Colla, Cássia; Paiva, Luciana Laureano; Thomaz, Rafaela Prusch

doi:10.1590/1980-5918.030.002.AR03

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Fisioterapia em Movimento

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Review articles • Fisioter. mov. 30 (2) • Abr 2017 • https://doi.org/10.1590/1980-5918.030.002.AR03 copiar

Exercícios terapêuticos para dor lombar e pélvica gestacional: uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Introdução:

Na gravidez o organismo materno passa por muitas transformações e a dor lombar e a dor pélvica são frequentes, podendo persistir após a gestação. Embora a literatura venha apontando a Fisioterapia como recurso terapêutico efetivo, existem poucos estudos sobre os efeitos da intervenção fisioterapêutica por meio de exercícios para esse fim.

Objetivo:

Desenvolver uma revisão sistemática sobre a abordagem da Fisioterapia, por meio de exercícios terapêuticos, na prevenção e no tratamento da dor lombar e pélvica gestacional.

Métodos:

Realizou-se uma busca sistemática por ensaios clínicos randomizados (ECRs) nas bases de dados PubMed, PEDro, Cochrane, EMBASE, LILACS e Periódicos Capes. Não houve restrição de data e de idioma. Os termos compreendidos na busca foram: “pregnancy”, “low back pain”, “pelvic pain”, “exercise therapy” e seus descritores em português. A qualidade metodológica foi avaliada por meio da escala PEDro, e uma análise descritiva dos estudos foi realizada.

Resultados:

Oito estudos, incluindo 1781 gestantes, foram selecionados. Dentre eles, um estudo aborda a temática da dor lombar, dois sobre dor pélvica e cinco sobre dor lombar e/ou pélvica. Sete estudos apresentaram alta qualidade metodológica, e somente um estudo apresentou qualidade metodológica baixa. Foram encontradas evidências limitadas para dor lombar e evidências conflitivas para dor pélvica e para dor lombar e/ou pélvica.

Conclusão:

Os ECRs sobre o tema ainda são escassos e heterogêneos, impossibilitando estabelecer consenso e conclusões sobre qual protocolo de exercícios terapêuticos é mais eficaz no manejo fisioterapêutico da dor lombar e pélvica gestacional.

Palavras-chave:
Fisioterapia; Gravidez; Terapia por exercício

Author/Year	Sample	Age (average (SD)) / Gestational age when included (median)	Intervention	Role of the Physical Therapist	Main Results	PEDro Score
Gil et al., 2011 ⁽³²⁾	N: 34;	EG: 29 (5.2); / 22;	EG: stretching the posterior chain with two active postures from the GPR method.	Assessment; pain-confirmation tests.	Pain intensity: significant decrease in the EG throughout the study and in comparison with the CG.	7
	EG: 17;	EG: 29 (5.2); / 22;	F: 40 min/week; D: eight weeks.
	CG: 17.	CG: 23.7 (3.9); / 22.	GC: pre-natal routine and guidance.		Functional limitations: significant decrease after the end of the interventions. Lower results in the EG.
		CG: 23.7 (3.9); / 22.	F: two follow-up encounters.

Author/Year	Sample	Age (average (SD)) / Gestational age when included (median)	Intervention	Role of the Physical Therapist	Main Results	PEDro Score
Depledge et al., 2005 ⁽³³⁾	N: 87;	EG1: 30.7 (4.0); / 32.2 (5.2);	EG1 - Specific muscle strengthening exercises to be performed at home, information and guidance;	Performed the initial examination, demonstrated the exercises and verified if the execution was correct.	Pain intensity and functional limitations: significant decrease for all groups. No difference between groups.	6
	EG1: 30;	EG2: 29.8 (4.6); / 30.5 (5.2);	EG2 - Same intervention as EG1 + rigid pelvic belt;
	EG2: 28;	EG3: 28.7 (6.3); / 31.1 (5.4).	EG3 - Same intervention as EG1 + non-rigid pelvic belt;
	EG3: 29.		F: 3x/day (at home); D: one week.
Nilsson-Wilkmar et al., 2005 ⁽³⁴⁾	N: 118;		EG1 - Information (anatomy, posture, ergonomics) + elastic pelvic belt;	Performed the physical examination, was responsible for the exercise programs, and assessed the questionnaires. On the EG2, explained the initial instructions as needed.	Pain intensity, pain design and functional capacity: no difference between groups during pregnancy and after-birth. Reduction in the results of all groups between the 38th gestational week and 12 months after birth.	7
	EG1: 40;	EG1: 28.4 (3.9); / 25 (7);	D: 10 weeks (median);
	EG2: 41	EG2: 29.5 (3.3); / 22 (7);	EG2 - Same intervention as EG1 + at home exercises: pelvic stabilization and stretching; Instructions: once a week; Follow-up: once after receiving the program;
			F: 2x/week; D: 14 weeks (median);
	EG3: 37.	EG3: 29.7 (5.4); / 21 (6)	EG3 - Same intervention as EG1 + exercises at the clinic: strengthening, stabilization, stationary bicycle and stretching.
			D: 16 weeks (median).

Author/Year	Sample	Age / Gestational Age (Average (SD))	Intervention	Role of the Physical Therapist	Main Results	PEDro Score
Eggen et al., 2012⁽³⁵35 Bastiaenen CHG, de Bie RA, Wolters PMJC, Vlaeyen JWS, Bastiaanssen JM, Klabbers ABA, et al. Treatment of pregnancy-related pelvic girdle and/or low back pain after delivery design of a randomized clinical trial within a comprehensive prognostic cohort study. BMC Public Health. 2004;4:67.⁾	N: 257; EG: 129; CG: 128.	EG: 30.6 (4.8); / 16.3 (1.8); CG: 30.0 (4.8); / 16.4 (2.0).	EG: in group; aerobic and strengthening exercises, stretching, body awareness, posture and guidance for EDAs. F: 60 min/week; D: 16 to 20 weeks. CG: cares with the routine and information (midwife). F: every four weeks.	Individual guidance and exercise adjustments	Prevalence of pelvic and low back pain and secondary outcomes (pain intensity in the morning, pain intensity at night, disablement and SF-8): no significant difference.	7
Martins et al., 2005⁽³⁶36 Gil VFB, Osis MJD, Faúndes A. Lombalgia durante a gestação: eficácia do tratamento com Reeducação Postural Global (RPG). Fisioter Pesqui. 2011;18(2):164-70.⁾	N: 69; EG: 33; CG: 36.	NI	EG: in group; eccentric stretches using the SGA method; F: 60 min/week; D: eight weeks. GC: medical guidance and return after eight weeks.	Pain-provoking tests, data collection, recommending compensations and guidance.	Pain intensity: decrease in the EG. Decrease not verified in the CG. Pain-provoking tests: decrease in low back pain. No significant difference regarding posterior pelvic pain. Self-report: pain decreased or stopped after the exercises; the exercises caused positive feelings.	< 5
Martins e Silva, 2015	N: 60; EG: 30; CG: 36.	CG: 26 (median); EG: 23 (median). (inclusion between the 12th and 32nd weeks).	GE: in group; yoga-type exercises (warm-up, breathing, postures, relaxation and meditation). F: 60 min/week; D: 10 weeks. GC: postural guidance through leaflets. D: 10 weeks.	Pain-provoking tests, administering the session/instructing about the method.	Pain intensity: Lower in the EG in comparison with the CG. Low back pain provoking tests: lower responses in relation to the pelvic pain provoking test.	5
Morkved et al., 2007⁽³⁷37 Depledge J, McNair PJ, Keal-Smith C, Williams M. Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts. Phys Ther. 2005;85(12):1290-300.⁾	N: 301; EG: 148; CG: 153.	EG: 28.0 (5.3); / Average NI (inclusion at 20 weeks); CG: 26.9 (3.9);/ Average NI (inclusion at 20 weeks).	EG: in group; aerobic and strengthening exercises, stretching, body awareness, breathing and relaxation, information. Daily at home training of the PFM. F: 60 min/week; D: 12 weeks. CG: information from the obstetrician	Conducted the groups, encouraged the performance of the exercises at home and reported group participation.	Self-report: EG was less prone to lumbopelvic pain after the intervention. Medical leaves: no significant difference; Functional state: EG had higher scores after the intervention.	8
Stafne et al., 2012⁽³⁸38 Nilsson-Wilkmar L, Holm K, Oijerstedt R, Harms-Ringdahl K. Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain: a randomized clinical trial with 3, 6, and 12 months follow-up postpartum. Spine (Phila Pa 1976). 2005;30(8):850-6.⁾	N: 855; EG: 429; CG: 426.	EG: 30.5 (4.4); / NI; CG: 30.4 (4.3); / NI	EG: in group. Aerobic and strengthening exercises, stretching, body awareness, breathing and relaxation, information. F: 60 min/week; D: 12 weeks; At home exercise program: resistance, strength and balance. F: 45 min 2x/week; CG: standard pre-natal and information.	Conducted the weekly group session and collected reports about the at home exercises.	Self-reports about lumbopelvic pain: no significant difference between the groups; Self-reports about medical leaves: proportion was lower in the G1; Deficiency index and pain intensity: no significant difference between groups.	7

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[1] *CC: Master’s Student, e-mail: cassia.colla1@gmail.com

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