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Effects of lumbar stabilization and muscular stretching on pain, disabilities, postural control and muscle activation in pregnant woman with low back pain: a pilot randomized trial [with consumer summary]
Fontana Carvalho AP, Dufresne SS, Rogerio de Oliveira M, Furlanetto KC, Dubois M, Dallaire M, Ngomo S, da Silva RA Jr
European Journal of Physical and Rehabilitation Medicine 2020 Jun;56(3):297-306
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Low back pain is common during pregnancy. Lumbar stabilization and stretching exercises are recommended to treat low back pain in the general population. However, few studies have applied the effects of these two interventions in pregnant women with low back pain. OBJECTIVES: To compare the effects of lumbar stabilization and stretching exercises for the treatment of gestational low back pain. DESIGN: A pilot randomized clinical trial. SETTING: Laboratory of Functional Evaluation and Human Motor Performance and physical therapy clinics. PARTICIPANTS: Initially, 30 pregnant women with low back pain were recruited, of which 24 met the following inclusion criteria: being between 19 to 29 weeks of gestation; being in prenatal clinical follow-up; having nonspecific mechanical low back pain started in pregnancy; not participating in specific low back pain treatment in the last 3 months. A total of 20 women completed the study (10 each group). METHODS: The main outcome measures were clinical (pain by visual analogue scale (VAS) and McGill Pain Questionnaire and disability by Roland Morris Questionnaire), and secondary outcome measures were: postural balance (force platform); muscle activation level of multifidus, iliocostalis lumborum, rectus abdominis and external abdominal oblique (electromyography). The women were randomized into 2 groups for 6 weeks of intervention 2 x week for a 50-minute treatment: (1) lumbar stabilization exercise protocol and (2) stretching exercise protocol. RESULTS: There was a significant reduction (p = 0.03) in pain (1.68 in VAS and 4.81 for McGill questionnaire) for both interventions, but no change in disability score. In addition, both interventions were comparable for a significant improvement in postural stability (in mean d = 0.77) for the velocity sway parameter, and significantly increased activation (p > 0.05) of the external abdominal oblique muscle after intervention. CONCLUSIONS: Both modalities (lumbar stabilization and stretching were efficient for pain reduction, improving balance and increasing one trunk activity muscle after 6 weeks of intervention in pregnant women with low back pain.

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