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Diagonal Trunk Muscle Exercises in Peripartum Pelvic Pain: A Randomized Clinical Trial

JMA Mens, MD, is Researcher, Department of Rehabilitation Medicine, Faculty of Medicine, Erasmus University, Rotterdam, the Netherlands, and Head, Department of Spine Rehabilitation, Spine and Joint Centre, Westerlaan 10, 3016 CK, Rotterdam, the Netherlands (sjceco{at}wxs.nl). Address all correspondence to Dr Mens at the second address
CJ Snijders, PhD, is Professor of Medical Technology and Head, Department of Biomedical Physics and Technology, Faculty of Medicine and Allied Health Sciences, Erasmus University
HJ Stam, MD, PhD, is Professor of Medical Rehabilitation and Head, Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, University Hospital Rotterdam, Erasmus University

Background and Purpose. Exercises for low back and pelvic pain are supposed to increase muscle force to reduce symptoms, but they could exacerbate symptoms by loading of the spinal and pelvic structures. The purpose of this study was to investigate the value of graded exercises of the diagonal trunk muscle systems. Subjects. The subjects were 44 women with persistent pelvic pain after pregnancy (mean age=31.7 years, SD=3.2, range=23.6–37.5; mean period postpartum=4.1 months, SD=2.2, range=1.7–5.6). Methods. Subjects were randomly assigned to 1 of 3 groups: (1) a group that performed exercises to increase the force of the diagonal trunk muscle systems, (2) a group that received training of the longitudinal trunk muscle systems, and (3) a group that was instructed to refrain from exercises. Pain, fatigue, perceived general health, and mobility of the pelvic joints as measured with radiographs were the outcome measures. Results. After 8 weeks, no differences were found among the 3 groups. Conclusion and Discussion. In treating patients with persistent pelvic pain, training of the diagonal trunk muscle systems, without individual coaching, has no additional value above instructions and use of a pelvic belt without exercises. Whether the treatment is ineffective or whether exacerbation of symptoms due to loading of the spinal and pelvic structures obscures any potential benefit of increased muscle force cannot be determined from the study design.

Key Words: Low back pain • Physical therapy • Pregnancy • Pubic symphysis • Randomized clinical trial • Sacroiliac joint

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