Back pain and post natal physical activity
There is moderate quality evidence to suggest effectiveness of exercise for relieving lumbopelvic pain in post-natal women. A recent evidence review of systematic reviews and meta-analysis of exercise for the prevention and treatment of low back pain, pelvic girdle and lumbopelvic pain during and in the post partum period found that being physically active during pregnancy did not reduce the odds of developing low back, pelvic or lumbopelvic pain either during pregnancy (OR 0.78, 95% CI 0.6, 1.02, I2 = 22%) or in the post partum period1. Physical activity performed in various formats during pregnancy was found to decrease the severity of low back, pelvic and lumbopelvic pain during pregnancy and the early post partum period1,2.
Quality of evidence
Grade B-there is evidence from RCTs for prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy and post partum1–4. However, these RCTs consist of very low to moderate quality evidence to suggest that a variety of types of prenatal exercise (e.g. aerobic exercise, yoga, specific strengthening exercise, general strengthening exercise or a combination of different types of exercise) did not reduce the odds of low back pain, pelvic girdle pain or lumbopelvic pain during pregnancy or post natal period1,4. However, there was very low to moderate quality evidence showing that prenatal exercise was an effective treatment to decrease the severity of low back pain, pelvic girdle pain and lumbopelvic pain during pregnancy and low to moderate quality evidence indicating that exercise during pregnancy decreased the severity of low back pain in the post partum period.
Strength of recommendation
Grade 2B-limited number of studies looking at subset populations.
Approximately 50% of women experience low back pain or pelvic girdle pain during pregnancy. Of these 25% continue to experience pain 1 year post delivery. Pelvic girdle pain is associated with a decrease in regular physical activity during pregnancy. Exercise should be recommended for pregnancy women, with a focus on activities on activities of daily living and avoidance of maladaptive movement patterns5 and further studies indicate that exercise may reduce pregnancy related low back pain4. Very recent systematic review and meta-analysis has found being physically active during pregnancy did not reduce the odds of developing low back, pelvic or lumbopelvic pain either during pregnancy or postpartum period. However, physical activity performed in various formats during pregnancy and following delivery1 does decrease the severity of low back, pelvic and lumbopelvic pain during the pregnancy and early post partum period1.
Trials used varying exercise programmes with differing durations. It is unclear which type of exercise programme and/or duration is optimum. However, it seems reasonable that thoroughly instructed regularly supervised high quality exercises designed to involve all relevant muscles of the pelvic girdle would be sensible and should result in high compliance rates and feasibility. Further robust randomised controls trials are needed in this field and with clearly disclosed definitions of classification of low back, pelvic girdle and lumbopelvic pain to further reliability of studies.
- Davenport MH, Marchand AA, Mottola MF, Poitras VJ, Gray CE, Jaramillo Garcia A, et al. Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: A systematic review and meta-analysis. Br J Sports Med. 2019;53(2):90–8.
- Tseng PC,PuthusseryS, Pappas Y, Gau ML. A systematic review of randomised controlled trials on the effectiveness of exercise programs on lumbo pelvic pain among postnatal women. BMC Pregnancy Childbirth [Internet]. 2015;15(1). Available from: http://dx.doi.org/10.1186/s12884-015-0736-4
- Mogren IM. Physical activity and persistent low back pain and pelvic painpost partum. BMC Public Health.2008;8:1–5.
- Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database Syst Rev [Internet]. 2015 Sep 30 [cited 2019 Apr23];(9):CD001139. Available from:http://www.ncbi.nlm.nih.gov/pubmed/26422811
- VleemingA, Albert HB, Östgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J [Internet]. 2008 Jun 8 [cited 2019 Apr 23];17(6):794–819. Available from: http://link.springer.com/10.1007/s00586-008-0602-4