By the end of the puerperium: Kinematic assessment of lumbar spine range of motion after experiencing cesarean or vaginal birth

Abstract

Background: Pregnancy induces spinal changes that are generally expected to resolve by the end of the puerperium. However, the mode of delivery may influence this recovery. Purpose: This study aimed to assess pain-free active lumbar spine range of motion (ROM) in postpartum women following Cesarean birth (CB) or vaginal birth (VB), compared to women who had never been pregnant. Methods: A cross-sectional analytical study included 66 women divided into three groups: Group A (n = 25, CB women), Group B (n = 16, VB women), and Group C (n = 25, controls). Lumbar ROM, including flexion, extension, bilateral side bending, and axial rotation, was measured using bubble inclinometers between the 6th and 12th postpartum weeks. Results: The Kruskal-Wallis test showed significant differences were found among the groups in extension ROM (P = 0.002) and bilateral side bending ROM (P = 0.002 right, 0.004 left). Post-hoc analysis showed that CB women had significantly decreased extension ROM than controls (P = 0.001), and significantly decreased right and left side bending compared to both VB (P = 0.009, 0.013) and control groups (P = 0.010, 0.014). No significant differences were observed in flexion (P = 0.877) or axial rotation (P = 0.412 right, 0.753 left). Conclusion: CB women exhibited persistent limitations in lumbar extension and side bending ROMs beyond the puerperium, possibly due to scar restrictions and core muscle weakness rather than pregnancy itself. VB women demonstrated spinal mobility more comparable to controls, suggesting VB may be more favorable for postpartum spinal recovery.