INTRODUCTION:

The most common problem among pregnant women during 2^nd and 3^rd trimester of pregnancy is low back pain.¹ Several ancient personalities including Hippocrates, Versalis and many others had described low back pain during pregnancy. The prevalence of pregnancy related low back pain from 25% to 90%.²

During the time of pregnancy, the female body undergoes many hormonal and anatomic changes which have a great impact on the musculoskeletal system.

The growing uterus needs to accommodate during pregnancy as a result of this the abdominal muscles stretches in width and length.⁴ The two sides of the rectus abdominis, obliques, and transversus abdominis expand and, in some cases, may separate by 3-6 inches. It creates lumbar lordosis which causes a shortening of the spinal extensors, lengthening of the abdominals and hip flexors. Studies have revealed that during pregnancy the abdominal muscles become insufficient.⁶

NEED FOR THE STUDY:

Maternal wellbeing and antenatal mothers’ fitness had been improved due to exercises. But very few studies have evaluated the efficiency of exercises during pregnancy on increasing the core abdominal muscle strength. Local core muscle consists of transverse abdominis, multifidus, pelvic floor muscles and diaphragm. Several studies have shown that at least 50% of women experience some kind of back pain during some period of pregnancy. The aetiology and pathogenesis of back pain related to pregnancy is unclear. Most hypotheses have been focused on changed load resulting from increased weight and decreased stability of the pelvic girdle due to hormonal changes.⁷

Nurses must be aware of interventions that are safe and effective to minimize the back pain during pregnancy. Most of the women report their concern such as low back pain to healthcare providers but unfortunately their pain has not been managed well. Pregnancy related low back pain is common among Indian women. The high prevalence of lumbo- pelvic pain during pregnancy in Indian women requires more attention by researchers and nursing professionals Therefore, this study was accomplished to determine the effect of a stretching exercises on pregnancy- related back pain.⁸

OBJECTIVES:

1. To assess the level of back pain among antenatal mothers before stretching exercises.

2. To evaluate the level of back pain among antenatal mothers after stretching exercises.

3. To determine the effectiveness of stretching exercises on level of back pain among antenatal mothers.

4. To determine the association between level of back pain among antenatal mothers with their selected socio demographic variables.

CONCEPTUAL FRAMEWORK:

The conceptual framework used for the present study is based on Modified Larson et.al Theory of Symptom Management.⁹

Research Methodology:

The current study used quantitative research approach and the research design was quasi-experimental design (non-equivalent control group design). Study was done in the selected rural areas of Panipat such as Baroli, Babarpur, Ganjbad, and Dadlana of Panipat (Haryana). Independent variable in the study was stretching exercises and the dependent variable was back pain. Sampling technique adopted in the study was purposive sampling technique and size of the samples was 60 (experimental group = 30 and control group = 30). Tool for pain assessment was done with the help of numerical pain scale and modified oswentry low back pain questionnaire. Pilot study was taken among 6 samples in village Simla Molana to determine the feasibility of the study. Steps in administering stretching exercises to the samples were as follows.

Samples in the experimental group was asked to perform the following steps in stretching exercises at least 4 times a day for 5-10 minutes and to stop the exercise in case of excessive fatigue, shortness of breath, feeling faint, difficulty in walking, marked decrease in movement of the baby, and dizziness.

Step 1: Ask the sample to stretch the back for 3-4 seconds then to relax

Step 2: Ask sample to lay on the floor with knees up and feet flat with soles of feet. The backside, mid/upper back, shoulders, and head were touching the floor, and the women were asked to maintain a space between the floor and low back as well as neck.

Step 3: Slow inhalation was encouraged to bring it to the abdomen, then towards the back and then was asked to exhale out slowly.

Step 4: The women were asked to continue the pulling and allowed the spine and pelvis to return to their original position.

Step 5: The women were advised to do the same procedure.

The Participants were motivated to perform the exercise in the morning and mid-afternoon under the supervision of the researcher as the researcher visited the antenatal women in their home every day. However, the pregnant women were reminded through a telephonic call to perform the exercise for the remaining two times a day. Further reinforcement was done by the researchers when the antenatal mothers visited the antenatal OPD during their subsequent visits. The control group continued the routine care.

The collected data were analysed through descriptive and inferential statistics.

Data Analysis and Interpretation:

Table – I depicted the frequency and percentage distribution of samples according to socio-demographic variables in experimental and control group.

With regard to age of the subjects in experimental group majority of the subjects 40% were present in 24 – 29 and 30 – 35 years of age. Where as in control group one half of the total subjects 50% were under age 24 – 29 years. Education of the subjects in experimental group shows that majority 66.7% had no formal education. Similarly in the control group majority 19 63.3% had no formal education. Next to them were maximum numbers of subjects with primary education in both the groups. Regarding occupation of the subjects in experimental and control group majority of them 53.3% and 56.7% were doing job for dally wages. Hours of working of the subjects shows that among experimental group majority 63.3% works for 8 hours and in the control group an overwhelming majority of the subject’s 96.7% works for 8 hours in a day. Parity of the subjects in the study reveals in experimental group little above three fourth of the subjects 76.7% were primipara and others in the experimental group were multipara. In the control group majority 73.3% of the subjects were primipara.

Table – I: Frequency and Percentage Distribution of Subjects According to Socio – Demographic Variables (N = 60)

S. No

Socio Demographic Variables

Experimental Group

Control Group

Age (Years)

a. 18 – 23

b. 24 – 29

c. 30 – 35

d. > 36

16.7

3.3

Education

a. No formal

b. Primary

c. Secondary

d. Graduate

66.7

26.7

3.3

63.3

33.3

3.3

Occupation

a. Home Maker

b. Private Job

c. Government Job

d. Daily Wages

26.7

53.3

3.3

36.7

3.3

56.7

Hours of Work

a. 6 hours

b. 8 hours

c. 12 hours

23.3

63.3

13.3

3.3

96.7

Parity

a. Primi

b. Multi

76.7

23.3

73.3

26.7

Type of Family

a. Nuclear

b. Joint

c. Extended

43.3

16.7

46.7

13.3

Type of Diet

a. Vegetarian

b. Non – Vegetarian

c. Eggetarian

73.3

6.7

46.7

13.3

Back Pain Duration

a. < 1 hour

b. 1 – 2 hours

c. > 2 hours

46.7

3.3

56.7

3.3

With regard to the type of family of the subjects, in experimental group majority of the subjects 43.3% were from nuclear family, similarly in control group 46.7% of the subjects belongs to nuclear family. In the experimental group 40% of the subjects were from extended families. But in contrast to the experimental group second highest number of subjects 40% were from joint family. Type of diet reveals that 73.3% from experimental group and 40% of the subjects from the control group were following vegetarian diets. Those who were non-vegetarian type of diet in experimental and control group were 20% and 46.7% respectively. Back pain duration of the subjects shows that in experimental group majority of the subjects 50% had pain between 1-2 hours daily. Where as in control group majority 56.7% had pain for 1-2 hours daily. The second highest number of subjects in experimental group and control group with pain duration for 1 hour were 46.7% and 40% respectively.

From table – II it was found that in experimental and in control group majority of the samples 66.7% had severe pain during pre-test where as at the time of post-test an overwhelming majority of the subjects 86.7% was with mild pain in contrast to this in control group majority of the subjects 60% were with severe pain.

Table – II: Frequency and Percentage Distribution of Subjects According to Level of Back Pain before and after Stretching Exercises as Measured by Numerical Pain Rating Scale.

Level of Pain	Experimental Group		Control Group
Level of Pain	Pre-test	Post-test	Pre-test	Post-test
No Pain	0 (0 %)	1 (3.3 %)	0 (0 %)	0 (0 %)
Mild Pain	0 (0 %)	26 (86. 7%)	0 (0 %)	0 (0 %)
Moderate Pain	10 (33.3 %)	3 (10 %)	10 (33.3 %)	12 (40 %)
Severe Pain	20 (66.7 %)	0 (0)	20 (66.7 %)	18 (60 %)

Fig. 2: Comparison of Back Pain as Measured by Modified Oswestry Low Back Pain Scale among Samples in Experimental and Control Group

Table III: Mean, Mean Difference, Standard Deviation, Independent‘t’ – test value among subjects between experimental and control group. (N = 60)

	Numerical Pain Rating Scale		Modified Oswentry Low Back Pain Scale
Groups	Group		Group
	Experimental	Control	Experimental	Control
Mean	2.07	6.57	4.67	8.6
Mean Difference	4.5		3.93
Standard Deviation	1.048	1.040	1.62	2.41
Independent ‘t’ test value	16.69 (df = 58)		7.39 (df = 58)
Table value	1.67		1.67
‘P’ Value	0.001*		0.001*

* Significant at ‘P’ value < than 0.05

According to figure – 2: in experimental group during pre-test an overwhelming majority of the subjects 90% had moderate low back pain disability. Among subjects in the control group all 100% of the subjects had moderate low back pain disability. With regard to post-test in experimental group majority of the subjects 73.3 % had mild level low back pain disability. Among subjects in the control group majority 53.3 % had mild level low back pain.

The above table showed the effectiveness of stretching exercise on low back pain among antenatal mothers.

Pain assessment by using numerical pain rating scale depicted the post- test mean and standard deviation value in experimental group was 2.07 + 1.048. in the control group, the post – test mean and standard deviation value was 6.57 + 1.040 the mean difference value was 4.5. Independent ‘t’ test score was 16.69 for the degree of freedom 58. The table value was 1.67. this was statistically significant at ‘P’ value < 0.01.

On the other hand, during pain assessment with the modified oswentry low back pain scale the post – test mean and standard deviation value in experimental group was 4.67 + 1.62. in the control group, the post – test mean and standard deviation value was 8.6 + 2.41 the mean difference value was 3.93 Independent ‘t’ test score was 7.39 for the degree of freedom 58. The table value was 1.67. this was statistically significant at ‘P’ value < 0.01.

DISCUSSION:

The above study findings are supported by the study done by Chandrasekaran B, Vincent C.S and Arulappan J (2020) their study aimed to determine the effect of back-stretch (BS) exercise on the perception of BP during pregnancy. Research design used was quasi-experimental pre-test-post-test control group. Study was done in Gottigere health center, Bangalore, Karnataka, India. The BS exercise intervention was provided to the mothers of the study group. Data were collected from 60 antenatal mothers, 30 in the study, and control group, respectively who were in their 28-32 weeks of gestation by using a non-probability purposive sampling technique. The intensity of BP was estimated using the visual analogues scale. Study result revealed the comparison between the study and control group has proved a remarkable BP reduction among the antenatal mothers after BS exercise in the study group. The post-test mean intensity of BP was lesser than the pre-test mean intensity of BP (48.73< 54.83) among mothers of the study group (P≤0.001). The antenatal mothers of the control group did not have a statistically significant reduction in the level of BP.¹⁰

Mythili G, Jency Thangasheela G and Macklin Abraham Navamani J (2018) conducted a study to find out the effect of exercise program in reduction of low back pain in pregnant women between 18 and 35 years. Thirty subjects aged between 20-35 years pregnant females who have low back pain during 2nd trimester is selected from Dr. Sengaliappan Nursing Home, Saibaba Colony and group A (15 subject) participated in an exercise program three time a week for 12 weeks and group B (15 subjects) as control group received only standard antenatal exercise. The outcome was measured by using Oswestry low back pain disability questionnaire (for assessing the low back pain), Trunk side bending test (for assessing the kinematics of spine) and Pregnancy mobility index (for assessing the mobility status of pregnant women). Result concluded that group A, who underwent abdominal strengthening exercise, hamstring strengthening exercise, hip flexor stretching exercise and paravertebral muscles stretching exercise are more effective in reducing the intensity of low back pain than Group B who underwent only standard antenatal exercise.¹¹

CONCLUSION:

From the data presentation and analysis, it is evident that in the study the researcher concluded that the antenatal mothers who underwent stretching exercises are more effective than the antenatal mother who underwent routine nursing care in reducing the intensity of low back pain and hereby the researcher suggested that every antenatal mother who suffers from low back pain can perform these stretching exercises and gets benefit in reduction from low back pain.

CONFLICT OF INTEREST:

The author declares no conflicts of intrest.

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11. Effectiveness of Exercise on Reducing the Intensity of Low Back Pain in Pregnant Women during 2nd Trimester of Pregnancy [Internet]. [cited 2021 Jun 28]. Available from: https:// www.ijsr.net/get_abstract.php?paper_id=8031905

Received on 27.06.2021 Modified on 09.07.2021

Int. J. of Advances in Nur. Management. 2021; 9(4):403-407.

DOI: 10.52711/2454-2652.2021.00093