The Effect of Dynamic Neuromuscular Stabilization on the Pelvic and Lumbar Functional Condition in Postpartum Women

Introduction. The physiological and anatomical changes that occur during pregnancy can significantly affect the musculoskeletal system and reduce the quality of life for postpartum woman (1, 2). Also, childbirth strongly affects pelvic floor muscle function and is linked to future urinary and fecal incontinence, as well as pelvic organ prolapse (3). The Dynamic Neuromuscular Stabilization (DNS) method, based on neurodevelopmental principles, is a potential approach to reduce the impact of these demanding changes that occur during pregnancy and childbirth due to its focus on sagittal stabilization mechanisms (4). Therefore, the aim of this study was to evaluate the effect of DNS exercises on lumbopelvic functional parameters in postpartum women. Research methods and organization. The Kaunas Regional Biomedical Research Ethics Committee approved the study: Nr. BE-2-92. The study was conducted between November of 2024 and February of 2025 at the "Fiziomedika" Functional Medicine Clinic in Kaunas. All participants signed informed consent forms. Inclusion criteria were postpartum women in the first 5-9 months after giving birth vaginally, age between 20-35 years, first or second birth, no history of pelvic trauma, rheumatic disease, osteoporosis. The study involved 24 participants (83.3% first-time mothers), with a mean age of 29.5 years and 6.5 months postpartum. Participants were examined twice, six weeks apart - before and after the exercise program, which was based on DNS methodology guidelines and functional positions. Participants were instructed to perform this home-based exercise program for six weeks, at least 3–4 times per week, for up to 30 minutes. To ensure participants engagement in the study, they were asked to keep a diary after each exercise session. To assess functional changes in the pelvis and lumbar region relevant indicators were evaluated. A modified Schober test was used to assess lumbar mobility. Pelvic-lumbar stability was assessed using the pressure biofeedback device. Pelvic floor muscle strength was evaluated using a hand-held dynamometer. The static endurance of the back and abdominal muscles was assessed using the McGill tests. The functional state of the pelvic floor muscles was assessed using the questionnaire - Pelvic Floor Distress Inventory Short Form-20 (PFDI-20). Data statistical analysis was performed with IBM SPSS Statistics 30.0.0.0. Dependent samples were compared using Wilcoxon tests. The McNemar test was used to compare qualitative data. Quantitative data are presented as median (xme), minimum value (xmin), maximum value (xmax), and mean (x̄), qualitative data are presented as absolute frequency and percentage - n(%). Differences were considered statistically significant if p<0,05. Results. Lumbar mobility statistically significantly improved (Z=-3,346; p<0,001) by 0,4 cm. The test results at first were 5,5 (3,5-7; 5,3) cm, after DNS 6 (4-7,5; 5,7) cm. Pelvic-lumbar stability statistically significantly (p=0,039) improved. After DNS only 4 (16.7%) of the participants had pelvic-lumbar instability. Abdominal and back muscles static endurance statistically significantly improved (flex: Z=-2,485; p=0,013; ext: Z=-3,245; p=0,001). At first, flexion static endurance was 34 (11-75; 37,1) seconds, after DNS 52 (10-78; 46,3) s. At first, extension static endurance was 41 (15-63; 40,9) s, after DNS 56 (24-73; 51,4) s. Looking at pelvic floor muscle changes - the final score of the questionnaire was statistically significantly reduced after DNS (Z=-3,823; p<0,001). A positive change in functional state of pelvic floor muscles was observed for 19 (79,16%) participants with the greatest effect on urinary incontinence. The incontinence scale score was 31,24 (0-62,50; 26,9) points at the first examination and 6,24 (0-54.16; 16.14) points after. Pubococcygeus m. strenght statistically significantly increased when observed the right (Z=-3,625; p<0,001) and left (Z=-3,795; p<0,001) sides. Right side muscle strenght was 6,3 (3,9-7,3; 6) kg and 6,4 (4,9-8,4; 6,5) kg after DNS. For the left side at first 6,2 (4-7,2; 6) kg and after DNS 6,5 (5-8,3; 6,5) kg. Iliococcygeus m. strength statistically significantly increased when observed the right (Z=-3,606; p<0,001) and left (Z=-2,836; p=0,005) sides. The right side muscle strength before was 6,6 (3,9-7,5; 6,3) kg, after DNS 6,8 (5-8,4; 6,8) kg. The left side muscle strength at first was 6,6 (3,8-7,5; 6,3) kg, after 6,8 (5-8,5; 6,7) kg. Ischiococcygeus m. strength statistically significantly increased when observed both sides (Z=-3,253; p=0,001). Before DNS muscle strength on the right side was 6,1 (4-8; 6,3) kg, after 6,9 (5-8,6; 6,8) kg. On the left side before was 6 (4,3-8,1; 6,2) kg, after DNS 6,9 (5,3-8,7; 6,8) kg. Conclusions. The study showed that dynamic neuromuscular stabilization exercise program improves lumbar mobility, pelvic-lumbar stability, static trunk endurance and pelvic floor muscle strength and function parameters for postpartum woman.

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