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The Relationship between Exercise and Back Pain During Pregnancy. Jennifer Y. McElroy, D.O. Sheila Dugan, M.D. Objective.

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The Relationship between Exercise and Back Pain During Pregnancy

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The relationship between exercise and back pain during pregnancy l.jpg

The Relationship between Exercise and Back Pain During Pregnancy

Jennifer Y. McElroy, D.O.

Sheila Dugan, M.D.


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Objective

  • Investigate self-reported back pain and patterns of physical activity in the first and second trimester of pregnancy to evaluate the relationship between exercise and back pain during pregnancy

  • Demonstrate the applicability of published pain scale models to the pregnant population


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Background

  • Studies have shown 50-90% of pregnant women experience back pain during pregnancy

  • Back pain cited as the most frequent reason for missed work days in pregnant population

  • Proposed etiologies range from biomechanical strain to altered hormonal influences


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Background

  • ACOG recommends 30 minutes of moderate exercise on most days of the week for pregnant patients

  • Benefits of exercise during pregnancy include fetal and maternal benefits (decreased GDM, labor, general discomforts)


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Hypothesis

  • An exercise program during pregnancy may prevent or minimize the intensity of low back pain during pregnancy

  • Little research has been published to support or debase this hypothesis


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Materials and Methods

  • Power analysis performed: 66 patients needed

  • Women’s Health Care Resident Clinic population enrolled

  • Patients consented and enrolled through the months of November 2005 to April 2006.


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Materials and Methods

  • Inclusion criteria: 18-34 years of age, singleton gestation, and the ability to read and write English

  • Exclusion criteria

  • 45 women enrolled, 10 excluded based on criteria

  • Socioeconomic information, presence and severity of back pain and patterns of activity were evaluated


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Trimester distribution of study participants


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Respective Focus of each Pain Questionnaire


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Results

  • Data collected from 35 women

    • Black 77.1%

    • Hispanic 17.7%

    • White 5.7%

  • Four (11.4%) participants reported a history of back pain prior to the current gestation

  • Three participants (8.6%) reported back pain during the current gestation


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Demographics and Reported Back Pain


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Results

  • Higher than expected activity level in the enrolled population

  • Eighty percent of those enrolled reported walking at least twice a week (4.7x a week average)

  • Seventy-three percent of the study population reported that they engaged in regular strenuous activity


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Reported incidence of Walking and Strenuous Exercise


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Discussion

  • Our hypothesis was that an exercise program may prevent or minimize the intensity of back pain during pregnancy

  • Collected data reveal a higher than expected level of physical activity in this study population, and coincidentally, a lower than expected incidence of back pain


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Discussion

  • Pre-pregnancy levels of activity did not predict levels of activity during pregnancy

  • The low frequency of reported back pain precluded meaningful statistical analysis and identification of risk factors


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Discussion

  • Given the low reported incidence of back pain in this active population it appears that a more active lifestyle may be protective against some of the discomforts experienced by pregnant patients.


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Areas for Further Study

  • Evaluation of risk factors that may predispose pregnant women to back pain with respect to physical activity

  • Pregnancy conditioning regimens and outcomes with respect to back pain


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Exclusion Criteria

Age <18 or >34

Multiple gestation

Unable to read/write English

History of back surgery

Considered to have high-risk pregnancy by health care provider. Examples include:

History of one or more of the following:

Prior neonatal death\

Two or more previous preterm deliveries <34 weeks

A single preterm delivery <30 weeks

Birth of a neonate with serious complications resulting in a handicapping condition

Recurrent spontaneous abortion or fetal demise

Family history of genetic disease

Incompetent cervix

Active chronic medical problems including:

Cardiovascular disease

Autoimmune disease

Reactive airway disease requiring treatment with corticosteroids

Seizure disorder

Hypertension controlled on a single medication

Controlled hyperthyroidism on replacement therapy

Idiopathic thrombocytopenia purpura

Thromboembolic disease

Malignant disease

Renal disease with functional impairment

HIV

Selected obstetric complications which present prior to 34 weeks:

Polyhydraminios

Oligohydramnios

Pre-eclampsia

Congenital viral disease

Maternal surgical conditions

Suspected fetal abnormality

Isoimmunization with antibody titers greater than 1:8

Antiphospholipid syndrome

DES exposure

IDDM Class A2 and B

Selected chronic medical conditions with a known increase in perinatal morality:

Cardiovascular disease with functional impairment

Respiratory failure requiring mechanical ventilation

Acute coagulopathy

Intractable seizures

Coma

Sepsis

Solid organ transplant

Active immune disease requiring corticosteroids therapy

Instable reactive airway disease

Renal disease requiring dialysis or a serum creatinine >1/5mg%

Active hyperthyroidism

Severe hemoglobinopathy

Selected obstetric complications which present prior to 32 weeks

Preterm labor

PROM

Severe pre-eclampsia

Isoimmunization with need for intrauterine transfusion

Exclusion Criteria


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References

  • Fast, A., Shapiro, D., Ducommun, E.J., Friedmann, L.W., Bouklas, T., & Floman, Y. (1987). Low-back pain in pregnancy. Spine, 12, 368-371.

  • 2 Noren, L., Ostgaard, S., Johansson, G., & Ostgaard, H.C. (2002). Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. European Spine Journal, 11, 267-271.

  • 3 Ostgaard, H.C. & Andersson, G.B. (1991). Previous back pain and risk of developing back pain in a future pregnancy. Spine, 16, 432-436.

  • 4 Kristiansson, P., Svardsudd, K., & von Schoultz, B. (1996). Bak pain during pregnancy: a prospective study. Spine, 21, 702-709.

  • 5 ACOG Committee Obstetric Practice (2002). ACOG Committee Opinion. (Rep. No. 267)

  • 6 Clapp, J.F., III, Kim, H., Burciu, B., & Lopez, B. (2000). Beginning regular exercise in early pregnancy: effect on fetoplacental growth. American Journal of Obstetrics and Gynecology., 183, 1484-1488.

  • Clapp, J. F., III, Kim, H., Burciu, B., Schmidt, S., Petry, K., & Lopez, B. (2002). Continuing regular exercise during pregnancy: effects of exercise volume on fetoplacental growth. American Journal of Obstetrics and Gynecology186,142-147.

  • Clapp, J. F., III & Little, K.D. 91995). Effect of recreational exercise on pregnancy weight gain and subcutaneous fat deposition. Medicine & Science in Sports & Exercise., 27, 170-177.

  • Dye, T.D., Knox, K.L., Artal, R., Aubry, R.H., & Wojtowyz, M.A. (1997). Physical activity, obesity, and diabetes in pregnancy. American Journal of Epidemiology, 146, 961-965.

  • Clapp, J.F., III (1990). The course of labor after endurance exercise during pregnancy. American Journal of Obstetrics and Gynecology., 163, t-805.

  • Horns, P.N., Ratcliffe, L.P., Leggett, J.C. & Swanson, M.S. (1996). Pregnancy outcomes among active and sedentary primiparous women. JOGNN- Journal of Obstetric, Gynecologic, & Neonatal Nursing., 25, 49-54.

  • Peterson, A. M., et al. (2005). Exercise in pregnancy. Medicine & Science in Sports & Exercise, 37, 1748-53.


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