The Relationship between Exercise and Back Pain During Pregnancy

1
The Relationship between Exercise and Back Pain
During Pregnancy

• Jennifer Y. McElroy, D.O.
• Sheila Dugan, M.D.

2
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

3
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

4
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)

5
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

6
Materials and Methods

• Power analysis performed 66 patients needed
• Womens Health Care Resident Clinic population
  enrolled
• Patients consented and enrolled through the
  months of November 2005 to April 2006.

7
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

8
Trimester distribution of study participants
9
Respective Focus of each Pain Questionnaire
10
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

11
Demographics and Reported Back Pain
12
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

13
Reported incidence of Walking and Strenuous
Exercise
14
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

15
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

16
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.

17
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

18
Exclusion Criteria

• Exclusion Criteria
• Age lt18 or gt34
• 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 lt34 weeks
• A single preterm delivery lt30 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

• 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
  18
• 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

19
References

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