Impaired trunk flexor strength, fatigability, and steadiness in postpartum women

Purpose To determine whether postpartum women (vaginal and cesarean delivery) have deficits in trunk flexor strength, fatigability and steadiness, compared with nulligravid women, up to 26 wk postpartum. We hypothesized that postpartum women would be weaker, more fatigable, and have greater torque fluctuations than controls, with cesarean delivery showing greater deficits than vaginal delivery. Methods Twenty-two control women (nulligravid) and 29 postpartum women (20-40 yr, 19 who delivered via vaginal birth, 13 via Caesarian section) participated. Postpartum women were tested 8 to 10 wk and 24 to 26 wk postpartum. Control women were tested 16 to 18 wk apart. Maximal voluntary isometric contractions (MVC) were performed at multiple trunk positions with the trunk flexor muscles. To determine trunk flexor fatigability, subjects performed intermittent isometric contractions at 50% MVC (6-s contraction, 4-s rest) in upright sitting until task failure. An MVC was performed during the fatiguing task (one per minute) and at 10 and 20 min of recovery. Results At 8 and 26 wk, postpartum women (groups pooled) were weaker at all trunk angles (38% and 44% respectively, P < 0.05) than controls despite no differences in handgrip strength. Postpartum women were more fatigable (71% and 52% respectively) and had greater torque fluctuations than controls (P < 0.05). At 8 wk postpartum, women who had a cesarean delivery, were 59% more fatigable (P = 0.004) than the vaginal delivery group, with no difference between delivery types at 26 wk postpartum. Conclusions Musculoskeletal recovery, including trunk flexor muscle strength and fatigability, is incomplete at 26 wk postpartum. These findings provide a rationale for future studies to address outcomes of rehabilitation programs specifically targeted at improving strength and fatigability of the trunk flexor muscles after pregnancy and childbirth.