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European Journal of Physical and Rehabilitation Medicine 2020 Feb 18

DOI: 10.23736/S1973-9087.20.06086-4

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Effects of lumbar stabilization and muscular stretching on pain, disabilities, postural control and muscle activation in pregnant woman with low back pain: a pilot randomized trial

Adriana P. FONTANA CARVALHO 1, 2, Sébastien S. DUFRESNE 4, Márcio ROGERIO de OLIVEIRA 2, 3, Karina C. FURLANETTO 1, 2, Maryane DUBOIS 4, Mathieu DALLAIRE 4, Suzy NGOMO 4, Rubens A. da SILVA 4

1 Doctoral and Masters Programs in Rehabilitation Sciences UEL/UNOPAR, LAFUP-UNOPAR, Universidade Pitagoras UNOPAR, Londrina, Brazil; 2 Department of Physical Therapy, Universidade Pitagoras Unopar, Laboratory of Functional Evaluation and Human Motor Performance (LAFUP), Londrina, Brazil; 3 Professional Master’s in Physical Exercise in Health Promotion, Pitagora UNOPAR, Laboratory of Functional Evaluation and Human Motor Performance (LAFUP), Pitagoras UNOPAR, Londrina, Brazil; 4 Département des Sciences de la Santé, Programme de Physiothérapie de l’Université McGill offert en extension à l’Université du Québec à Chicoutimi (UQAC), Centre intersectoriel en santé durable, Lab BioNR et Cupht - UQAC, Saguenay, Québec, Canada


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BACKGROUND: Low back pain is common during pregnancy. Lumbar stabilization and stretching exercises are recommended to treat low back pain in the general population. However, few studies have applied the effects of these two interventions in pregnant women with low back pain.
OBJECTIVES: To compare the effects of lumbar stabilization and stretching exercises for the treatment of gestational low back pain.
DESIGN: A pilot randomized clinical trial.
SETTING: Laboratory of Functional Evaluation and Human Motor Performance and physical therapy clinics.
PARTICIPANTS: Initially, 30 pregnant women with low back pain were recruited, of which 24 met the following inclusion criteria: being between 19-29 weeks of gestation; being in prenatal clinical follow-up; having nonspecific mechanical low back pain started in pregnancy; not participating in specific low back pain treatment in the last 3 months. A total of 20 women completed the study (10 each group).
METHODS: The main outcome measures were clinical (pain by Visual Analogue Scale (VAS) and McGill Pain Questionnaire and disability by Roland Morris Questionnaire), and secondary outcome measures were: postural balance (force platform); muscle activation level of multifidus, iliocostalis lumborum, rectus abdominis and external abdominal oblique (electromyography). The women were randomized into 2 groups for 6 weeks of intervention 2 x week for a 50-minute treatment: 1) lumbar stabilization exercise protocol and 2) stretching exercise protocol.
RESULTS: There was a significant reduction (p = 0.03) in pain (1.68 in VAS and 4.81 for McGill questionnaire) for both interventions, but no change in disability score. In addition, both interventions were comparable for a significant improvement in postural stability (in mean d = 0.77) for the velocity sway parameter, and significantly increased activation (p >0.05) of the external abdominal oblique muscle after intervention.
CONCLUSIONS: Both modalities (lumbar stabilization and stretching were efficient for pain reduction, improving balance and increasing one trunk activity muscle after 6 weeks of intervention in pregnant women with low back pain.
CLINICAL REHABILITATION IMPACT: The present study has implications, especially for clinical decision-making in regards to therapy choice in pregnant women with LBP to reduce pain and improve trunk function as measured through balance performance.


KEY WORDS: Low back pain; Pregnancy; Exercise; Postural balance; Electromyography

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