Comparação das variáveis cinemáticas da marcha entre gestantes sem dor e com dor lombopélvica no 3° trimestre de gestação: um estudo transversal preliminar

Abstract

During pregnancy, it is theorized that the anterior displacement of the center of mass, due to the increased abdominal volume and breast size, leads to postural changes that increase lumbar hyperlordosis and the tension of the paravertebral muscles. Previous studies have shown reduced gait speed in pregnant women with lumbopelvic pain in the third trimester. This study is justified by the hypothesis that biomechanical changes resulting from pregnancy may contribute to the development of lumbar and pelvic pain, and by the association between reduced gait speed and changes in joint kinematic and kinetic parameters. The objective was to compare kinematic and spatiotemporal gait variables, at both usual and fast speeds, between pregnant women with and without lumbopelvic pain in the third trimester of pregnancy. Twenty-three pregnant women in the third trimester participated and were allocated into two groups: group A (without pain, n=11) and group B (with lumbopelvic pain that began during pregnancy, n=12). Pain was identified by marking anatomical images of the areas of low back pain, posterior pelvic pain, and pubic symphysis pain. To confirm posterior pelvic pain, the Posterior Pelvic Pain Provocation Test was used, and for pubic symphysis pain, the modified Trendelenburg test was applied. The following instruments were used: Baecke Questionnaire on Habitual Physical Activity, to assess physical activity level; Tampa Scale for Kinesiophobia, to evaluate fear of movement; Numerical Pain Rating Scale, to assess pain intensity; RolandMorris Disability Questionnaire, for functional disability related to low back pain; and Pelvic Girdle Questionnaire, for disability related to pelvic pain. Participants walked along a 10-meter walkway at usual and fast speeds, using five inertial sensors fixed on the dominant side to collect kinematic and spatiotemporal gait variables. For statistical analysis, the Student’s t-test was used for numerical variables with normal distribution, the Wilcoxon Rank Sum Test for variables with non-normal distribution, and the chi-square test for categorical variables, with a significance level of 5% and a confidence interval of 95%. There were no significant differences between groups in physical activity and kinesiophobia scores. The group with pain presented a moderate level of pain, mild disability related to low back pain, and moderate disability related to pelvic pain. Compared to the group without pain, the group with pain showed greater hip adduction during the stance phase, greater lateral trunk range of motion, longer stride duration and time in the stance phase, as well as lower gait speed, cadence, and time in the swing phase. In this preliminary analysis, it is concluded that lumbopelvic pain may influence gait pattern, leading to adaptations in hip mechanics, trunk movement, and spatiotemporal gait parameters. Data collection will continue in order to increase the number of participants and the statistical power of the study.