The effects of manual therapeutic techniques on low back pain and pelvic girdle pain in pregnancy and postpartum

Uvod: Več kot polovica žensk v različnih fazah nosečnosti izrazi bolečino v ledvenem predelu. V literaturi zasledimo izraza bolečina v križu in bolečina v medeničnem obroču. Ti dve stanji lahko jasno razlikujemo. Vztrajna bolečina v križu ali bolečina medeničnem obroču sta pogosti stanji, ki ju navajajo ženske med nosečnostjo in po porodu in imata lahko velik vpliv na kakovost življenja. Vaje za telesno pripravljenost pred nosečnostjo zmanjšajo tveganje za nastanek bolečine v križu in bolečine v medeničnem obroču med nosečnostjo in v kateri koli poznejši nosečnosti, vendar pa v mnogih primerih ne morejo preprečiti tega zapleta, zato za lajšanje bolečine in zmanjševanje funkcijske nezmožnosti fizioterapevti posegajo po različnih postopkih manualne terapije. Namen: Namen diplomskega dela je s pregledom literature predstaviti učinkovitost različnih manualnih terapevtskih postopkov pri zmanjševanju bolečine v križu in medeničnem obroču ter zmanjševanju nezmožnosti pri nosečnicah in ženskah v prvih mesecih po porodu. Metode: Iskanje literature je potekalo preko spleta v podatkovnih zbirkah PubMed, PEDro, Medline, CINAHL in Science Direct. Analizirane so bile raziskave, objavljene med leti 2008 in 2016, v angleškem jeziku, v katerih so preverjali učinkovitost različnih manualnih terapevtskih postopkov na zmanjševanje bolečine in funkcijske nezmožnosti zaradi bolečine v križu in/ali medeničnem obroču med nosečnostjo ali po porodu. Rezultati: Analiziranih je bilo devet raziskav. Šest jih je preučevalo učinke manualnih terapevtskih postopkov med nosečnostjo, tri pa po porodu. Rezultati potrjujejo, da manualni terapevtski postopki pozitivno vplivajo na zmanjšanje bolečine in stopnje nezmožnosti. Razprava in sklep: Pri analizi raziskav smo ugotovili, da so različni manualni terapevtski postopki omilil bolečino v križu/medeničnem obroču ter uspešno zmanjšali oziroma preprečili napredovanje stopnje nezmožnosti. Raziskave so se med seboj razlikovale po vrsti postopkov, velikosti vzorca, kriterijih za vključitev v raziskavo ipd., zato ne moremo trditi, kateri izmed postopkov je najbolj učinkovit. Za zagotovitev učinkovitosti različnih manualnih postopkov bi bilo potrebno v prihodnosti opraviti metodološko bolj kakovostne raziskave.Introduction: More than half of women in different phases of pregnancy expresses low back pain. Researching the subject, we often come upon the terms low back pain and pelvic girdle pain. The two states are clearly distinguishable. Persistent low back pain and pelvic girdle pain are frequently reported problems by both pregnant women and women who\u27ve given birth and it can considerably affect the quality of life Body fitness exercise before pregnancy reduces risk of both low back pain and pelvic girdle pain during the first pregnancy and during any of the following pregnancies however in many cases cannot prevent the complications. Therefore, physical therapists utilize various manual therapy techniques to alleviate the pain and reduce the functional disability of patient. Purpose: The purpose of this thesis is to show the efficiency of the different manual therapy techniques in reducing back and pelvic girdle pain of pregnant women and of women in the months after birth by the means of analysis of the existing literature on the subject. Methods: Articles were sourced from the scientific databases PubMed, PEDro, Medline, CINAHL and Science Direct. Analysis included the articles published in English between 2008 and 2016 that studied the effects of manual therapy techniques on pain alleviation and redusing functional disability because of low back pain and/or pelvic girdle pain during pregnancy and after birth. Results: Nine studies were analised. Six studied the effects of manual therapy techniques during the pregnancy and three studied the effects of manual therapy techniques after birth. The findings confirm that manual therapy techniques have a positive effect on pain alleviation and reducing functional disability. Discussion and conclusion: Our analysis led to the conclusion that various manual therapy techniques help in alleviating low back pain and pelvic girdle pain and succeed in stopping the progression of functional disability. However, we cannot definitively state which of the techniques is the most effective in achieving the positive outcome as the studies we analysed used different admission cirteria, different methodology and different sample sizes among others. To definitively state the efficiency of different methods, a high-quality controlled randomized study is required