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Uvod: Več kot polovica žensk v različnih fazah nosečnosti izrazi bolečino v ledvenem predelu. V literaturi zasledimo izraza bolečina v križu in bolečina v medeničnem obroču. Ti dve stanji lahko jasno razlikujemo. Vztrajna bolečina v križu ali bolečina medeničnem obroču sta pogosti stanji, ki ju navajajo ženske med nosečnostjo in po porodu in imata lahko velik vpliv na kakovost življenja. Vaje za telesno pripravljenost pred nosečnostjo zmanjšajo tveganje za nastanek bolečine v križu in bolečine v medeničnem obroču med nosečnostjo in v kateri koli poznejši nosečnosti, vendar pa v mnogih primerih ne morejo preprečiti tega zapleta, zato za lajšanje bolečine in zmanjševanje funkcijske nezmožnosti fizioterapevti posegajo po različnih postopkih manualne terapije. Namen: Namen diplomskega dela je s pregledom literature predstaviti učinkovitost različnih manualnih terapevtskih postopkov pri zmanjševanju bolečine v križu in medeničnem obroču ter zmanjševanju nezmožnosti pri nosečnicah in ženskah v prvih mesecih po porodu. Metode: Iskanje literature je potekalo preko spleta v podatkovnih zbirkah PubMed, PEDro, Medline, CINAHL in Science Direct. Analizirane so bile raziskave, objavljene med leti 2008 in 2016, v angleškem jeziku, v katerih so preverjali učinkovitost različnih manualnih terapevtskih postopkov na zmanjševanje bolečine in funkcijske nezmožnosti zaradi bolečine v križu in/ali medeničnem obroču med nosečnostjo ali po porodu. Rezultati: Analiziranih je bilo devet raziskav. Šest jih je preučevalo učinke manualnih terapevtskih postopkov med nosečnostjo, tri pa po porodu. Rezultati potrjujejo, da manualni terapevtski postopki pozitivno vplivajo na zmanjšanje bolečine in stopnje nezmožnosti. Razprava in sklep: Pri analizi raziskav smo ugotovili, da so različni manualni terapevtski postopki omilil bolečino v križu/medeničnem obroču ter uspešno zmanjšali oziroma preprečili napredovanje stopnje nezmožnosti. Raziskave so se med seboj razlikovale po vrsti postopkov, velikosti vzorca, kriterijih za vključitev v raziskavo ipd., zato ne moremo trditi, kateri izmed postopkov je najbolj učinkovit. Za zagotovitev učinkovitosti različnih manualnih postopkov bi bilo potrebno v prihodnosti opraviti metodološko bolj kakovostne raziskave. Introduction: More than half of women in different phases of pregnancy expresses low back pain. Researching the subject, we often come upon the terms low back pain and pelvic girdle pain. The two states are clearly distinguishable. Persistent low back pain and pelvic girdle pain are frequently reported problems by both pregnant women and women who've given birth and it can considerably affect the quality of life Body fitness exercise before pregnancy reduces risk of both low back pain and pelvic girdle pain during the first pregnancy and during any of the following pregnancies however in many cases cannot prevent the complications. Therefore, physical therapists utilize various manual therapy techniques to alleviate the pain and reduce the functional disability of patient. Purpose: The purpose of this thesis is to show the efficiency of the different manual therapy techniques in reducing back and pelvic girdle pain of pregnant women and of women in the months after birth by the means of analysis of the existing literature on the subject. Methods: Articles were sourced from the scientific databases PubMed, PEDro, Medline, CINAHL and Science Direct. Analysis included the articles published in English between 2008 and 2016 that studied the effects of manual therapy techniques on pain alleviation and redusing functional disability because of low back pain and/or pelvic girdle pain during pregnancy and after birth. Results: Nine studies were analised. Six studied the effects of manual therapy techniques during the pregnancy and three studied the effects of manual therapy techniques after birth. The findings confirm that manual therapy techniques have a positive effect on pain alleviation and reducing functional disability. Discussion and conclusion: Our analysis led to the conclusion that various manual therapy techniques help in alleviating low back pain and pelvic girdle pain and succeed in stopping the progression of functional disability. However, we cannot definitively state which of the techniques is the most effective in achieving the positive outcome as the studies we analysed used different admission cirteria, different methodology and different sample sizes among others. To definitively state the efficiency of different methods, a high-quality controlled randomized study is required.

Uvod: V nosečnosti različne telesne spremembe pogosto vodijo k mišično-skeletnim problemom. Eden pogostejših je bolečina v medeničnem obroču. Nosečnice so zaradi nje omejene pri izvajanju vsakodnevnih aktivnosti, nemalo posameznic zaradi teh težav potrebuje bolniški stalež. Potrebna je posebna obravnava s strani strokovnjakov, največkrat so napotene na fizioterapijo. Namen: Namen diplomskega dela je prikazati fizioterapevtsko obravnavo nosečnice z bolečino v medeničnem obroču v kombinaciji z aplikacijo elastičnih lepilnih trakov, ugotoviti vpliv na simptome in aktivnosti, omejene zaradi bolečine, ter ali je ta vpliv odvisen od prisotnosti elastičnega lepilnega traku. Metode dela: Obravnava, sestavljena iz petih obiskov, je potekala osem tednov. Obravnavali smo 33-letno pacientko v 19. tednu prve nosečnosti z bolečino v medeničnem obroču. Pacientko smo ocenili ob začetku, med potekom in ob koncu obravnave. Ocenjevali smo intenziteto bolečine, izvedli fizikalni pregled in klinične teste za ugotavljanje prisotnosti bolečine v medeničnem obroču. Izpolnila je vprašalnik o medeničnem obroču in Oswestryjev indeks nezmožnosti. Obravnava je temeljila na podajanju informacij o problemu in ergonomskih nasvetov, učenju stabilizacijskih vaj in aplikaciji elastičnega lepilnega traku. Rezultati: Intenziteti stalne in najhujše bolečine, merjeni z vizualno analogno lestvico, sta se precej zmanjšali. Hitrost hoje se je normalizirala, čas faze opore na eno in drugo nogo se je izenačil. Gibljivost v smeri predklona in zaklona se je izboljšala in ni povzročala bolečin. Ob koncu se je število pozitivnih kliničnih testov povečalo za enega, rezultat testa aktivnega dviga stegnjenega spodnjega uda od podlage se je izboljšal s 3 na 1. Izboljšal se je tako rezultat Oswestryjevega indeksa nezmožnosti (s težke na minimalno nezmožnost), kot tudi rezultat vprašalnika o medeničnem obroču (z 52,8 % na 4 %). Razprava in sklep: Obravnava je bila zelo uspešna pri izboljšanju stanja, a je treba poudariti vpliv bolniškega staleža na rezultate. Ob ocenjevanju stanja tekom terapije smo ugotovili, da je bilo stanje boljše ob prisotnosti elastičnega lepilnega traku. Zaključili smo, da je fizioterapevtska obravnava v kombinaciji z elastičnim lepilnim trakom uspešna pri obvladovanju bolečine v medeničnem obroču. Posledično priporočamo vključitev elastičnih lepilnih trakov kot dopolnilno intervencijo v splošno obravnavo tega problema. Introduction: There are many different physical changes during pregnancy. These often lead to musculoskeletal problems, and pelvic girdle pain is a common one. It negatively effects daily activities of pregnant women and many of them consequently need to take a sick leave. A special management from different health professionals is needed, and pregnant women are frequently referred to a physiotherapist. Purpose: To show a physiotherapy management of a pregnant woman with pelvic girdle pain in combination with a kinesiology tape application to find out effects on symptoms and affected activities, and whether these effects depend on the presence of the kinesiology tape. Methods: The physiotherapy management lasted eight weeks and consisted of five appointments. Patient was a 33-year-old in her 19th week of pregnancy (first one) with pelvic girdle pain. We evaluated her at the beginning, during and at the end of the management. Pain intensity was measured, a physical examination and clinical tests for identifying the pelvic girdle pain were carried out. The patient filled in The Pelvic Girdle Questionnaire and Oswestry Disability Index. The management included information, ergonomic advice, stability exercises and application of the kinesiology tape. Results: Intensity of constant and the worst pain, measured with visual analogue scale, has decreased. Walking speed normalized and stance phase was equal on both sides. Bending forward and backward were not restricted and painful anymore. The amount of positive clinical tests increased for one, but the active straight test improved from 3 to 1. Results of both questionnaires improved – The Pelvic Girdle Questionnaire from 52,8 % to 4 %, and Oswestry Disability Index from severe to minimal disability. Discussion and conclusion: Physiotherapy management considerably improved patient’s condition. However, it is important to stress the influence of sick leave on obtained results. As we evaluated patient’s condition during physiotherapy management, we noticed that the condition was better in presence of the kinesiology tape. We conclude that physiotherapy management in combination with application of the kinesiology tape is successful at relieving pelvic girdle pain. Therefore, we recommend its use in general physiotherapy management of pelvic girdle pain as a supplementary intervention.