This Study Aimed to Evaluate the Effect of Dynamic Neuromuscular Stabilization (DNS) on Pain Intensity and Functional Disability in Women With PLBP as Common Problem Affect t he Women After Birth Which Often Impacting Their Quality of Life and Ability to Perform Daily Activities

Summary

The aim of this study was to determine the effect of DNS on women with post-partum LBP.

Post-partum low back pain (PLBP) represents a prevalent and clinically significant condition that adversely impacts mobility, pelvic floor integrity, functional performance, and quality of life in women following childbirth. Epidemiological data suggest that approximately 50% of women who experience pregnancy-related low back pain continue to report symptoms up to 12 months post-partum, while nearly 20% may develop chronic or disabling pain lasting up to three years. Moreover, the onset of LBP within the first three months postpartum is a strong predictor for the development of persistent or recurrent symptoms, emphasizing the importance of early intervention (Fukano et al., 2021).

Dynamic Neuromuscular Stabilization (DNS) provides a novel and integrative rehabilitation framework based on developmental kinesiology, emphasizing the restoration of optimal joint centration, intra-abdominal pressure regulation, and neuromuscular coordination across the entire core system. DNS targets not just local symptoms but the underlying movement dysfunctions that contribute to persistent post-partum pain. This approach stands in contrast to traditional rehabilitation techniques that often emphasize symptomatic relief over functional re-patterning (Ghavipanje et al., 2021).

The significance of this study lies in its investigation of DNS as an evidence-based, functional intervention for women with PLBP. It highlights the role of active patient engagement, corrective movement strategies, and motor control retraining in promoting long-term recovery. By demonstrating the effectiveness of DNS, this research contributes to the evolving body of literature supporting core-centric, integrated neuromuscular rehabilitation for post-partum populations, with potential implications for improving clinical outcomes and enhancing women's physical autonomy after childbirth.

Delimitations

The present study was delimited to the following criteria to ensure homogeneity of the sample and clinical relevance to post-partum rehabilitation:

1. Participants: Sixty post-partum women diagnosed with mechanical low back pain of 3 to 6 months duration were included, reflecting a subacute pain profile relevant for neuromuscular retraining.
2. Age Range: Participants were between 18 and 34 years of age, corresponding to typical reproductive and early post-partum demographic profiles.
3. Body Mass Index (BMI): Only individuals with a BMI between 25 kg/m² and 35 kg/m² were included to account for mild to moderate overweight status, a known factor in post-partum back dysfunction.
4. Medication Exclusion: Participants did not receive any analgesics, anti-inflammatories, or therapeutic interventions throughout the study period to eliminate confounding effects.
5. Medical Exclusion: Women with a history of severe trauma, skeletal injuries, fractures, neurologic or chronic inflammatory disorders, primary or metastatic neoplasms, osteoporosis, or chronic neuromuscular conditions contributing to LBP were excluded.
6. Consent and Stability: Only medically stable women who provided written informed consent were included, in line with ethical standards for human subject research.

Limitations

Despite careful design and standardized intervention protocols, the current study was subject to several limitations inherent in clinical research involving post-partum populations:

1. Emotional and Psychological Factors: The emotional state of post-partum women - including symptoms of fatigue, anxiety, or depressive mood - may have influenced motivation, engagement, and consistency during therapeutic sessions. These psychosocial elements are known to modulate both pain perception and motor performance (Morin et al., 2018).
2. Participant Cooperation and Compliance: Variability in the degree of cooperation and adherence to prescribed home exercises may have introduced inconsistencies in treatment effects. Factors such as childcare responsibilities and sleep disturbances can influence session attendance and follow-through (Boissonnault \& Blanpied, 2018).
3. Individual Response to Therapy: There may have been biological and neuromuscular differences in how participants responded to the DNS approach. Genetic variability, post-partum recovery rate, and prior physical activity levels are all variables that can modulate treatment outcomes (Kolar et al., 2014).
4. Motor Learning and Skill Acquisition: DNS-based exercises require a level of motor learning and sensory awareness, which varies among individuals. Differences in performance ability and learning curve may have affected the precision and efficiency with which patients executed the exercises (Kolar et al., 2012).
5. Socioeconomic and Cultural Differences: Economic status, educational background, and cultural norms influenced participants' access to resources, health beliefs, and commitment to therapeutic regimens. (smith et al.2023)

Conditions

• Post -Partum Low Back Pain
• Dynamic Neuromuscular Stabilization (DNS)
• Women's Health / Physiotherapy
• Musculoskeletal Rehabilitation
• Core Stability and Functional Disability

Interventions

BEHAVIORAL

Intervention Group: Name: Dynamic Neuromuscular Stabilization (DNS) Exercises

Distinguishing Description for DNS Intervention This intervention consists of a structured Dynamic Neuromuscular Stabilization (DNS) exercise program specifically tailored for post-partum women with mechanical low back pain. DNS emphasizes restoring functional motor patterns through: Breathing-based core activation techniques Developmental positions mimicking infant motor milestones (e.g., supine 90/90, quadruped, side-lying) Coordination of the diaphragm, pelvic floor, and transverse abdominis muscles Progressive motor control retraining over 6 weeks, 3 sessions/week What distinguishes this intervention: It integrates developmental kinesiology principles with respiratory-pelvic-lumbar coordination. DNS is performed under supervised sessions by a physiotherapist, ensuring precision and progression. This protocol replaces standard strengthening/stretching exercises and focuses on neuromuscular re-patterning, not just symptom relief.

DEVICE

Control Group:Name: Conventional Physiotherapy (Ultrasound and Infrared Therapy)

1-Therapeutic Ultrasonic: comparison group also received treatment through therapeutic ultrasound, which was applied three times per week. The ultrasound therapy was delivered to the paraspinal muscles of the lumbar region, using a stroking technique where each stroke overlapped by about 50% with the preceding stroke. The ultrasound used a frequency of 3 MHz and an intensity range of 1.0 to 1.5 W/cm²,The ultrasound head was placed over the L4 to L5 and L5 to S1 regions and moved in a circular motion for a total duration of 5 minutes per treatment session (Shobari et al., 2024). infra red the infrared lamp was placed at 75 cm distance from the patient's back so that the radiation struck the surface at or near a right angle to achieve maximum penetration. The treatment duration was 15 minutes. Each woman with post-partum low back pain was treated by 20 minutes infrared irradiation 40 cm away from the low back region, from prone3 sessions per week for 6 weeks (El-Lassy and Madian, 2018

Sponsors & Collaborators

• Gehad Alaa

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

34 Years

Sex

FEMALE

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2025-08-01

Primary Completion

2025-11-30

Completion

2025-12-30

Countries

• Egypt