Effects of four weeks of physical exercise in water on the severity of low back pain in pregnant women with previous history of pregnancy low back pain: a randomized controlled clinical trial

Document Type : Original Article


1 Assistant Professor, Department of Orthopedics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

2 Associate Professor, Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

3 Assistant Professor, Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.


Introduction: Given the high prevalence of low back pain in pregnancy and the increase in pain intensity in women with a history of low back pain in previous pregnancies and the recommendation of not to use analgesics in pregnancy, this study was performed with aim to investigate the effect of four weeks of physical exercise in water on the severity of low back pain in pregnant women with previous history of pregnancy low back pain.
Methods: This randomized controlled clinical trial study was conducted with participation of 80 pregnant women with pregnancy low back pain and previous history of pregnancy low back pain at Tabriz University of Medical Sciences in 2019. In addition to lifestyle modification, the intervention group performed stretching and strengthening exercises for 16 session of 1 hour in the water, and the control group was only encouraged to improve their lifestyle. The Qubak questionnaire and demographic information were used before and after the intervention for all participants. Data was analyzed by SPSS software (version 20) and Clomogrov-Smirnov and dependent T-test. P <0.05 was considered statistically significant.
Results: At the end of the intervention, the intensity of pain in the intervention group (23.45±03.56) was significantly lower than the control group (77.15±13.03) (P=0.001); on the other hand, in the intervention group, the intensity of pain at the end of the study (23.45±03.56) was significantly reduced compared to the beginning of the study (73.19±11.42) (P=0.001). While in the control group, no significant changes occur after the intervention (77.15±13.03) compared to before it (74.36±12.23) (P=0.419).
Conclusion: Four weeks of physical exercise in the water could reduce the severity of low back pain in pregnant women with a history of low back pain; these movements are recommended for pregnant women.



    1. Holliday CN, McCauley HL, Silverman JG, Ricci E, Decker MR, Tancredi DJ, et al. Racial/Ethnic Differences in Women's Experiences of Reproductive Coercion, Intimate Partner Violence, and Unintended Pregnancy. J Womens Health (Larchmt) 2017; 26(8):828-835.
    2. Bowers K, Ding L, Gregory S, Yolton K, Ji H, Meyer J, et al. Maternal distress and hair cortisol in pregnancy among women with elevated adverse childhood experiences. Psychoneuroendocrinology 2018; 95:145-148.
    3. Lagadec N, Steinecker M, Kapassi A, Magnier AM, Chastang J, Robert S, et al. Factors influencing the quality of life of pregnant women: a systematic review. BMC Pregnancy Childbirth 2018; 18(1):455.
    4. Alvandfar D, Alizadeh M, Khanbabayi Gol M. Prevalence of pregnancy varicose and its effective factors in women referred to gynecology hospitals in Tabriz. Iran J Obstet Gynecol Infertil 2019; 22(9):1-7.
    5. Nadeau-Vallée M, Obari D, Palacios J, Brien MÈ, Duval C, Chemtob S, et al. Sterile inflammation and pregnancy complications: a review. Reproduction 2016; 152(6):R277-R292.
    6. Haghdoost M, Mousavi S, Gol MK, Montazer M. Frequency of Chlamydia trachomatis infection in spontaneous abortion of infertile women during first pregnancy referred to tabriz university of medical sciences by nested PCR method in 2015. International Journal of Women's Health and Reproduction Sciences 2019; 7(4):526-30.
    7. Chen L, Ferreira M, Beckenkamp P, Caputo E, Ferreira P. Comparative efficacy and safety of conservative care for pregnancy-related low back pain: a systematic review and network meta-analysis. Osteoarthritis and Cartilage 2019; 27:S456-S7.
    8. Sehmbi H, D'Souza R, Bhatia A. Low Back Pain in Pregnancy: Investigations, Management, and Role of Neuraxial Analgesia and Anaesthesia: A Systematic Review. Gynecol Obstet Invest 2017; 82(5):417-436.
    9. Davenport MH, Marchand AA, Mottola MF, Poitras VJ, Gray CE, Jaramillo Garcia A, et al. Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. Br J Sports Med 2019; 53(2):90-98.
    10. Hall H, Cramer H, Sundberg T, Ward L, Adams J, Moore C, et al. The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain: A systematic review with meta-analysis. Medicine (Baltimore) 2016; 95(38):e4723.
    11. Colla C, Paiva LL, Thomaz RP. Therapeutic exercise for pregnancy low back and pelvic pain: a systematic review. Fisioterapia em Movimento 2017; 30(2):399-411.
    12. Morino S, Ishihara M, Umezaki F, Hatanaka H, Iijima H, Yamashita M, et al. Low back pain and causative movements in pregnancy: a prospective cohort study. BMC Musculoskelet Disord 2017; 18(1):416.
    13. Ibanez G, Khaled A, Renard J, Rohani S, Nizard J, Baiz N, et al. Back Pain during Pregnancy and Quality of Life of Pregnant Women. Primary Health Care: Open Access. 2017; 7(1):1-6.
    14. Bø K, Stuge B, Hilde G. Specific Musculoskeletal Adaptations in Pregnancy: Pelvic Floor, Pelvic Girdle, and Low Back Pain: Implications for Physical Activity and Exercise.  Exercise and Sporting Activity During Pregnancy: Springer; 2019. p. 135-55.
    15. Shiri R, Coggon D, Falah-Hassani K. Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials. Am J Epidemiol 2018; 187(5):1093-1101.
    16. Kinser PA, Pauli J, Jallo N, Shall M, Karst K, Hoekstra M, et al. Physical Activity and Yoga-Based Approaches for Pregnancy-Related Low Back and Pelvic Pain. J Obstet Gynecol Neonatal Nurs 2017; 46(3):334-346.
    17. Turner AJ, Chander H, Knight AC. Falls in Geriatric Populations and Hydrotherapy as an Intervention: A Brief Review. Geriatrics (Basel) 2018; 3(4):71.
    18. Pinto C, Salazar AP, Marchese RR, Stein C, Pagnussat AS. The Effects of Hydrotherapy on Balance, Functional Mobility, Motor Status, and Quality of Life in Patients with Parkinson Disease: A Systematic Review and Meta-analysis. PM R 2019; 11(3):278-291.
    19. Schitter AM, Nedeljkovic M, Baur H, Fleckenstein J, Raio L. Effects of Passive Hydrotherapy WATSU (WaterShiatsu) in the Third Trimester of Pregnancy: Results of a Controlled Pilot Study. Evid Based Complement Alternat Med 2015; 2015:437650.
    20. Eröksüz R, Erol Forestier FB, Karaaslan F, Forestier R, İşsever H, Erdoğan N, et al. Comparison of intermittent and consecutive balneological outpatient treatment (hydrotherapy and peloidotherapy) in fibromyalgia syndrome: a randomized, single-blind, pilot study. Int J Biometeorol 2020; 64(3):513-520.
    21. Sedaghati P, Daneshmandi H, Saremi A, Ashtari M. Effect of eight weeks aquatic gymnastics training on the intensity of low back pain in primiparous women. 2018.
    22. Reneman MF, Jorritsma W, Schellekens JM, Göeken LN. Concurrent validity of questionnaire and performance-based disability measurements in patients with chronic nonspecific low back pain. J Occup Rehabil 2002; 12(3):119-129.
    23. Weis CA, Barrett J, Tavares P, Draper C, Ngo K, Leung J, et al. Prevalence of Low Back Pain, Pelvic Girdle Pain, and Combination Pain in a Pregnant Ontario Population. J Obstet Gynaecol Can 2018; 40(8):1038-1043.
    24. Sencan S, Ozcan-Eksi EE, Cuce I, Guzel S, Erdem B. Pregnancy-related low back pain in women in Turkey: Prevalence and risk factors. Ann Phys Rehabil Med 2018; 61(1):33-37.
    25. Acharya RS, Tveter AT, Grotle M, Eberhard-Gran M, Stuge B. Prevalence and severity of low back-and pelvic girdle pain in pregnant Nepalese women. BMC pregnancy and childbirth 2019; 19(1):247.
    26. Soultanakis HN. Aquatic Exercise and Thermoregulation in Pregnancy. Clin Obstet Gynecol 2016; 59(3):576-590.