Exercise can improve pelvic pain and posture associated with endometriosis

Let’s do some exercise!

Key Points

Highlight:

• Study try to determine the effect of an exercise program on pelvic pain and posture associated with endometriosis.

Importance:

• "Low impact and moderate exertion" exercise for 30-60 minute per day for three times a week are beneficial to decrease pelvic pain associated with endometriosis.

What's done here:

• A group of 20 patients (26–32 years of age) with mild to moderate endometriosis were recruited.
• The exercise program used was suitable for sedentary women and based on the American College of Obstetricians and Gynecologists guidelines.
• Pain intensity scale was used to assess the intensity of endometriosis pain.
• A raster stereography system was used to assess the posture.
• The patients were assessed after 4 weeks and after 8 weeks of exercise program.

Data:

• After 8 weeks exercise program, women with endometriosis showed a statistically significant decrease in pain intensity and thoracic kyphosis, as compared to those prior exercise.

Limitations:

• The study is lacking objective outcome measure for pain.
• The authors did not assess the long-term effect of exercise.
• The study did not have control subject with endometriosis who received no exercise for comparison.

Lay Summary

Nearly half of women affected by endometriosis have mild to severe chronic pelvic pain (CPP). Clinically, postural changes are frequently seen in CPP sufferers. These postural changes can include uneven positions, shortenings, antalgic postures, and tensions. Moreover, endometriosis is also associated with pelvic floor dysfunction and secondary musculoskeletal impairments in the region of endometrial implantation e.g., on the psoas or lumbar musculature producing musculoskeletal symptoms.

Physical therapy can reduce pain and improve quality of life in endometriosis through teaching patients to relax their muscles, which helps to break the pain cycle. Regular physical exercise may also have protective effects against inflammatory processes and has been claimed to promote the reduction of menstrual flow, ovarian stimulation, and action of estrogen. However, there is a lack of available evidence to identify whether physical exercise could be beneficial for women with endometriosis. This article by Awad et al. published in The Journal of Physical Therapy Science from Department of Physical Therapy for Pediatrics and Women’s Health at Beni-Suef University, Egypt determined the effect of an exercise on pelvic pain and posture associated with endometriosis.

The study design compared one group of patients diagnosed with mild or moderate endometriosis before, after 4 weeks, and after 8 weeks of an exercise program. Twenty patients age 26 to 32 years and BMI below 29 kg/m2 were recruited at the Physical Therapy Department of Bab El-Sharia University Hospital between December 2015 to April 2016.

Before exercise program, baseline pain intensity was measured by pain intensity scale from 0 to 4 (no pain=0, mild pain=1, moderate pain=2, severe pain=3, and unbearable pain=4).  The measurement was taken again after 4 weeks (12 sessions) and 8 weeks (24 sessions) of performing the exercise program. The postural assessment was assessed by measuring the thoracic kyphosis angle in the spinal shape analysis laboratory at the same time points. The exercise program was based on the American College of Obstetricians and Gynecologists guidelines for sedentary women which included a minimum of three times/week frequency, moderately hard perceived exertion intensity, 30–60 min/day and low impact type.

The results showed a statistically significant reduction in the intensity of endometriosis pain after performing the exercise program, as well as the thoracic kyphosis angle related to postural kyphosis deformity. The findings are in agreement with previous studies suggesting that progressive muscular relaxation training can improve pain, anxiety, and depression in women with endometriosis under hormonal therapy. On the other hand, it must also be noted that there is evidence that physical exercise did not have a role in preventing the occurrence or progression of endometriosis.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29643586