Low Back Pain Intensity and Core Muscle Strength After Different Delivery Modes

Study Overview
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Brief Summary
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Cesarean delivery (CD) may trigger an increase in low back pain (LBP) intensity and induce core muscle weakness. This study will assess the correlation between low back pain intensity and core muscle strength of transverse abdominis and Lumbar multifidus among women who underwent CD and compare it with those without previous pregnancy.

Detailed Description
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Cesarean delivery (CD) is one of the most common surgical procedures in obstetrics, and it is also one of the oldest medical procedures. The rise in the rate of cesarean sections is one of the most striking hallmarks of modern obstetrics. In Egypt, the prevalence of CD has increased dramatically over the last decade, with the most recent Egypt Demographic and Health Survey (EDHS) reporting a rate of 52 percent, implying that cesarean sections may be overused or utilized for improper reasons. The two deep local core muscles are the transversus abdominis and the lumbar multifidus muscles. The definition of Core muscle strength is the active ability of these muscles to not only produce but also, maintain stresses to provide stability for the spine through management of the intra-abdominal pressure. LBP prevalence in mothers undergoing cesarean delivery was higher compared to its counterpart in mothers undergoing vaginal delivery. The related mechanisms for LBP during the postpartum period following cesarean or vaginal deliveries may be overweight and obesity, postural adaptations, and stressful positions that mothers assume during either delivery or lactation.

Official Title
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Testing the Association Between Low Back Pain Intensity and Core Muscle Strength in Women Who Underwent Cesarean or Vaginal Deliveries

Conditions
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Low Back Pain and Core Muscle

Intervention / Treatment
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* Other: Visual analogue scale (VAS)
* Device: Pressure Biofeedback Unit (PBU)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All women are either primiparous or multiparous. Their ages ranged from 18 to 35 years. All participants had a body mass index (BMI) of not more than 30, and a waist-to-hip ratio of not more than 1. Participants were assessed between the 6th week to the 12th week postnatal. All participants were able to continue all assessment procedures. They were medically stable. Exclusion Criteria: Women with urinary tract infections. Women who were below 18 years old or above 35 years old. Women who had a (BMI) above 30 or a waist-to-hip ratio above 1. Women who did not continue all assessment procedures. Women who had a past history of specific LBP as those who were diagnosed with spondylolisthesis, lumbar disc prolapse, or structural scoliosis.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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Female

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group A<br>40 participants have been exposed to cesarean delivery | Other: Visual analogue scale (VAS)<br>* VAS is a reliable and valid method for assessing the intensity of low back pain (LBP)<br>Device: Pressure Biofeedback Unit (PBU)<br>* PBU is a valid and reliable instrument for measuring the maximal voluntary isometric contraction of both lumbar multifidus and transversus abdominis muscles (core muscle strength)<br>|
| Group B<br>15 participants have been exposed to vaginal delivery | Other: Visual analogue scale (VAS)<br>* VAS is a reliable and valid method for assessing the intensity of low back pain (LBP)<br>Device: Pressure Biofeedback Unit (PBU)<br>* PBU is a valid and reliable instrument for measuring the maximal voluntary isometric contraction of both lumbar multifidus and transversus abdominis muscles (core muscle strength)<br>|
| Group C<br>40 participants who were in the control negative group (no previous pregnancy), | Other: Visual analogue scale (VAS)<br>* VAS is a reliable and valid method for assessing the intensity of low back pain (LBP)<br>Device: Pressure Biofeedback Unit (PBU)<br>* PBU is a valid and reliable instrument for measuring the maximal voluntary isometric contraction of both lumbar multifidus and transversus abdominis muscles (core muscle strength)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The intensity of LBP | The intensity of low back pain is a standardized method to quantify the severity of low back pain | Assessment will be done 6-12 weeks after Cesarean OR Vaginal deliveries | 
| The maximal voluntary isometric contraction of the transversus abdominis muscle | The maximum voluntary isometric contraction (MVIC) is an objective standardized method with high reliability used to evaluate and quantify muscle strength | Assessment will be done 6-12 weeks after Cesarean or Vaginal Deliveries | 
| The maximal voluntary isometric contraction of the lumbar multifidus muscle | The maximum voluntary isometric contraction (MVIC) is an objective standardized method with high reliability used to evaluate and quantify muscle strength | Assessment will be done 6-12 weeks after Cesarean or Vaginal Deliveries | 
| The correlation coefficient between low back pain intensity and core muscle strength | The correlation coefficient between two variables of outcome is a valid statistical method to the association between them | Assessment will be done 6-12 weeks after Cesarean or Vaginal Deliveries |