Therapeutic exercise for pain relief of ligamentous hyperlaxity in pregnant women: literature review
Keywords:
pelvic pain, pregnancy, therapeutic exercise, lumbar stabilization, physiotherapy, ligamentous hyperlaxityAbstract
Although pain caused by ligamentous hyperlaxity associated with the influence of relaxin and other hormones affects the quality of life of many women during pregnancy –a period of significant physiological, morphological, and hormonal changes– information is insufficient to address it. This study examines the effectiveness of therapeutic exercise in reducing low back and pelvic pain and related complications in pregnant women. For this purpose, bibliographic searches were performed in databases such as PubMed, Scopus, ScienceDirect and Scielo, with publications between 2018 and 2023. The search equation was: Joint instability AND pregnancy AND pelvic girdle pain AND exercise. After applying the inclusion and exclusion criteria, a total of 456 articles were identified, of which 8 were included in the review. The desk review highlights that postpartum lumbopelvic pain is common, is associated with weakness of certain muscles, and can affect the mother's quality of life, baby rearing, and family finances. The close relationship between this pain and weakness of the hip extensors, pelvic floor muscles, and transversus abdominis muscles is emphasized. Stabilization exercises and Pilates are recommended to improve postpartum pain and quality of life. This pain is the main focus of treatment, and therapeutic exercise helps to reduce it. The most important are lumbar stabilization and pelvic floor strengthening exercises, which have been shown to significantly reduce pain in pregnant women.
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1. Arce-Gálvez, L., Méndez-Vega, D. A., Mancera-Álzate, J. M., Benavídez-Ramírez, A., y Rodríguez-Vélez, L. M. (2022). Dolor lumbar en el embarazo: aspectos fisiopatológicos y tratamiento. Revista Chilena de Obstetricia y Ginecología, 87(2), 111-121. https://dx.doi.org/10.24875/rechog.22000004
2. Bagwell, J. J., Reynolds, N., Smith, J. A., Walaszek, M., Runez, H., Lam, K., Peterson, J., y Katsavelis, D. (2022). An Exploratory Analysis of Gait Biomechanics and Muscle Activation in Pregnant Females with High and Low Scores for Low Back or Pelvic Girdle Pain During and After Pregnancy. Clinical Biomechanics, 97, 105705. https://doi.org/10.1016/j.clinbiomech.2022.105705
3. Budler L. C., y Budler, M. (2020). Physical Activity During Pregnancy: A Systematic Review for the Assessment of Current Evidence with Future Recommendations. BMC Sports Science, Medicine & Rehabilitation, 14(1),133. https://doi.org/10.1186/s13102-022-00524-z
4. Chen, H., D’Onofrio, G., y Hameed, F. (2020). Role of Exercise Treatment of Low Back Pain in Pregnancy. Current Physical Medicine and Rehabilitation Reports, 8(4), 322-328. https://doi.org/10.1007/s40141-020-00292-2
5. Daneau, C., Houle, M., Pasquier, M., Ruchat, S. M., y Descarreaux, M. (2021). Association Between Pregnancy-Related Hormones and Lumbopelvic Pain Characteristics in Pregnant Women: A Scoping Review. Journal of Manipulative and Physiological Therapeutics, 44(7), 573-583. https://doi.org/10.1016/j.jmpt.2021.10.001
6. Davenport, M. H., Marchand, A. A., Mottola, M. F., Poitras, V. J., Gray, C. E., Jaramillo García, A., Barrowman, N., Sobierajski, F., James, M., Meah, V. L., Skow, R. J., Riske, L., Nuspl, M., Nagpal, T. S., Courbalay, A., Slater, L. G., Adamo, K. B., Davies, G. A., Barakat, R., y Ruchat, S. M. (2019). Exercise for the Prevention and Treatment of Low Back, Pelvic Girdle and Lumbopelvic Pain During Pregnancy: A Systematic Review and Meta-Analysis. British Journal of Sports Medicine, 53(2), 90-98. https://doi.org/10.1136/bjsports-2018-099400
7. Ehsani, F., Sahebi, N., Shanbehzadeh, S., Arab, A. M., y ShahAli, S. (2020). Stabilization Exercise Affects Function of Transverse Abdominis and Pelvic Floor Muscles in Women with Postpartum Lumbo-Pelvic Pain: A Double-Blinded Randomized Clinical Trial Study. International Urogynecology Journal, 31(1), 197-204. https://doi.org/10.1007/s00192-019-03877-1
8. ElDeeb, A. M., Abd-Ghafar, K. S., Ayad, W. A., y Sabbour, A. A. (2019). Effect of Segmental Stabilizing Exercises Augmented by Pelvic Floor Muscles Training on Women with Postpartum Pelvic Girdle Pain: A Randomized Controlled Trial. Journal of Back and Musculoskeletal Rehabilitation, 32(5), 693-700. https://doi.org/10.3233/BMR-181258
9. Fontana Carvalho, A. P., Dufresne, S. S., Rogerio de Oliveira, M., Couto Furlanetto, K., Dubois, M., Dallaire, M., Ngomo, S., da Silva, R. A. (2020). Effects of Lumbar Stabilization and Muscular Stretching on Pain, Disabilities, Postural Control and Muscle Activation in Pregnant Woman with Low Back Pain. European Journal of Physical and Rehabilitation Medicine, 56(3), 297-306. https://doi.org/10.23736/s1973-9087.20.06086-4
10. Gashaw, M., Yitayal, M. M., Zemed, A., Nigatu, S. G., Kasaw, A., Belay, D. G., Aragaw, F. M., Endalew, M., Tsega, N. T., Asratie, M. H., y Janakiraman, B. (2022). Level of Activity Limitations and Predictors in Women with Pregnancy-Related Pelvic Girdle Pain: Prospective Cross-Sectional Study. Annals of Medicine and Surgery, 78, 103754. https://doi.org/10.1016/j.amsu.2022.103754
11. Ghandali, N. Y., Iravani, M., Habibi, A., y Cheraghian, B. (2021). The Effectiveness of a Pilates Exercise Program During Pregnancy on Childbirth Outcomes: A Randomised Controlled Clinical Trial. BMC Pregnancy and Childbirth, 21(480), 1-11. https://doi.org/10.1186/s12884-021-03922-2
12. Girard, M. P., O'Shaughnessy, J., Doucet, C., Ruchat, S. M., y Descarreaux, M. (2020). Association between Physical Activity, Weight Loss, Anxiety, and Lumbopelvic Pain in Postpartum Women. Journal of Manipulative and Physiological Therapeutics, 43(6), 655-666. https://doi.org/10.1016/j.jmpt.2019.11.008
13. Hu, X., Ma, M., Zhao, X., Sun, W., Liu, Y., Zheng, Z., y Xu, L. (2020). Effects of Exercise Therapy for Pregnancy-Related Low Back Pain and Pelvic Pain: A Protocol for Systematic Review and Meta-Analysis. Medicine, 99(3), e17318. https://doi.org/10.1097/md.0000000000017318
14. Linjuan, W. Yan, W., Yinghu, P., Qitao, T., Yaodong, G., Li, L., y Ming, Z. (2023). Review of Biomechanical Deviations among Nonpregnant, Pregnant, and Postpartum Cohorts. Medicine in Novel Technology and Devices, 18, 100226. https://doi.org/10.1016/j.medntd.2023.100226
15. Mamipour, H., Farazmehr, S., Negahban, H., Nazary-Moghadam, S., Dehghan-Manshadi, F., Nezhad, M. N., Jafari, S., y Sharifzadeh, S. (2023). Effect of Core Stabilization Exercises on Pain, Functional Disability, and Quality of Life in Pregnant Women with Lumbar and Pelvic Girdle Pain: A Randomized Controlled Trial. Journal of Manipulative and Physiological Therapeutics, 46(1), 27-36. https://doi.org/10.1016/j.jmpt.2023.05.005
16. Nayab, I., Ghous, M., Shakil Ur Rehman, S., y Yaqoob, I. (2021). The Effects of an Exercise Programme for Core Muscle Strengthening in Patients with Low Back Pain after Caesarian-Section: A Single Blind Randomized Controlled Trial. The Journal of the Pakistan Medical Association, 71(5), 1319-1325. https://doi.org/10.47391/JPMA.596
17. Ogollah, R., Bishop, A., Lewis, M., Grotle, M., y Foster, N. E. (2019). Responsiveness and Minimal Important Change for Pain and Disability Outcome Measures in Pregnancy-Related Low Back and Pelvic Girdle Pain. Physical Therapy, 99(11), 1551-1561. https://doi.org/10.1093/ptj/pzz107
18. Peng, Y. C., y Chou, F. H. (2019). Different Exercise Intensities for Relieving Lumbopelvic Pain in Pregnant Women. The Journal for Nurse Practitioners, 15(3), 249-255. https://doi.org/10.1016/j.nurpra.2018.11.018
19. Ribeiro Lira, S. O., Soares de Sousa, V. P., y de Souza Ramalho Viana, E. (2022). Therapeutic Exercise versus Other Modalities for Prevention and Treatment of Low Back, Pelvic Girdle, and Lumbopelvic Pain During Pregnancy: A Review Protocol. PLoS ONE, 17(9), e0274471. https://doi.org/10.1371/journal.pone.0274471
20. Sakamoto, A., Nakagawa, H., Nakagawa, H. y Gamada, K. (2018). Effects of Exercises with a Pelvic Realignment Device on Low-Back and Pelvic Girdle Pain after Childbirth: A Randomized Control Study. Journal of Rehabilitation Medicine, 50(10), 914-919. https://doi.org/10.2340/16501977-2487
21. Sanders, J., Blaylock, R., Dean, C., Petersen, I., Trickey, H., y Murphy, C. (2023). Women's Experiences of Over-the-Counter and Prescription Medication During Pregnancy in the UK: Findings from Survey Free-Text Responses and Narrative Interviews. BMJ Open, 13(3), e067987. https://doi.org/10.1136/bmjopen-2022-067987
22. Santos, F. F., Lourenço, B. M., Souza, M. B., Maia, L. B., Oliveira, V. C., y Oliveira, M. X. (2023). Prevention of Low Back and Pelvic Girdle Pain During Pregnancy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials with GRADE Recommendations. Physiotherapy, (118), 1-11. https://doi.org/10.1016/j.physio.2022.09.004
23. Sonmezer, E., Özköslü, M. A., y Yosmaoğlu, H. B. (2021). The Effects of Clinical Pilates Exercises on Functional Disability, Pain, Quality of Life and Lumbopelvic Stabilization in Pregnant Women with Low Back Pain: A Randomized Controlled Study. Journal of Back and Musculoskeletal Rehabilitation, 34(1), 69-76. https://doi.org/10.3233/BMR-191810
24. Stolarczyk, A., Stępiński, P., Sasinowski, Ł., Czarnocki, T., Dębiński, M., y Maciąg B. (2021). Peripartum Pubic Symphysis Diastasis-Practical Guidelines. Journal of Clinical Medicine, 10(11), 2443. https://doi.org/10.3390/jcm10112443
25. Stuge, B. (2019). Evidence of Stabilizing Exercises for Low Back and Pelvic Girdle Pain: A Critical Review. Brazilian Journal of Physical Therapy, 23(2), 181-186. https://doi.org/10.1016/j.bjpt.2018.11.006
26. Stuge, B. (2019). Evidence of Stabilizing Exercises for Low Back- and Pelvic Girdle Pain - A Critical Review. Brazilian Journal of Physical Therapy, 23(2), 181-186. https://doi.org/10.1016/j.bjpt.2018.11.006
27. Sward, L., Manning, N., Murchison, A. B., Ghahremani, T., McCaulley, J. A., y Magann, E. F. (2023). Pelvic Girdle Pain in Pregnancy: A Review. Obstetrical & Gynecological Survey, 78(6), 349-357. https://doi.org/10.1097/OGX.0000000000001140
28. The American College of Obstetricians and Gynecologists. (2020). Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstetrics & Gynecology, 135(4), e178-e188. https://doi.org/10.1097/aog.0000000000003772
29. Wang, H., Feng, X., Liu, Z., Liu, Y., y Xiong, R. (2021). A Rehabilitation Programme Focussing on Pelvic Floor Muscle Training for Persistent Lumbopelvic Pain after Childbirth: A Randomized Controlled Trial. Journal of Rehabilitation Medicine, 53(4), 1-6. https://doi.org/10.2340/16501977-2812
30. Wuytack, F., Begley, C., y Daly, D. (2020). Risk Factors for Pregnancy-Related Pelvic Girdle Pain: A Scoping Review. BMC Pregnancy and Childbirth, 20(739), 1-14. https://doi.org/10.1186/s12884-020-03442-5
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