Evidence of stabilizing exercises for low back- and pelvic girdle pain - a critical review

Redefining Maternal Wellness: The Role of Antenatal Exercises in Musculoskeletal Issues Among Primigravida Mothers

During pregnancy, there are notable alterations in biomechanics, hormones, and vascular functioning, which frequently result in a range of musculoskeletal ailments, including back pain, leg cramps, and pelvic girdle discomfort. The significance of pregnancy-related musculoskeletal problems on women's daily functioning and general well-being is highlighted by their widespread occurrence worldwide, necessitating heightened focus and implementation of effective therapeutic approaches. The main aims of this study were to assess the effectiveness of prenatal exercises in musculoskeletal discomfort and investigate the association between post-intervention levels of discomfort and certain demographic factors. A quantitative technique was used in this study, utilizing a pre-experimental design conducted for three months. A total of 60 primigravida mothers were selected as participants through purposive sampling. The study was conducted in a Maternity Tertiary Care Center located in Tamil Nadu. The intervention encompassed the provision of antenatal exercises, specifically focusing on abdominal tightness, pelvic tilting, and foot and ankle movements. The researcher demonstrated the exercises for 20 minutes, and afterward, mothers were asked to perform the activities themselves. The process was monitored and observed for two weeks. The findings were statistically significant, suggesting a noteworthy decrease in musculoskeletal disorders following the implementation of the intervention. The statistical analysis revealed a significant degree of significance (P = 0.001), confirming the efficacy of the exercises. Before the implementation of the intervention, a significant proportion of mothers, namely, 45 (75%) reported experiencing moderate back pain. However, following the intervention, this percentage notably fell to 33.34% (20). The incidence of moderate pelvic pain decreased from 80% (48) to 30% (18), and a comparable pattern was observed in the reduction of leg cramps. Additionally, the research identified significant associations between the improvements and a range of demographic and obstetric factors, including the level of education, occupation, family structure, age at marriage, and weight of the mother. The results highlight the significance of incorporating antenatal exercises as a regular component of prenatal care to minimize musculoskeletal discomfort, hence promoting the overall health and well-being of expectant mothers.

Therapeutic exercise versus other modalities for prevention and treatment of low back, pelvic girdle, and lumbopelvic pain during pregnancy: A review protocol

Background

The female body changes during pregnancy to create a favorable environment for fetal development which may result in musculoskeletal disorder and painful symptoms in the lumbopelvic region.

Objective

To analyze the evidence of therapeutic exercise versus other modalities to prevent and treat LBP, LGP, and LPP during pregnancy.

Methods

Full text randomized controlled trials (RCT) evaluating interventions to prevent or treat LBP, PGP, and LPP during pregnancy (any gestational age) that comparing therapeutic exercises with usual care or other modalities to reduce the incidence or severity of LBP or PGP or both during pregnancy will be included. 5 electronic databases will be searched to identify studies. Assess risk of bias in each study using the Cochrane Handbook for Systematic Reviews of Interventions and quality of overall body of evidence for all primary outcomes will be assessed for all comparisons using the approach outlined in GRADE Handbook.

Comparison of the effects of foot-toe orthoses on three-dimensional pelvic kinematics in individuals with hallux valgus during gait

BACKGROUND

Most previous studies focused on the possible relationship between hallux valgus deformity and biomechanical characteristics in the foot and lower leg. Very few investigated the association of pelvic kinematics and hallux valgus during gait according to various foot-toe orthoses for hallux valgus.

OBJECTIVE

To investigate the effect of soft or hard foot-toe orthoses on pelvic kinematics in individuals with hallux valgus deformity during gait.

STUDY DESIGN

This study has a repeated measures design.

METHODS

Three-dimensional range of motion in the pelvic segment was collected from 22 individuals (18 women and 4 men) aged 21 to 52 years (mean 31.7 years, SD 8.7) with hallux valgus. All participants exhibited a hallux valgus angle of more than 20 degree in both feet. A motion analysis system with eight infrared cameras was used to obtain pelvic kinematic data in the hard plastic orthosis, soft silicone orthosis, and without foot-toe orthosis conditions during gait. The two types of hallux valgus orthoses used in this experiment were commercially available products. The participants performed 8-10 walking trials. The walkway length was 6 m. Repeated-measures analysis of variance was used to determine the effects of each orthosis condition on the pelvic kinematic values.

RESULTS

The hard plastic orthosis condition was associated with decreased pelvic motion compared with the soft-type orthosis and no orthosis conditions for depression (F (2,42) = 7.329, P = 0.004), external rotation (F (2,42) = 4.367, P = 0.027), and overall transverse motion (F (2,42) = 4.897, P = 0.019) of the pelvic segment during gait. There were no significant differences in other pelvic motion variables between the without foot-toe orthosis and soft silicone orthosis conditions ( P > 0.05).

CONCLUSIONS

The results of this study suggest that the hard-type foot-toe orthosis for hallux valgus reduced pelvic motion and contributed to preventing excessive pelvic movement during gait.

Pain Neuroscience Education and Motor Control Exercises versus Core Stability Exercises on Pain, Disability, and Balance in Women with Chronic Low Back Pain

Background: Several interventions have been used to relieve chronic low back pain (CLBP). This study aimed to compare the effects of pain neuroscience education (PNE) followed by motor control exercises (MCEs) with core stability training (CST) on pain, disability, and balance in women with CLBP. Methods: Thirty-seven women with CLBP were randomly divided into two groups of PNE/MCE (n = 18, 55.2 ± 2.6 years) or CST (n = 19, 54.6 ± 2.4 years). Eight weeks of PNE/MCE or CST were prescribed for each group, independently. Pain intensity (VAS scale), disability (Roland Morris Disability Questionnaire), unipodal static balance, and dynamic balance (time up and go test) were measured at the beginning and 8 weeks after the intervention. Two-way mixed ANOVA was used to analyze the results with alpha of 5%. Results: After 8 weeks, there was a significant difference in VAS scale between groups (p = 0.024), with both PNE/MCE and CST showing 58% and 42% reductions, respectively. There were no differences for all other variables between groups. Regarding pre- to post-comparisons, both groups showed improvements in all dependent variables (p < 0.001). Conclusion: The treatment with PNE/MCE was more effective in improving pain disability and unipodal static and dynamic balance than treatment with CST. Even so, both treatments were shown to be valid and safe in improving all dependent variables analyzed in women with CLBP.

Lifestyle and Chronic Pain in the Pelvis: State of the Art and Future Directions

During their lifespan, many women are exposed to pain in the pelvis in relation to menstruation and pregnancy. Such pelvic pain is often considered normal and inherently linked to being a woman, which in turn leads to insufficiently offered treatment for treatable aspects related to their pain experience. Nonetheless, severe dysmenorrhea (pain during menstruation) as seen in endometriosis and pregnancy-related pelvic girdle pain, have a high impact on daily activities, school attendance and work ability. In the context of any type of chronic pain, accumulating evidence shows that an unhealthy lifestyle is associated with pain development and pain severity. Furthermore, unhealthy lifestyle habits are a suggested perpetuating factor of chronic pain. This is of specific relevance during lifespan, since a low physical activity level, poor sleep, or periods of (di)stress are all common in challenging periods of women’s lives (e.g., during menstruation, during pregnancy, in the postpartum period). This state-of-the-art paper aims to review the role of lifestyle factors on pain in the pelvis, and the added value of a lifestyle intervention on pain in women with pelvic pain. Based on the current evidence, the benefits of physical activity and exercise for women with pain in the pelvis are supported to some extent. The available evidence on lifestyle factors such as sleep, (di)stress, diet, and tobacco/alcohol use is, however, inconclusive. Very few studies are available, and the studies which are available are of general low quality. Since the role of lifestyle on the development and maintenance of pain in the pelvis, and the value of lifestyle interventions for women with pain in the pelvis are currently poorly studied, a research agenda is presented. There are a number of rationales to study the effect of promoting a healthy lifestyle (early) in a woman’s life with regard to the prevention and management of pain in the pelvis. Indeed, lifestyle interventions might have, amongst others, anti-inflammatory, stress-reducing and/or sleep-improving effects, which might positively affect the experience of pain. Research to disentangle the relationship between lifestyle factors, such as physical activity level, sleep, diet, smoking, and psychological distress, and the experience of pain in the pelvis is, therefore, needed. Studies which address the development of management strategies for adapting lifestyles that are specifically tailored to women with pain in the pelvis, and as such take hormonal status, life events and context, into account, are required. Towards clinicians, we suggest making use of the window of opportunity to prevent a potential transition from localized or periodic pain in the pelvis (e.g., dysmenorrhea or pain during pregnancy and after delivery) towards persistent chronic pain, by promoting a healthy lifestyle and applying appropriate pain management.

Systematic reviews evaluating the effectiveness of motor control exercises in patients with non-specific low back pain do not consider its principles - A review

BACKGROUND

Motor control exercise (MCEs), spinal stabilization or core stability exercises were developed with the aim of restoring the coordination, control, and capacity of the trunk muscles and systematic reviews (SR) evaluating their effectiveness has shown conflicting results. This we hypothesized was due to the non-consideration of principles of neuroplasticity. The objective of this review was to review the operating definitions used in these reviews for these exercises and evaluate if these reviews have considered and satisfied the principles of these exercises in persons with NSLBP, both acute and chronic.

METHODS

The available evidence to address the research question was sought in the reviews published in English between January 2006 and April 2019 using the population, intervention, comparison, and outcome format. Data were extracted against the following factors: satisfy the principles of specific inclusion criteria; interventions; experience-dependent plasticity; and measure any one of the concepts of motor control. The quality of the evidence obtained was graded using the National Institute for Health and Care Excellence protocol and the quality of SRs evaluated using the R-AMSTAR.

RESULTS

Eleven reviews on core stability/spinal stabilization exercises and four reviews on MCE were considered in this review. The results showed that most of the studies considered by the reviews did not adhere to the principles of these exercises.

CONCLUSION

There is wide heterogeneity in the understanding, administration, and progression of exercises. The exercises were implemented without considering the potential for neuroplasticity of the nervous system and the principles of motor learning.

The pelvic girdle pain deadlock: 1. Would 'deconstruction' help?

INTRODUCTION

Pelvic Girdle Pain (PGP) is an important clinical problem that deserves more attention. Several treatment regimens have been presented that appear to be somewhat promising, but it was reported that about 10% of patients still suffer from the problems 11 years after their inception. This situation should be improved.

PURPOSE

We present a personalized history, with first the acceptance of the concept of 'PGP', around 2005, and then continued problems in really understanding PGP's nature and causes. We propose to engage in 'deconstruction' of PGP, that is, disentangling the large variety of processes involved.

IMPLICATIONS

Deconstructing PGP is a venture into the unknown. Still, science should proceed on the basis of what we know already. To understand PGP, experts emphasize the importance of biomechanics or of psychology, and we propose to insert 'inflammation' between these two levels of understanding, that is to say, the full development from low grade local inflammation to systemic inflammation and neuroinflammation. Inflammation is bidirectionally related to biomechanical as well as psychological processes. For clinicians, challenging our "beliefs and understanding of PGP, rather than being 'stuck' with a preferred modus operandi" has major practical implications. It requires continuous monitoring of the patient, and a willingness to change direction. More scientific disciplines are relevant to understanding, and treating, PGP than a single human being can master. Creative flexibility of clinicians would be a promising starting point to improve overall treatment effects in PGP.