Laboratory of Functional Evaluation and Human Motor Performance (LAFUP), Universidade Pitagoras UNOPAR, Londrina, PR, Brazil.
Doctoral Program in Rehabilitation Sciences, UEL/UNOPAR, Londrina, PR, Brazil.
Eur J Phys Rehabil Med. 2020 Jun;56(3):297-306. doi: 10.23736/S1973-9087.20.06086-4. Epub 2020 Feb 18.
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.
To compare the effects of lumbar stabilization and stretching exercises for the treatment of gestational low back pain.
A pilot randomized clinical trial.
Laboratory of Functional Evaluation and Human Motor Performance and physical therapy clinics.
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).
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 two groups for 6 weeks of intervention twice a week for a 50-minute treatment: 1) lumbar stabilization exercise protocol and 2) stretching exercise protocol.
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.
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.
The present study has implications, especially for clinical decision-making with regard to therapy choice in pregnant women with LBP to reduce pain and improve trunk function as measured through balance performance.
孕期腰痛较为常见。腰椎稳定和伸展运动被推荐用于治疗普通人群的腰痛。然而，很少有研究将这两种干预措施应用于患有腰痛的孕妇。
比较腰椎稳定和伸展运动治疗妊娠腰痛的效果。
一项先导随机临床试验。
功能评估和人体运动表现实验室和物理治疗诊所。
最初招募了 30 名腰痛的孕妇，其中 24 名符合以下纳入标准：妊娠 19-29 周；产前临床随访；非特异性机械性腰痛始于妊娠；过去 3 个月未参加特定腰痛治疗。共有 20 名女性完成了研究（每组 10 名）。
主要结局指标为临床指标（视觉模拟评分（VAS）和麦吉尔疼痛问卷的疼痛和罗尔蒙德·莫里斯问卷的残疾），次要结局指标为：姿势平衡（力平台）；多裂肌、髂肋肌、腹直肌和腹外斜肌的肌肉激活水平（肌电图）。这些女性被随机分为两组，每周进行两次 6 周的干预，每次 50 分钟：1）腰椎稳定运动方案和 2）伸展运动方案。
两种干预措施均显著降低了疼痛（VAS 为 1.68，麦吉尔问卷为 4.81）（P=0.03），但残疾评分无变化。此外，两种干预措施都能显著改善姿势稳定性（速度摆动参数的平均 d 值为 0.77），并且在干预后显著增加了腹外斜肌的激活（P>0.05）。
在 6 周的干预后，两种方法（腰椎稳定和伸展）均能有效减轻腰痛，改善平衡，增加腰痛孕妇的躯干活动肌肉。
本研究具有重要意义，特别是在治疗决策方面，可选择治疗孕妇腰痛，以减轻疼痛和改善躯干功能，通过平衡表现来衡量。
