Advances in Social Science, Education and Humanities Research, volume 535

Proceedings of the 1st Paris Van Java International Seminar on Health, Economics,
Social Science and Humanities (PVJ-ISHESSH 2020)

Back Massage Therapy to Reduce Low Back Pain

in Pregnancy
1st Indah Puspitasari 2nd Irawati Indrianingrum
Midwifery Departement Midwifery Departement
Health Faculty Health Faculty
Universitas Muhammadiyah Kudus Universitas Muhammadiyah Kudus
Indonesia Indonesia
*[email protected]

Abstract—Pregnancy is a unique natural condition increased hormones namely the hormones

experienced by women. In pregnant women, an adjustment somatomammotropin, estrogen and progesterone, maternal
process occurs that can cause physiological changes, which cause psychology such as attention and affection for her pregnancy
discomfort in pregnant women. In most pregnant women report and fetal development over time. From these changes,
almost 50% - 80% feel discomfort back pain experienced by eventually the mother will experience a period that causes the
mothers during pregnancy. Pregnancy with low back pain
(LBP) is a common complaint that occurs in pregnant women.
mother to feel uncomfortable and disturbed. Generally this
This can potentially affect the quality of their lives which will physiological state occurs even without the need to use certain
have a negative impact. Factors that influence LBP include medications. But sometimes if not handled properly this
mechanical, hormonal and other factors. Massage therapy is a discomfort will turn into a pathological state that can interfere
non-pharmacological method that provides pressure by the with maternal activity, can even endanger the pregnancy of the
hands on soft tissue, usually on muscles, tendons or ligaments, mother.[2]
without causing a shift or change in joint position to reduce pain, In most pregnant women report almost 50% - 80% feel
produce relaxation, and improve circulation. By paying discomfort during pregnancy. Among the discomforts due to
attention to the things mentioned above, researchers are back pain experienced by mothers during pregnancy. [3] A
interested in conducting a study of the effect of back massage
therapy on decreasing low back pain in pregnant women.
number of studies on back pain related to pregnancy are
Method: This research is a type of experimental research, around 25% to 90%, most studies estimate that 50% of
nonequivalent control group design and research approaches pregnant women will suffer from back pain. One third of them
using quasi-experimental or quasi-experimental research. The will suffer severe pain, which will reduce their quality of life.
population in this study were all pregnant women in the area of 80% of pregnant women who suffer from back pain while
Kudus Gribig Health Center. Samples amounted to August- pregnant say that it affects their daily routine and 10% of them
September 2018 of 30 pregnant women. The sampling technique report that they cannot work.[3] About 80% of women will
uses consecutive sampling that meets the inclusion and exclusion experience back pain at some point during pregnancy. Most
criteria. The inclusion criteria were trimester 3 (28-32 weeks) back pain during pregnancy results from changes in the
pregnant women, primiparous and multiparous, experiencing
back pain, and willing to be the subject of research. The results
backbone muscles that are as much as 70%. Without strong
showed that there were significant differences before and after back muscles, injuries to the ligamental will get worse so that
back massage was given to decrease lower back pain in pregnant posture worsens, the rest or 30% of back pain during
women. Conclusion: the application of back massage therapy pregnancy may be due to irregularities in the condition of the
has proven to be effective in reducing the discomfort of low back spine that occurred before.[4]
pain experienced by pregnant women. It is important for Discomfort of back pain in pregnancy may be expected by
midwives to support pregnant women in antenatal care, most pregnant women, but what they want if this is
especially in utilizing non-pharmacological methods as an experienced over and over is the knowledge gained during
effective method for reducing discomfort during pregnancy. antenatal care about how to cope or reduce the pain or
Keywords—Massage, Therapy, Reduce Low, Back Pain, discomfort.[2]
pregnancy Pregnancy with low back pain (LBP) is a common
complaint that occurs in pregnant women. This can potentially
I. INTRODUCTION
affect the quality of their lives which will have a negative
Pregnancy is a unique natural condition experienced by
impact. Factors that influence LBP include mechanical,
women. In pregnant women, an adjustment process occurs that
hormonal and other factors.[3] During pregnancy along with
can cause physiological changes, which cause discomfort in
the enlargement of the uterus, the center of gravity will move
pregnant women.[1] During pregnancy several maternal body
towards the front so that pregnant women must adjust their
systems experience changes that result from fetal development
position, where pregnant women must depend on muscle
that occurs. These changes are the basis for the emergence of
strength, weight gain, joint relaxation, fatigue and posture
discomfort that occurs in most pregnant women. This will
before pregnancy. Improper posture will force additional
cause changes in the mother's body, which causes discomfort
stretching and fatigue in the body, especially in the spine so
due to changes in the mother's body such as changes in
that it will cause pain or pain in the back of pregnant
external genetal organs, internal genetals and breasts,
women.[5]

Copyright © 2021 The Authors. Published by Atlantis Press SARL.

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 Advances in Social Science, Education and Humanities Research, volume 535

This is in line with the theory that the process of pregnancy primary data for both dependent and independent variables.
will cause various changes in the entire body system. The Previously, pregnant women as respondents were asked to be
impact of changes in the musculoskeletal system often causes willing to play a role in this study. If you are willing, then you
pregnant women to feel pain in the lower back region. The sign the informed consent form. Furthermore, pregnant
enlargement of the uterus affects the center of gravity, women were measured the level of back pain felt using a
stretches out and weakens the abdominal muscles, changes visual analogue scale (Visual Analog Scale, VAS) which is a
posture and puts pressure on the back. This is what causes back horizontal line with a range of 0-10. as a pre test. Then back
pain, besides being overweight will certainly affect the massage is performed on pregnant women by the husband or
muscles to work more so that it causes stress on the joints.[6, researcher. The technique of massage on the back in question
7] is to give a gentle and unstressed stroke with gentle rubbing
Lower back pain in pregnant women is the most frequently with both palms and fingers on the back of the maternal
reported problem in pregnancy. Lower back pain experienced cervical high 7 outward towards the side of the rib cage with a
by pregnant women will reach its peak in the 24th to 28th duration of 30 minutes with a frequency of 40 times rubbing /
week, just before the abdominal growth reaches its maximum minute, but try the tip of the finger does not escape the surface
point. During this time pregnant women consider that of the skin.[9-11] This massage therapy is carried out by the
complaints of back pain is a natural thing that occurs during mother at home for four weeks (28 days).
pregnancy. So the efforts that have been made so far to reduce After that, the researchers then gave a post-test to measure
complaints of low back pain are just resting. Usually to reduce the severity of back pain felt by the mother after back massage
back pain, pregnant women only rest or lie alone because the therapy. The instrument used to collect data from the
average thought the pain will decrease by itself. Then at the independent and dependent variables was a questionnaire with
time of control at the doctor or midwife they rarely complain several questions regarding characteristics (age, education,
of back pain because it is considered normal for pregnant occupation, and parity) and low back pain that the mother felt.
women. If when you are back pain, it will inhibit the activity Then the data is collected for further data processing and data
of pregnant women.[7] presentation. Data processing uses the Wilcoxon Test to
According to the results of research various determine the effect of back massage therapy on reducing low
complementary techniques that can be applied to the back pain in pregnant women.
treatment of low back pain in pregnancy that have been
III. FINDING AND DISCUSSION
developed include massage (61.4%), relaxation (42.6%),
chiropractic (36.6%), acupuncture (44 , 6%), yoga (40.6%) The results of the study include data normality tests, and
and acupressure.[8] One non-pharmacological method that differences in lower back pain in pregnant women before and
can reduce pain is massage, which is also a non- after back massage
pharmacological method that gives pressure to the hands on therapy.
TABLE I. NORMALITY TEST BASED ON THE PAIN VARIABLE
soft tissue, usually on muscles, tendons or ligaments, without Variable Respondent % P*
causing a shift or change in joint position to reduce pain, N=30
produce relaxation, and increase circulation.[7] Pain_pre 0.000
By paying attention to the things mentioned above, Mild pain 17 56.7
Moderate pain 7 23.3
researchers are interested in conducting a study of the effect of
Severe pain 6 20
back massage therapy on decreasing low back pain in pregnant Pain _post 0.000
women. No Pain 4 13.3
Mild pain 20 66.7
II. METHODS Moderate pain 6 20
This research is a type of experimental research. Using a *Shapiro-Wilk
non equivalent control group design and research approach
using quasi-experimental or quasi-experimental. The Table1 Shows that the In the normality test, the
population in this study were all pregnant women in the area significance value obtained for the two data groups is p <0.05,
of Kudus Gribig Health Center. Samples amounted to August- which means the distribution of the two data is not normal, so
September 2018 of 30 pregnant women. The sampling the paired group difference test uses the Wilcoxon Test
technique in this study uses consecutive sampling that meets
the inclusion and exclusion criteria. TABLE 2. DIFFERENCE IN DECREASE IN LOW BACK PAIN IN
The inclusion criteria in this study were pregnant women PREGNANT WOMEN BEFORE AND AFTER GIVEN BACK
trimester 3 (28-32 weeks), primiparous and multiparous, MASSAGE THERAPY
Variable n P*
experiencing back pain, and willing to be the subject of
Pain_pre 30 0,002
research. Exclusion criteria were pregnant women with Pain_post 30
complications, comorbidities, gameli diagnoses, and women
who moved places. The data collected comes from primary Table2 Shows that the Based on the results of data analysis,
data and secondary data. Data collection was started by there are differences in lower back pain in pregnant women
collecting secondary data, namely data of third trimester between before and after given back massage therapy, with a
pregnant women who experienced complaints and fulfilled the value (p <0.05). So that Ho is accepted and Ha is rejected. So,
inclusion and exclusion criteria in the working area of the the results showed that there were significant differences
Gribig Community Health Center in Kudus Regency. After
collecting secondary data, the researchers then collected

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before and after back massage was given to decrease lower production of encephalines by the adrenal medulla so that it
back pain in pregnant women. will affect mood and give a relaxed feeling.[23]
IV. DISCUSSION Relaxation techniques will stimulate endorphins secretion
During pregnancy, the posture of the mother's body will in the brain. The statement was supported by Newberg and
change naturally. The hormones produced during pregnancy Waldman (2013) who found that feeling comfortable, both
cause the ligaments that support the joint to relax. This makes physically and psychologically, is a response from the
the joints experience more movement and more risk of injury. expenditure of endorphins. Based on these two findings, back
During pregnancy, weight will lean forward or heavier on the massage can stimulate an increase in endorphins. Relaxation
front, thereby shifting the center of gravity. The position of will trigger the release of endorphins. The hormone is in the
the joints and muscles, especially on the pelvis and lower form of polypeptides which contain 30 units of amino acids
back, so that it can make pregnant women become less stable that bind to opiate receptors in the brain. This hormone acts
and lose balance, especially in late pregnancy, this can cause like morphine, even said to be 200 times more effective than
pain in the back.[21] morphine. Endorphins can cause feelings of euphoria, happy,
Pain is an uncomfortable feeling that is very subjective comfortable, create calm and improve one's mood to make
and only the person who experiences it can explain and someone relax. Relaxation will trigger the limbic system and
evaluate the feeling. The level of pain is said to be severe pain trigger the hypothalamus to secrete endorphins. Under these
if the pregnant woman subjectively says severe pain and conditions, the concentration of endorphins in the brain will
objectively the client cannot follow orders but still responds increase. Increased endorphins in the brain will create a
to actions, can indicate the location of pain, cannot be feeling of physical relaxation. With increasing endorphins,
overcome with deep breathing techniques and distractions cortisol secretion will be suppressed so that the mother will
properly and does not affect activity. If back pain is not feel a psychological sensation of relaxation. Increased
treated immediately, it can lead to long-term back pain, endorphins after back massage will cause vasodilation of
increasing the tendency of postpartum back pain and chronic blood vessels which has implications for improving
back pain that will be more difficult to treat or cure.[22] Back circulation where oxygen and energy supply is improved. In
pain (LBP) is a difficult condition to prevent, but it is addition, feeling relaxed will reduce the metabolic rate and
important to inform the mother about methods that mothers reduce energy requirements. Increased endorphins will be
can take to overcome and reduce low back pain during followed by simultaneous suppression of cortisol. With the
pregnancy including how to maintain body posture in daily decrease in cortisol, it will reduce psychological problems
activities, how to lift weights, sleeping position and such as depression and anxiety. Back massage is an
application back massage therapy that is proven effective in intervention that can affect the physical and psychological
reducing back pain.[2] aspects of the mother.[23, 24].
Back massage therapy, a non-pharmalogical method that V. CONCLUSION
is without using drugs, is safer, simpler, does not require Based on the results of the study, it was found that the
many tools, is easy to do and does not cause adverse effects application of back massage therapy has been proven
and refers to the care of dear mothers. This massage aims to effective in reducing the discomfort of low back pain
improve blood circulation, put pressure on, and warm the experienced by pregnant women. It is important for midwives
abdominal muscles and increase physical and mental to support pregnant women in antenatal care, especially in
relaxation.[10] utilizing non-pharmacological methods as an effective
Massage on the back stimulates certain points along the method to reduce discomfort during pregnancy. Apart from
spinal cord meridians that are transmitted through large nerve being safer, not requiring many tools, easy to do and not
fibers to the reticular formation, that thealamus and limbic causing side effects and referring to maternal care, it also aims
system of the body will release endorphins. Endorphins are to increase the mother's physical and psychological
neurotransmitters or neuromodulators that inhibit the delivery relaxation.
of pain stimuli by attaching opiate receptors to nerves and ACKNOWLEDGMENT
spinal cord so that they can block pain messages to a higher We thank to the participants, Rector of Muhammadiyah
center and can reduce pain sensations.[11] University of Kudus, the department of research and
This back massage therapy can be done both by health community service and those who have helped this research:
workers, the patient's family, and the patient himself. To the Gribig Community Health Center, Gebog Subdistrict,
Massage on the back stimulates the receptors that make the Kudus Regency.
mother more comfortable due to muscle relaxation.
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