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

NCT07099755 | Completed DMC

• 1 other identifier: No:P.T.REC/012/005604
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief 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. 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. 2.Age Range: Participants were between 18 and 34 years of age, corresponding to typical reproductive and early post-partum demographic profiles.
3. 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. 4.Medication Exclusion: Participants did not receive any analgesics, anti-inflammatories, or therapeutic interventions throughout the study period to eliminate confounding effects.
5. 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. 6.Consent and Stability: Only medically stable women who provided written informed consent were included, in line with ethical standards for human subject research.
7. 7.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).
8. 8.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).
9. 9.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).
10. 10.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).
11. 11.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

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

Outcome Measures

Primary Outcomes (2)

• Pain Intensity

  Assessed using the Numeric Pain Rating Scale (NPRS) - a subjective self-reported scale ranging from 0 (no pain) to 10 (worst imaginable pain).

  Baseline (Week 0) and Post-Treatment (After 6 Weeks of Intervention)

• Functional Disability

  Evaluated using the Modified Oswestry Disability Questionnaire (MODQ) - a validated tool for measuring limitations in daily activities due to low back pain.

  Baseline (Week 0) and Post-Treatment (After 6 Weeks of Intervention)

Study Arms (2)

Study Arms

EXPERIMENTAL

Intervention Group (Experimental Arm): Participants in this group received a comprehensive physiotherapy program consisting of: Ultrasound therapy (continuous mode, 1 MHz, 1.5 W/cm² for 5 minutes), Infrared therapy (15 minutes per session), Dynamic Neuromuscular Stabilization (DNS) exercises focused on breathing control, core activation, and developmental movement patterns (e.g., supine 90/90, quadruped, side-lying, etc.), administered 3 times per week for 6 weeks.

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

Control Group (Conventional Treatment Arm):

EXPERIMENTAL

Participants in this group received the same physiotherapy program as the intervention group Ultrasound therapy (continuous mode, 1 MHz, 1.5 W/cm² for 5 minutes) Infrared therapy (15 minutes per session), but without DNS exercises.

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

Interventions

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

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.

Also known as: Behavioral Physiotherapy for PLBP, Postural Motor Control Exercises, Core Stabilization Exercises, DNS Training

Study Arms

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

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

Also known as: Standard Physical Therapy, US + IR Therapy, Non-exercise-based conservative treatment, Control group treatment protocol

Control Group (Conventional Treatment Arm):

Eligibility Criteria

• Age: 18 Years - 34 Years
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Women aged 18 to 34 years
• Post-partum (3 to 6 months after delivery)
• Diagnosed with mechanical low back pain
• Body Mass Index (BMI) between 25 and 35 kg/m²
• Medically stable and provided written informed consent

You may not qualify if:

• Use of analgesics, anti-inflammatories, or any physical therapy interventions during the study period
• History of severe trauma, skeletal injury, fracture, or neurological/chronic inflammatory disorders
• Presence of malignancies (primary or metastatic) or osteoporosis
• Diagnosed with chronic neuromuscular conditions
• Failure to comply with instructions or attend regular sessions

Sponsors & Collaborators

• Gehad Alaa: lead

Study Sites (1)

Faculty of Physical Therapy

Cairo, Giza Governorate, Egypt

Location

MeSH Terms

Interventions

Exercise; Ultrasonography

Intervention Hierarchy (Ancestors)

Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Diagnostic Imaging; Diagnostic Techniques and Procedures; Diagnosis

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Gehad alaa mohy el-deen abd el-raheem

Model Details: This study employed a parallel assignment interventional model in which 60 postpartum women with low back pain were randomly assigned to one of two groups: Experimental Group: Received Dynamic Neuromuscular Stabilization (DNS) exercises in addition to conventional therapy (ultrasound and infrared therapy). Control Group: Received only conventional therapy without DNS. Both groups followed the assigned intervention protocol 3 times per week for 6 weeks. Outcome measures (pain intensity and functional disability) were assessed at baseline and after the intervention period using the Numeric Pain Rating Scale (NPRS) and Modified Oswestry Disability Questionnaire (MODQ). Randomization ensured comparable baseline characteristics and minimized selection bias.

Study Record Dates

• First Submitted: July 25, 2025
• First Posted: August 1, 2025
• Study Start: August 1, 2025
• Primary Completion: November 30, 2025
• Study Completion: December 30, 2025
• Last Updated: January 29, 2026

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will share

Locations

EG (1)