Gebelikle İlişkili Lumbopelvik Ağrı ve Güncel Fizyoterapi Yöntemleri: Geleneksel Derleme

Öz

Gebelikle ilişkili lumbopelvik ağrı, gebelik döneminde yaşanan bel ve pelvik kuşak ağrısının birlikte tanımlanması için kullanılan bir terimdir. Gebelikle ilişkili lumbopelvik ağrının insidansı %86’dır ve gebelikte yaygın görülen şikâyetlerden biridir. Lumbopelvik ağrı genellikle gebeliğin 24 ile 36. haftaları arasında en yüksek seviyeye ulaşmaktadır. Gebelikle ilişkili lumbopelvik ağrıya, relaksin hormonunun, gebelikte alınan kilonun neden olabileceği düşünülmektedir. Beden Kütle İndeksinin fazla olması, gebelikte depresyon, bel ağrısı öyküsünün bulunması ve gebelik sırasında ağır iş yükü öyküsü lumbopelvik ağrının gelişimi için bilinen risk faktörleridir. Lumbopelvik ağrı, gebelerin günlük aktivitelerini, yaşam kalitelerini ve cinsel yaşamını olumsuz etkilemektedir. Tedavi edilmediği takdirde ise kronik hale gelmektedir. Bu derlemenin amacı, gebeliğe bağlı lumbopelvik ağrının tedavisinde uygulanan güncel fizyoterapi yöntemlerini gözden geçirmek, etkinliklerini incelemek ve etkinlikleri hakkında bilgi vermektir. Gebelikle ilişkili lumbopelvik ağrının farklı birçok tedavi yönteminin olmasının yanı sıra fetüse ve kadına zarar vermemesi/komplikasyonu bulunmaması nedeniyle günümüzde fizyoterapi yöntemlerinin önemi artmaktadır. Su içi aerobik egzersiz, pelvik tilt, diz çekme, kegel egzersizi, squat, adduktör germe, pelvik elevasyon, pelvik rotasyon ve bacak kaldırma gibi germe ve güçlendirme egzersizleri, yoga, sakroiliak eklem mobilizasyonu, Transkutanöz Elektriksel Sinir Stimülasyonu (TENS), manuel terapi, ortez ve hasta eğitiminin, gebelikle ilişkili lumbopelvik ağrı tedavisinde uygulanan güncel fizyoterapi yöntemleri arasında bulunmaktadır. Ancak bu fizyoterapi yöntemlerinden hangisinin daha etkili olduğuna dair kesin kanıt bulunmamaktadır. Bu nedenle daha fazla randomize kontrollü çalışmalara ihtiyaç duyulmaktadır.

Anahtar Kelimeler

• Gebelik
• lumbopelvik ağrı
• fizyoterapi

Pregnancy-Related Lumbopelvic Pain and Current Physiotherapy Methods

Öz

Pregnancy-related lumbopelvic pain is a term used to describe low back and pelvic girdle pain experienced during pregnancy. The incidence of pregnancy-associated lumbopelvic pain is 86% and is a common complaint during pregnancy. Lumbopelvic pain usually peaks between 24 and 36 weeks of gestation. It is thought that pregnancy-related lumbopelvic pain may be caused by relaxin hormone and weight gain during pregnancy. A high body mass index, depression during pregnancy, a history of low back pain and a history of heavy workload during pregnancy are known risk factors for the development of lumbopelvic pain. Lumbopelvic pain negatively affects the daily activities, quality of life and sexual life of pregnant women. If left untreated, it becomes chronic. The aim of this review is to review the current physiotherapy methods applied in the treatment of pregnancy-related lumbopelvic pain, to examine their effectiveness and to provide information about their effectiveness. The importance of physiotherapy methods is increasing today since there are many different treatment modalities for pregnancy-related lumbopelvic pain and it does not harm the fetus and the woman/there are no complications. Stretching and strengthening exercises such as in-water aerobic exercise, pelvic tilt, knee pull, kegel exercise, squats, adductor stretching, pelvic elevation, pelvic rotation and leg raises, yoga, sacroiliac joint mobilization, Transcutaneous Electrical Nerve Stimulation (TENS), manual therapy, orthotics and patient education are among the current physiotherapy methods applied in the treatment of pregnancy-related lumbopelvic pain. However, there is no conclusive evidence on which of these physiotherapy methods is more effective. Therefore, more randomized controlled trials are needed.

Anahtar Kelimeler

• Pregnancy
• lumbopelvic pain
• physiotherapy

Kaynakça

1. Wadephul F, Glover L, Jomeen J, Hanefeld N. A systematic exploration of a perinatal wellbeing framework through women's experiences of lumbo-pelvic pain. Midwifery. 2021;100:103031. doi: 10.1016/j.midw.2021.103031.
2. Vleeming A, Albert HB, Östgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal. 2008;17:794-819. doi: 10.1007/s00586-008-0602-4.
3. Wu WH, Meijer OG, Uegaki K, et al. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. European Spine Journal. 2004;13:575-589. doi: 10.1007/s00586-003-0615-y.
4. Vermani E, Mittal R, Weeks A. Pelvic girdle pain and low back pain in pregnancy: A review. Pain Practice. 2010;10(1):60-71. doi: 10.1111/j.1533-2500.2009.00327.x.
5. Mogren IM. Previous physical activity decreases the risk of low back pain and pelvic pain during pregnancy. Scandinavian Journal of Public Health. 2005;33(4):300-306. doi: 10.1177/140349480503300410.
6. Kristiansson P, Svärdsudd K, Von Schoultz B. Reproductive hormones and aminoterminal propeptide of type III procollagen in serum as early markers of pelvic pain during late pregnancy. American Journal of Obstetrics and Gynecology. 1999;180(1):128-134. doi: 10.1016/S0002-9378(99)70162-6.
7. Gutke A, Boissonnault J, Brook G, Stuge B. The severity and impact of pelvic girdle pain and low-back pain in pregnancy: A multinational study. Journal of Women's Health. 2018;27(4):510-517. doi: 10.1089/jwh.2017.6342.
8. Robinson HS, Eskild A, Heiberg E, Eberhard-Gran M. Pelvic girdle pain in pregnancy: The impact on function. Acta Obstetricia et Gynecologica Scandinavica. 2006;85(2):160-164. doi: 10.1080/00016340500410024.

9. Sönmezer E, Özköslü MA, Yosmaoğlu HB. 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. 2021;34(1):69-76. doi: 10.3233/BMR-191810.
10. Ng BK, Kipli M, Karim AKA, Shohaimi S, Ghani NAA, Lim PS. Back pain in pregnancy among office workers: risk factors and its impact on quality of life. Hormone Molecular Biology and Clinical Investigation. 2017;32(3):20170037. doi: 10.1515/hmbci-2017-0037.
11. Elden H, Gutke A, Kjellby-Wendt G, Fagevik-Olsen M, Ostgaard HC. Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study. BMC Musculoskeletal Disorders. 2016;17:1-13. doi: 10.1186/s12891-016-1154-0.
12. Bryndal A, Majchrzycki M, Grochulska A, Glowinski S, Seremak-Mrozikiewicz A. Risk factors associated with low back pain among A group of 1510 pregnant women. Journal of Personalized Medicine. 2020;10(2):51. doi: 10.3390/jpm10020051.
13. Reese ME, Casey E. Hormonal influence on the neuromusculoskeletal system in pregnancy. Musculoskeletal Health in Pregnancy and Postpartum. 2015;19-39.
14. Stuge B. Current knowledge on low back pain and pelvic girdle pain during pregnancy and after childbirth: A narrative review. Current Women's Health Reviews. 2015;11(1):68-74.
15. Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: Prevalence and risk factors. Spine. 2005;30(8):983-991. doi: 10.1097/01.brs.0000158957.42198.8e.
16. Wiezer M, Hage-Fransen MAH, Otto A, et al. Risk factors for pelvic girdle pain postpartum and pregnancy related low back pain postpartum; A systematic review and meta-analysis. Musculoskeletal Science and Practice. 2020;48:102154. doi: 10.1016/j.msksp.2020.102154.
17. Mogren IM. Does caesarean section negatively influence the post-partum prognosis of low back pain and pelvic pain during pregnancy? European Spine Journal. 2007;16:115-121. doi: 10.1007/s00586-006-0098-8.
18. Stomp-van den Berg SG, Hendriksen IJ, Bruinvels DJ, Twisk JW, Van Mechelen W, Van Poppel MN. Predictors for postpartum pelvic girdle pain in working women: The Mom@ Work cohort study. Pain. 2012;153(12):2370-2379. doi: 10.1016/j.pain.2012.08.003.
19. Bjelland EK, Stuge B, Engdahl B, Eberhard‐Gran M. The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study. BJOG: An International Journal of Obstetrics & Gynaecology. 2013;120(1):32-40. doi: 10.1111/1471-0528.12029.
20. Van Benten E, Pool J, Mens J, Pool-Goudzwaard A. Recommendations for physical therapists on the treatment of lumbopelvic pain during pregnancy: A systematic review. Journal of Orthopaedic & Sports Physical Therapy. 2014;44(7):464-A15. doi: 10.2519/jospt.2014.5098.
21. Shim MJ, Lee YS, Oh HE, Kim JS. Effects of a back-pain-reducing program during pregnancy for Korean women: A non-equivalent control-group pretest–posttest study. International Journal of Nursing Studies. 2007;44(1):19-28. doi: 10.1016/j.ijnurstu.2005.11.016.
22. George JW, Skaggs CD, Thompson PA. A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy. American Journal of Obstetrics & Gynecology. 2013;208(295):e1-7. doi: 10.1016/j.ajog.2012.10.869.
23. Kordi R, Abolhasani M, Rostami M, Hantoushzadeh S, Mansournia MA, Vasheghani-Farahani F. Comparison between the effect of lumbopelvic belt and home based pelvic stabilizing exercise on pregnant women with pelvic girdle pain; A randomized controlled trial. Journal of Back and Musculoskeletal Rehabilitation. 2013;26(2):133-139. doi: 10.3233/BMR-2012-00357.
24. Nilsson-Wikmar L, Holm K, Öijerstedt R, Harms-Ringdahl K. Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain: A randomized clinical trial with 3, 6, and 12 months follow-up postpartum. Spine. 2005;30(8):850-856. doi: 10.1097/01.brs.0000158870.68159.d9.
25. Bushman BA. Physical activity guidelines for Americans: The relationship between physical activity and health. ACSM's Health & Fitness Journal. 2019;23(3):5-9. doi: 10.1249/FIT.0000000000000472.
26. Tsakiridis I, Bakaloudi DR, Oikonomidou AC, Dagklis T, Chourdakis M. Exercise during pregnancy: A comparative review of guidelines. Journal of Perinatal Medicine. 2020;48(6):519-525. doi: 10.1515/jpm-2019-0419.
27. Pennick V, Liddle SD. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database of Systematic Reviews. 2013;8:1-82. doi:10.1002/14651858.CD001139.pub3.
28. Özdemir S, Bebis H, Ortabağ T, Açıkel C. Evaluation of the efficacy of an exercise program for pregnant women with low back and pelvic pain: A prospective randomized controlled trial. Journal of Advanced Nursing. 2015;71(8):1926-1939. doi: 10.1111/jan.12659.
29. Granath AB, Hellgren MS, Gunnarsson RK. Water aerobics reduces sick leave due to low back pain during pregnancy. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2006;35(4):465-471. doi: 10.1111/j.1552-6909.2006.00066.x.
30. Mirmolaei ST, Ansari NN, Mahmoudi M, Ranjbar F. Efficacy of a physical training program on pregnancy related lumbopelvic pain. International Journal of Women's Health and Reproduction Sciences. 2018;6(2):161-166. doi: 10.15296/ijwhr.2018.27.
31. Mohamed ASA, Khedr NFH, Elsherbiny EAF. Effect of practicing sitting pelvic tilt exercise on the intensity of pregnancy-related lumbopelvic pain. International Journal of Nursing. 2020;7:121-128. doi: 10.15640/ijn.v7n2a14.
32. Daneau C, Marchand AA, Bussières A, O'Shaughnessy J, Ruchat SM, Descarreaux M. Effects of a motor control exercise program on lumbopelvic pain recurrences and intensity in pregnant women with a history of lumbopelvic pain: A study protocol for a randomized controlled feasibility trial. Pilot and Feasibility Studies. 2022;8(1):1-9. doi: 10.1186/s40814-022-01024-0.
33. Akmeşe ZB, Oran NT. Effects of progressive muscle relaxation exercises accompanied by music on low back pain and quality of life during pregnancy. Journal of Midwifery & Women's Health. 2014;59(5):503-509. doi: 10.1111/jmwh.12176.
34. Holden SC, Manor B, Zhou J, Zera C, Davis RB, Yeh GY. Prenatal yoga for back pain, balance, and maternal wellness: a randomized, controlled pilot study. Global Advances in Health and Medicine. 2019;8:2164956119870984. doi: 10.1177/2164956119870984.
35. Babbar S, Shyken J. Yoga in pregnancy. Clinical Obstetrics and Gynecology. 2016;59(3):600-612. doi: 10.1097/GRF.0000000000000210.
36. Bhoir KV, Honkalas P, Golhar S. Comparative effect of yoga therapy and conventional therapy on pain, functional disability and quality of life in post natal females with lumbopelvic pain: Randomized clinical trial. International Journal of Physical Education, Sports and Health. 2022;9(3):115-120.
37. Martins RF, e Silva JLP. Treatment of pregnancy-related lumbar and pelvic girdle pain by the yoga method: A randomized controlled study. Journal of the Australian-Traditional Medicine Society. 2016;22(4):238. doi: 10.1089/acm.2012.0715.
38. Sukamti S, Aticeh A, Sari GN. Exercise for pain relief in yoga is effective in reducing pelvic girdle pain during the third trimester of pregnancy. Women, Midwives and Midwifery. 2022;2(1):58-64. doi: 10.36749/wmm.2.1.58-64.2022.
39. Johnson MI, Bjordal JM. Transcutaneous electrical nerve stimulation for the management of painful conditions: focus on neuropathic pain. Expert Review of Neurotherapeutics. 2011;11(5):735-753. doi: 10.1586/ern.11.48.
40. Vaidya SM. Sacroiliac joint mobilisation versus transcutaneous electrical nerve stimulation for pregnancy induced posterior pelvic pain-a randomised clinical trial. Journal of Clinical & Diagnostic Research. 2018;12(1):4-7. doi: 10.7860/JCDR/2018/26696.10781.
41. Keskin EA, Onur O, Keskin HL, Gümüş II, Kafalı H, Turhan N. Transcutaneous electrical nerve stimulation improves low back pain during pregnancy. Gynecologic and Obstetric Investigation. 2012;74(1):76-83. doi: 10.1159/000337720.
42. Ekdahl AS, Olsén MF, Jendman T, Gutke A. Maintenance of physical activity level, functioning and health after non-pharmacological treatment of pelvic girdle pain with either transcutaneous electrical nerve stimulation or acupuncture: A randomised controlled trial. BMJ Open. 2021;11(10): e046314. doi: 10.1136/bmjopen-2020-046314.
43. Galfat D, Mishra A. Management of low back pain in pregnancy with transcutaneous electrical nerve stimulation: A prospective study. Obstet Gynecol. 2019;7(4):645-648.
44. Wahyuni S, Hartati L, Dewi NP, Sari J. Comparison transcutaneous electrical nerve stimulation kinesio taping and decreasing to scale back pain in pregnant women under third trimester in public health district Juwiring Klaten, Indonesia. Proceedings of the International Conference on Applied Science and Health. 2017;1:204-209.
45. Al-Sayegh NA, George SE, Boninger ML, Rogers JC, Whitney SL, Delitto A. Spinal mobilization of postpartum low back and pelvic girdle pain: an evidence-based clinical rule for predicting responders and nonresponders. Physical Medicine and Rehabilitation. 2010;2(11):995-1005. doi: 10.1016/j.pmrj.2010.07.481.
46. Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: A randomized controlled trial. American Journal of Obstetrics and Gynecology. 2010;202(1):43-e1. doi: 10.1016/j.ajog.2009.07.057.
47. Peterson CD, Haas M, Gregory WT. A pilot randomized controlled trial comparing the efficacy of exercise, spinal manipulation, and neuro emotional technique for the treatment of pregnancy-related low back pain. Chiropractic & Manual Therapies. 2012;20:1-13. doi: 10.1186/2045-709X-20-18.
48. Elden H, Östgaard HC, Glantz A, Marciniak P, Linnér AC, Olsén MF. Effects of craniosacral therapy as adjunct to standard treatment for pelvic girdle pain in pregnant women: A multicenter, single blind, randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica. 2013;92(7):775-782. doi: 10.1111/aogs.12096.
49. Kalus S, Kornman L, Quinlivan JA. Managing back pain in pregnancy using a support garment: A randomised trial. BJOG: An International Journal of Obstetrics & Gynaecology. 2008;115(1):68-75. doi: 10.1111/j.1471-0528.2007.01538.x.
50. Bertuit J, Van Lint CE, Rooze M, Feipel V. Pregnancy and pelvic girdle pain: Analysis of pelvic belt on pain. Journal of Clinical Nursing. 2018;27(1-2):e129-e137. doi: 10.1111/jocn.13888.