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The Relationship between Exercise and Back Pain During Pregnancy Jennifer Y. McElroy, D.O. Sheila Dugan, M.D. 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 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 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) 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 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. 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 Trimester distribution of study participants Trimester Number of patients First trimester 18 Second trimester 17 Respective Focus of each Pain Questionnaire Pain Questionnaire Focus McGill Pain Questionnaire Pain Description Oswestry Questionnaire Perceived Functional Status Numeric Rating Scale Pain Intensity Physical Activity Index Physical Activity Level Physical Discomforts of Physical Discomforts Pregnancy 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 Demographics and Reported Back Pain Back Pain Enrolled Back Pain prior this Population to pregnancy pregnancy Black 77.1% (n=27) 7.4% (n=2) 3.7% (n=1) Hispanic 17.7% (n=6) 0.0 % (n=0) 16% (n=1) White 5.7% (n=2) 100% (n=2) 50% (n=1) Married 40% (n=14) 14.2% (n=2) 7.1% (n=1) Single 60% (n=21) 9.5% (n=2) 9.5% (n=2) All 11.4% (n=4) 8.6% (n=3) Enrollees 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 Reported incidence of Walking and Strenuous Exercise Walking as Strenuous Exercise Exercise Black 77.7% (n=21) 66.6% (n=18) Hispanic 83.3% (n=5) 100% (n=6) White 100% (n=2) 100% (n=2) Married 85.7% (n=12) 78.5% (n=11) Single 76.2% (n=16) 71.43% (n=15) All enrollees 80.0% (n=28) 73.5% (n=25) 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 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 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. 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 Exclusion Criteria Selected obstetric complications which present prior Exclusion Criteria to 34 weeks: – Polyhydraminios Age <18 or >34 – Oligohydramnios Multiple gestation – Pre-eclampsia Unable to read/write English – Congenital viral disease – Maternal surgical conditions History of back surgery – Suspected fetal abnormality Considered to have high-risk pregnancy by – Isoimmunization with antibody titers greater than 1:8 health care provider. Examples include: – Antiphospholipid syndrome – DES exposure History of one or more of the following: – IDDM Class A2 and B – Prior neonatal death\ – Two or more previous preterm deliveries <34 weeks Selected chronic medical conditions with a known – A single preterm delivery <30 weeks increase in perinatal morality: – Birth of a neonate with serious complications resulting in a – Cardiovascular disease with functional impairment handicapping condition – Respiratory failure requiring mechanical ventilation – Recurrent spontaneous abortion or fetal demise – Acute coagulopathy – Family history of genetic disease – Intractable seizures Incompetent cervix – Coma Active chronic medical problems including: – Sepsis – Cardiovascular disease – Solid organ transplant – Autoimmune disease – Active immune disease requiring corticosteroids – Reactive airway disease requiring treatment with therapy corticosteroids – Instable reactive airway disease – Seizure disorder – Renal disease requiring dialysis or a serum creatinine – Hypertension controlled on a single medication >1/5mg% – Controlled hyperthyroidism on replacement therapy – Active hyperthyroidism – Idiopathic thrombocytopenia purpura – Severe hemoglobinopathy – Thromboembolic disease – Malignant disease Selected obstetric complications which present prior – Renal disease with functional impairment to 32 weeks – HIV – Preterm labor – PROM – Severe pre-eclampsia – Isoimmunization with need for intrauterine transfusion References 1. 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. 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. 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. 4 Kristiansson, P., Svardsudd, K., & von Schoultz, B. (1996). Bak pain during pregnancy: a prospective study. Spine, 21, 702-709. 5. 5 ACOG Committee Obstetric Practice (2002). ACOG Committee Opinion. (Rep. No. 267) 6. 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. 7. 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. 8. 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. 9. 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. 10. Clapp, J.F., III (1990). The course of labor after endurance exercise during pregnancy. American Journal of Obstetrics and Gynecology., 163, t-805. 11. 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. 12. Peterson, A. M., et al. (2005). Exercise in pregnancy. Medicine & Science in Sports & Exercise, 37, 1748-53.
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