VIDEO 2: Lowback Pain in Prenatal Period

The prenatal period is defined as the period from conception until the onset of labour. In this video you will learn the methods used in the evaluation of a patient presenting with low back pain in the prenatal period.

History taking in the prenatal period (will be given in e manual)

1. Facial expression, gait and posture are examined from the moment the patient first walks through the door.
2. The patient’s Demographic information, such as age, height, weight and occupation, is questioned.
3. The patient’s factors that increase or decrease pain are questioned.
4. The area where the patient’s pain spreads and the type of pain are questioned.

Evaluation of the individual with low back pain in the prenatal period:

Visual Analog Scale (VAS) can be used to assess the pain of a prenatal patient with pain.

1. Visual Analogue Scale (VAS):

On a 100 mm vertical ruler, 0 (meaning “no pain”) at the lower end and 10 (meaning “the most severe pain you have ever felt”) at the upper end is a scale used to measure and monitor the patient’s pain. On the VAS 100 mm (10 cm) chart, the pain intensity is evaluated as mild pain in the range of 1,2,3 cm, moderate pain in the range of 4,5,6 cm, and severe pain in the range of 7,8,9,10 cm. The visual pain scale applied to the pregnant woman can provide information about her pain.

b) The Oswestry Disability Index (ODI): The Oswestry Disability Index (ODI) serves as a valuable tool for evaluating functional impairments in individuals experiencing low back pain. Comprising 10 questions, each rated on a scale of 0 to 5, the ODI assesses the severity of pain and its impact on various daily activities, including self-care, lifting, walking, sitting, standing, sleeping, engaging in social activities, and travelling. Additionally, it gauges the degree of change in pain experienced by the individual, offering a comprehensive evaluation of the effects of low back pain on their overall functionality.

• Circumference measurements: (will be given in e manual)

Circumference measurements, which are part of anthropometric measurements, are used to evaluate variables such as body fat tissue, edema and increase in muscle mass, especially growth and nutrition. Edema in the body is a common condition in pregnant women due to increased load on the body and hormonal and biomechanical changes. For this reason, circumferential measurements to be made to pregnant women in the prenatal period help us learn about the changes and positively change them. Chest, waist, abdominal, hip, thigh, leg, hand and ankle measurements should be evaluated. Regarding respiratory measurements, maximal inspiration or expiration in chest measurements can be evaluated and information about thoracic cage flexibility can be obtained.

d) Lumbopelvic stabilization assessment (stabilizer pressure biofeedback): (will be given in e manual)

It is used to measure deep lumbar muscle strength and to teach pregnant women the perception of normal posture. This device consists of a pressure pad consisting of three chambers, a manometer and an air bulb connected to the pad. The pressure change in the cushion is read in millimetres of mercury (mmHg) on the manometer dial. During the assessment, the patient is positioned in an inclined supine position, and the pressure cell is placed under the lumbar spine and inflated to a base pressure of 40 mm Hg.  The patient is asked to perform the abdominal hollowing manoeuvre without moving the spine and pelvis and to maintain the contraction for 10 seconds.  The change in pressure during abdominal hollowing is measured and recorded.