Purpose: to determine the impact of the developed physical therapy program on the dynamics of dorsopathic symptoms in women in the postpartum period after abdominal delivery (cesarean section).
Methods. 112 postpartum women were examined. The comparison group (CG) consisted of 47 women who gave birth naturally. The main group 1 (MG1) consisted of 32 women after cesarean section, who recovered on their own. The main group 2 (MG2) consisted of 33 women after cesarean section, who underwent postpartum physical therapy for 12 months. The developed program included: kinesitherapy, abdominal bandage, kinesiological taping, abdominal massage and general; health nutrition, psychological relaxation, education of women. The basis of kinesitherapy as the main method that influenced the symptoms of dorsopathy was functional training (to normalize the motor stereotype, restore the muscles of the torso and limbs, posture) with reference to household movements for child care. During the first weeks after the cesarean section, the movements that contributed to the tension of the postoperative suture were restricted, and the facilitated starting positions were chosen. Women were taught the optimal dynamic stereotype with the prevention of back overload during habitual movements - lifting, feeding the baby, carrying a stroller, and more.
Determination of signs of dorsopathy (intensity of pain on a visual analog scale, the state of mobility of the spine with tests Ott, Schober, Tomaer, Sedin, changes in life on Roland-Morris Disability Questionnaire and Pregnancy Mobility Index) was performed 4 times: 5-7 days after birth, in the late postpartum period (6-8 weeks), 6 and 12 months after delivery.
Research results. It is estimated that almost 80% of women during pregnancy were determined by signs of dorsopathies. Women after childbirth, regardless of the type of birth, there is a high risk of new and prolonged symptoms of existing dorsopathies due to increased physical and mental stress on the background of structural and functional recovery of the body and the risk of postpartum depression. In the postpartum period, dorsopathy in women manifests itself in the form of moderate back pain (diagnosed on a visual analog scale), limited mobility of the spine even in the absence of pain (determined by Ott, Schober, Tomaer, Sedin tests), limited vital functions (established by Roland-Morris Disability Questionnaire, Pregnancy Mobility Index). The use of physical therapy allowed women to have a statistically significant (p <0.05) improvement in the results of the visual-analog scale and the Roland-Morris Disability Questionnaire, Pregnancy Mobility Index compared to not only MG1 but also CG parameters. As for the flexibility of the spine, women CG and MG2 were able to achieve normalization 6 months after delivery, women MG1 - a year later. Women who underwent a cesarean section, but recovered on their own with the help of general recommendations, were able to reach the levels of women who gave birth naturally and women who underwent physical therapy only one year after giving birth.
Conclusions. Physical therapy should be prescribed from the first day of postpartum rehabilitation to reduce the intensity of symptoms of dorsopathy and prevent chronic pain, threatens psychoneurological disorders, disability, reduced quality of life, for rapid postpartum recovery and return of women to full life.
Telerreabilitação em grupo para pacientes com dor lombar crônica: Estudo longitudinal retrospectivo