Super abdomen: Combination intervention for preventing and treating pregnancy related lumbopelvic pain Wan-Chun Fang May 7, 2008

Background significance -1 Low back pain (LBP) is one of the most common musculoskeletal complaints of pregnant women. 50–90% prevalence Hippocrates theorized that an irreversible relaxation and widening of the pelvis occurs with the first pregnancy.

Background significance % women still feel pain postpartum Caucasian women have higher incidence Psychological effect The cost for sick leave in Sweden was more than $2.5 billion in one year National medical care expenditure survey  $ 13 billion

Lumbopelvic pain (LPP) Between 5th and 7th months of pregnancy Catching feeling when walking, paralyzed when perform leg rising. Reaction time, coordination, and postural control

pain Difficult walking getting up from the floor(97%) Sexual intercourse(82%). problem during sleep at night (30%) houseworkexerciseemployment activities with the children Hansen et al Maclennan et al. 1997

Possible mechanism Posture change  Increase lumbar lordosis Endocrine change  Relaxin Body water content Pelvic joint relaxation

Specific aims To examine the effectiveness To assess the change in participant’s knowledge, behavior and clinical diagnostic factors To evaluated the maintenance effect To determine participant opinion of acceptability and benefits

Preliminary studies -1 Stabilization exercise: "core," or center of the body, which consists of the deep abdominal muscles along with the muscles closest to the spine. Provide lumbar vertebral control Increase lumbar stability Improved global muscle group to provide fine co-contraction movements Precise neural control

Preliminary studies -2 Pelvic belt Most common suggestion for LPP Instant effect Low-cost and accessible

Methodology -1 Study design During pregnancy and one-year postpartum, prospective, randomized control, two-group design with repeated measurements Target population Previous low back pain Receiving epidural anesthesia during previous labor Overweight Strenuous work Too young or too old for pregnancy.

Methodology -2 Sample selection and recruitment

Methodology -3 Intervention Examination Once two month during pregnancy 1st, 3rd, 6th,12th month postpartum Combination group: Fill in questionnaire Fitted with a pelvic belt Booklet include basic management and instruction of stabilization exercise Control group: Fill in questionnaire Booklet include basic management and instruction of stabilization exercise

Outcome measure Questionnaires: pain in pregnancy profile (PIP), visual analog pain scale (VAS) Disability rating index Pain provocation test Pain assessment

Future study Small sample size Emphasize on treatment specific for lumbar pain and pelvic pain Longitudinal follow-up research

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