The effect of 6 weeks dynamic neuromuscular stabilization (DNS) breathing exercises on postpartum balance and quality of life in primiparous women with low back pain

Document Type : Original Article


1 M.Sc. in Sports Injury and Corrective Exercises, Department of Sports Sciences, Imam Reza International University, Mashhad, Iran.

2 Assistant Professor, Department of Sports Injury and Corrective Exercises, Department of Sports Sciences, Imam Reza International University, Mashhad, Iran.

3 Professor, Department of Obstetrics & Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: Postpartum period is a critical stage, the consequences of which can lead to problems such as decreased balance and quality of life. The present study was performed aimed to investigate the effect of dynamic neuromuscular stabilization (DNS) breathing exercises on postpartum balance and quality of life in primiparous women with low back pain.
Methods: This randomized controlled clinical trial was conducted in 2020 on 24 primiparous women with postpartum low back pain referred to Ommol-banin Obstetrics and Gynecology Hospital in Mashhad. The subjects were randomly divided into two experimental (n=12) and control (n=12) groups. The variables of static and dynamic balance and quality of life before and after the study were measured by the Sharpened-Romberg test, time up and go test, and quality of life questionnaire, respectively. The experimental group participated in the training program for six weeks. Data were analyzed by SPSS software (version 23), parametric test, and Repeated Measures Analysis of Variance (RM-ANOVA). P< 0.05 was considered statistically significant.
Results: In the experimental group, changes in static balance with open and closed eyes, dynamic balance and quality of life after delivery were significant (P<0.005). But no significant difference was observed in the control group and in the variables of static balance with open eyes (P=0.701), with closed eyes (P=0.220), dynamic balance (P=0.339) and quality of life (P=0.210). A significant difference was observed between the two groups in the research variables in the study of intergroup results of the repeated measures test (P<0.005).
Conclusion: DNS exercises are suitable, low-cost and low risk intervention, which can be used as one of the best interventions for postpartum women.


  1. Zahedpour F, Mohammadi M, Damavandi M, Agah J. The effect of core stability training on postpartum lumbar lordosis and low back pain in nulliparous women. Iran J Obstet Gynecol Infertil 2017; 20(3):89-97.
  2. Bezzoli E, Andreotti D, Pianta L, Mascheroni M, Piccinno L, Puricelli L, et al. Motor control exercises of the lumbar-pelvic region improve respiratory function in obese men. A pilot study. Disability and rehabilitation 2018; 40(2):152-8.
  3. Ramezanpour MR, Laeli A, Amirkhani Z. Effect of Aerobic Training in Morning and Evening on Maternal Body Composition Two Months Postpartum. Iran J Obstet Gynecol Infertil 2018; 21(10):13-19.
  4. Saeedi S. Evaluation changes in lumbar lordosis and low back pain during pregnancy and the effects of exercise on lumbar lordosis correction postpartum women (Doctoral dissertation, Master Thesis]. Sharekord, Iran: Physical Education and Sport Sciences, Sharekord University).
  5. Saeedi S. Effect of exercise program on symptoms of postpartum depression. Iran J Obstet Gynecol Infertil 2012; 15(34):26-31.
  6. Parameswaran K, Todd DC, Soth M. Altered respiratory physiology in obesity. Canadian respiratory journal 2006; 13(4):203-10.
  7. Courtney R, Greenwood KM, Cohen M. Relationships between measures of dysfunctional breathing in a population with concerns about their breathing. Journal of bodywork and movement therapies 2011; 15(1):24-34.
  8. De Troyer A, Estenne M. Functional anatomy of the respiratory muscles. Clinics in chest medicine 1988; 9(2):175-93.
  9. Hodges PW, Gandevia SC, Richardson CA. Contractions of specific abdominal muscles in postural tasks are affected by respiratory maneuvers. Journal of Applied Physiology 1997.
  10. Loring SH, Mead J. Action of the diaphragm on the rib cage inferred from a force-balance analysis. Journal of Applied Physiology 1982; 53(3):756-60.
  11. Malatova R, Dřevikovská P. Testing procedures for abdominal muscles using the muscle dynamometer SD02. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 2009; 223(8):1041-8.
  12. Szczygieł E, Blaut J, Zielonka-Pycka K, Tomaszewski K, Golec J, Czechowska D, et al. The impact of deep muscle training on the quality of posture and breathing. Journal of motor behavior 2018; 50(2):219-27.
  13. Sobhani E, Babakhani N, Alebouyeh MR. The effectiveness of mindfulness-based stress reduction on the depression, anxiety, stress, and pain perception in females with obstructed labour-induced chronic low back pain. Iranian Journal of Psychiatry and Clinical Psychology 2019; 25(3):266-77.
  14. Gausel AM, Kjærmann I, Malmqvist S, Dalen I, Larsen JP, Økland I. Pelvic girdle pain 3–6 months after delivery in an unselected cohort of Norwegian women. European Spine Journal 2016; 25(6):1953-9.
  15. Mazloomi MS, Ghazinezhad N, Dehghani TA. Consider quality of life nulliparous women of Noshar 2015. Toloo-E-Behdasht 2017; 16(1):23-32.
  16. Frank C, Kobesova A, Kolar P. Dynamic neuromuscular stabilization & sports rehabilitation. International journal of sports physical therapy 2013; 8(1):62.
  17. Kolar P. Clinical rehabilitation. Alena Kobesová; 2014.
  18. Stuge B, Veierød MB, Lærum E, Vøllestad N. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a two-year follow-up of a randomized clinical trial. Spine 2004; 29(10):E197-203.
  19. Anderson BE, Bliven KC. The use of breathing exercises in the treatment of chronic, nonspecific low back pain. Journal of sport rehabilitation 2017; 26(5):452-8.
  20. Ehsani F, Sahebi N, Shanbehzadeh S, Arab AM, ShahAli S. Stabilization exercise affects function of transverse abdominis and pelvic floor muscles in women with postpartum lumbo-pelvic pain: a double-blinded randomized clinical trial study. International urogynecology journal 2020; 31(1):197-204.
  21. Alizadeh S, Irandoust K, Taheri M. The effect of 8-weeks Pilates training on static and dynamic balance of athletes with chronic back injuries. Journal for Research in Sport Rehabilitation 2016; 4(8):75-83.
  22. Holden SC, Manor B, Zhou J, Zera C, Davis RB, Yeh GY. Prenatal yoga for back pain, balance, and maternal wellness: a randomized, controlled pilot study. Global advances in health and medicine 2019; 8:2164956119870984.
  23. Miketa T, Ivančić N, Kuzmanić B. Relationship of breathing exercises with improvement of postural stability in healthy adults. Acta Kinesiologica 2017; 11(2):59-62.