydney, abstract 21; 2002.
GattiRFaccendiniSTettamantiABarberoMBalestriACaloriG. Efficacy of trunk balance exercises for individuals with chronic low back pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2001; 41(8): 542-552.
54.
McGillS. Normal and injury mechanics of the lumbar spine. In: low back disorders: Evidence-Based prevention and rehabilitation. Champing: Human Kinetics; 2002.
