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 • Women’s 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 Age <18 or >34 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 <34 weeks A single preterm delivery <30 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 Seizure disorder Hypertension controlled on a single medication Controlled hyperthyroidism on replacement therapy Idiopathic thrombocytopenia purpura Thromboembolic disease Malignant disease Renal disease with functional impairment HIV 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 1:8 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 Active immune disease requiring corticosteroids therapy Instable reactive airway disease Renal disease requiring dialysis or a serum creatinine >1/5mg% Active hyperthyroidism Severe hemoglobinopathy Selected obstetric complications which present prior to 32 weeks Preterm labor PROM Severe pre-eclampsia Isoimmunization with need for intrauterine transfusion Exclusion Criteria

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