Effektivität prä- und postpartal durchgeführter stabilisierender Übungen zur Reduzierung der postpartalen lumbopelvinen Schmerzintensität

Zusammenfassung

Lumbopelvine Schmerzen nach der Entbindung stellen ein häufiges Problem dar. Mögliche Ursachen liegen in veränderten biomechanischen Verhältnissen und einer verminderten Stabilität im lumbopelvinen Bereich.

Diese systematische Übersichtsarbeit untersuchte anhand bisheriger Studien die Effektivität stabilisierender Übungen zur Reduktion lumbopelviner Schmerzen nach der Schwangerschaft. Die eingeschlossenen Arbeiten zeigten nur eine schwache Evidenz.

Abstract

Lumbopelvic pain following childbirth is a common problem. Changes in biomechanical conditions and a decreased stability of the lumbopelvic area are possible causes.

This systematic review examined existing studies to assess the effectiveness of stabilising exercises for the reduction of lumbopelvic pain after pregnancy. The included articles demonstrated only poor evidence.

Schlüsselwörter

lumbopelvine Schmerzen - stabilisierende Übungen - postpartal - Behinderung

Keywords

lumbopelvic pain - stabilising exercises - postpartal - disability

• Literatur

• 1 Albert H, Godskesen M, Westergaard J. Prognosis in four syndromes of pregnancy related pelvic pain. Acta Obstetricia et Gynecologica Scandinavica 2001; 80: 505-510
• 2 Ammar TA, Mitchell K, Saleh A. Stabilization exercises in postnatal low back pain. Indian Journal of Physiotherapy and Occupational Therapy 2011; 5: 122-124
• 3 Bastiaenen CHG, de Bie RA, Wolters PM et al. Effectiveness of a tailor-made intervention for pregnancy-related pelvic girdle and/or low back pain after delivery: short-term results of a randomized clinical trial. BMC Musculoskeletal Disorders 2006; 7: 19
• 4 Bastiaenen CHG, de Bie RA, Vlaeyen JWS et al. Long-term effectiveness and costs of a brief self-management intervention in women with pregnancy-related low back pain after delivery. BMC Pregnancy Childbirth 2008; 8: 19
• 5 Bergström C, Persson M, Mogren I. Pregnancy-related low back pain and pelvic girdle pain approximately 14 months after pregnancy – pain status, self-rated health and family situation. BMC Pregnancy Childbirth 2014; 14: 48
• 6 Betten C. Zusammenhang zwischen Beckengürtelschmerzen und Beckenmuskulatur. manuelletherapie 2009; 13: 100-108
• 7 Beurskens AJ, de Vet HC, van der Heijten GJ et al. Measuring the functional status of patients with low back pain. Spine 1995; 20: 1017-1028
• 8 De Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Australian Journal of Physiotherapy 2009; 55: 129-133
• 9 Depledge J, McNair PJ, Keal-Smith C et al. Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts. Physical Therapy 2005; 85: 1290-1300
• 10 Elden H, Ostgaard HC, Fagevik-Olsen M et al. Treatments of pelvic girdle pain in pregnant women: Adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate. BMC Complementary and Alternative Medicine 2008; 8: 34
• 11 Fairbank JCT, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25: 2940-2953
• 12 Ferreira CWS, Alburquerque-Sendín F. Effectiveness of physical therapy for pregnancy-related low back and/or pelvic pain after delivery: A systematic review. Physiotherapy Theory and Practice 2013; 29: 419-431
• 13 George JW, Skaggs CD, Thompson PA et al. A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy. American Journal of Obstetrics and Gynecology 2013; 208: 295-295
• 14 Grotle M, Garratt AM, Krogstad JenssenH et al. Reliability and construct validity of self-report questionnaires for patients with pelvic girdle pain. Physical Therapy 2012; 92: 111-123
• 15 Gutke A, Sjodahl J, Oberg B. Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial. Journal of Rehabilitation Medicine 2010; 42: 929-935
• 16 Haugland KS, Rasmussen S, Daltveit AK. Group intervention for women with pelvic girdle pain in pregnancy. A randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica 2006; 85: 1320-1326
• 17 Von Korff M, Jensen MP, Karoly P. Assessing global pain severity by self-report in clinical and health services research. Spine 2000; 25: 3140-3151
• 18 Kovacs FM, Garcia E, Royuela A et al. Prevalence and Factors Associated with Low Back. Spine 2012; 37: 1516-1533
• 19 Maher CG, Sherrington C, Herbert RD et al. Reliability of the PEDro Scale for rating quality of randomized controlled trials. Physical Therapy 2003; 83: 713-721
• 20 Malmqvist S, Kjaermann I, Andersen K et al. Prevalence of low back and pelvic pain during pregnancy in a Norwegian population. Journal of Manipulative and Physiological Therapeutics 2012; 35: 272-278
• 21 Mens JMA, Snijders CJ, Stam HJ. Diagonal trunk muscle exercises in peripartum pelvic pain: A randomized clinical trial. Physical Therapy 2000; 80: 1164-1173
• 22 Moher D, Cook DJ, Jadad AR et al. Assessing the quality of reports of randomised trials: implications for the conduct of meta-analyses. Health Technology Assessment 1999; 3: 1-98
• 23 Mørkved S, Åsmund SK, Schei B et al. Does group training during pregnancy prevent lumbopelvic pain? A randomized clinical trial. Acta Obstetricia et Gynecologica Scandinavica 2007; 86: 276-282
• 24 Nilsson-Wikmar L, Pilo C, Pahlbäck M et al. Perceived pain and self-estimated activity limitations in women with back pain post-partum. Physiotherapy Research International 2003; 8: 23-35
• 25 Nilsson-Wikmar L, Holm K, Oijerstedt R et al. 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: 850-856
• 26 Norén L, Östgaard S, Johansson G et al. Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. European Spine Journal 2002; 11: 267-271
• 27 Östgaard HC, Zetherstrom G, Roos-Hansson E et al. Reduction of back and posterior pelvic pain in pregnancy. Spine 1994; 19: 894-900
• 28 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. Chiropractice and Manual Therapies 2012; 20: 18
• 29 Van de Pol G, de Leeuw JRJ, van Brummen HJ et al. The pregnancy mobility index: a mobility scale during and after pregnancy. Acta Obstetricia et Gynecologica Scandinavica 2006; 85: 786-791
• 30 Richardson CA, Snijders CJ, Hides JA et al. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine 2002; 27: 399-405
• 31 Ritchie JR. Orthopedic considerations during pregnancy. Clinical Obstetrics and Gynecology 2003; 46: 456-466
• 32 Röhrig B, du Prel JB, Wachtlin D et al. Fallzahlplanung in klinischen Studien. Deutsches Ärzteblatt International 2010; 107: 552-558
• 33 Rolland M, Morris R. A study of the natural history back pain. Part I: Development of a reliable and sensitive measure of disability in low back pain. Spine 1983; 8: 141-144
• 34 Salén BA, Spangfort EV, Nygren ÅL et al. The disability rating index: an instrument for the assessment of disability in clinical settings. Journal of Clinical Epidemiology 1994; 47: 1423-1434
• 35 Schomacher J. Gütekriterien der visuellen Analogskala zur Schmerzbewertung. physioscience 2008; 4: 125-133
• 36 Smeets R, Köke A, Lin CW et al. Measures of function in low back pain/disorders: Low Back Pain Rating Scale (LBPRS), Oswestry Disability Index (ODI), Progressive Isoinertial Lifting Evaluation (PILE), Quebec Back Pain Disability Scale (QBPDS), and Roland-Morris Disability Questionnaire (RDQ). Arthritis Care Res (Hoboken) 2011; 63: 158-173
• 37 Snijders CJ, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs. Clinical Biomechanics 1993; 8: 285-301
• 38 Stuge B, Laerum E, Kirkesola G et al. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: A randomized controlled trial. Spine 2004; 29: 351-359
• 39 Stuge B, Veierod MB, Laerum E et al. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a two-year follow-up of a randomized clinical trial. Spine 2004; 29: E197-E203
• 40 Theermann C, Schumacher S, van der Wurff P. Effektivität stabilisierender Übungen bei schwangerschaftsassoziierten lumboiliosakralen Schmerzen. manuelletherapie 2007; 11: 136-141
• 41 Vleeming A, Albert HB, Östgaard HC et al. European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal 2008; 17: 794-819
• 42 Wedenberg K, Moen B, Norling A. A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy. Acta Obstetricia et Gynecologica Scandinavica 2000; 79: 331-335
• 43 Whitcome KK, Shapiro LJ, Lieberman DE. Fetal load and the evolution of lumbar lordosis in bipedal hominins. Nature 2007; 450: 1075-1083
• 44 Wilke HJ, Wolf S, Claes LE et al. Stability increase of the lumbar spine with different muscle groups. Spine 1995; 20: 192-198
• 45 Windeler J, Antes G, Behrens J et al. Kritische Evaluation ist ein Wesensmerkmal ärztlichen Handelns. Deutsches Ärzteblatt 2008; 105: A565-A571
• 46 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