A RESEARCH REPORT OF ‘‘PREVALENCE OF

MUSCULOSKELETAL DISORDERS IN MULTIPAROUS

WOMEN”

Submitted to Dr.Sumaira Nawaz

By
Aisha Siddiqa 15-US-364-61
Syeda Aiza Bukhari 15-US-364-80
Faryal Tariq 15-US-364-69
Hira Asghar 15-US-364-70
Rameesha Mazhar 15-US-364-75
Rimsha Islam 15-US-364-76
Students of

ISLAM COLLEGE OF PHYSICAL THERAPY, SIALKOT THE

DEGREE FOR THE PARTIAL FULFILMENT OF CRITERIA TO
AWARD OF DOCTOR OF PHYSICAL THERAPY (DPT)

I
 PREVALENCE OF MUSCULOSKELETAL DISORDERS IN
MULTIPAROUS WOMEN

DOCTOR OF PHYSICAL THERAPY (DPT) UNIVERSITY

OF SARGODHA, SARGODHA PREVALENCE OF
MUSCULOSKELETAL DISORDERS IN MULTIPAROUS
WOMEN

Observational Study

Session (2015-2020)

A project submitted to

Dr. Sumaira Nawaz

By
Aisha Siddiqa
Syeda Aiza Bukhari
Faryal Tariq
Hira Asghar
Rameesha Mazhar
Rimsha Islam

DOCTOR OF PHYSICAL THERAPY (DPT) ISLAM COLLEGE OF PHYSICAL

THERAPY AFFILIATED WITH UNIVERSITY OF SARGODHA, SARGODHA

II
RESEARCH SUPERVISOR:

Dr. Sumaira Nawaz Physiotherapist

III
DPT, BCMT, MS (OMPT)
Islam College of Physical Therapy Sialkot

Signature

CO-SUPERVISOR:

Dr. Nimra Naveed Physiotherapist

DPT (UOS)
Lecturer Islam College of Physical Therapy Sialkot
Signature

Dr. Touqeer Ahmed

MBBS, PhD, MPhill
Head of Department
Department of Physical Therapy
Islam College of Physical Therapy
Signature

CERTIFICATE OF ORIGINALITY
The thesis entitled “PREVALENCE OF MUSCULOSKELETAL DISORDERS

IV
IN MULTIPAROUS WOMEN” submitted by me in Department of Allied Health
Sciences, Islam College of Physical Therapy, University of Sargodha, for the partial
requirement of the degree of Doctor of Physical Therapy (DPT) is original, and
nothing has been stolen/ copied/ plagiarized from any source.

Students Name: Aisha Siddiqa (9200)

Syeda Aiza Bukhari (9202)
Faryal Tariq (9201)
Hira Asghar (9198)
Rameesha Mazhar (9203)
Rimsha Islam (9199)

Date
ISLAM COLLEGE OF PHYSICAL THERAPY, SIALKOT
Internal supervisor name: ____________________
Signature: ____________________
Date: _________________
Co-supervisor: ____________________
External supervisor: ____________________
Signature: ____________________
Date: ____________________

STUDENT CONSENT FORM

We, Aisha Siddiqa, Syeda Aiza Bukhari, Faryal Tariq,Rameesha Mazhar,Rimsha Islam
and Hira Asghar are submitting our original research work to the supervisor
Dr.Sumaira Nawaz, for the Terminal project for the completion of “Doctor of
Physical Therapy” Program. We agree that upon acceptance by my supervisor, all

V
copyright ownership for the thesis is transferred to the Islam college of Physical
therapy. The undersigned stipulate that the thesis submitted to Islam college of
Physical therapy is new, original and has not been submitted to another publication
for concurrent consideration. The Islam college of Physical therapy holds the right
to reject my thesis on account of ethical misconduct after the printing of thesis. It is
also attested that after acceptance of our thesis, will be the property of Islam college
of Physical therapy, Pakistan. The material used in my thesis will not be published,
reprint and rewrite without written permission from competent authority of Islam
college of Physical therapy. We also attest that any human and /or animal studies
undertaken as part of the research from which this manuscript was derived are in
compliance with regulation of our institution(s) and with generally accepted
guidelines governing such work. I further attest that I have herein disclosed any and
all financial or other relationships which could be construed as a conflict of interest
and that all sources of financial support for this study have been disclosed and are
indicated in the acknowledgement.

Aisha Siddiqa
SyedaAizaBukhari
Faryal Tariq
Hira Asghar
Rameesha Mazhar
Rimsha Islam

VI
DEDICATION
I dedicate my work to Allah Almighty and Holy prophet Hazrat MUHAMMAD
(PBUH).
&
In dedication to my parents for making me to be who I am and my teachers and all
others who have helped me along.

ACKNOWLEDGMENT
First and foremost, praises and thanks to God, the Almighty, for His showers of
blessings throughout my research work to complete the research successfully. I
would like to express my deep and sincere gratitude to my research supervisor, DR.
SUMAIRA NAWAZ for allowing me to do research and providing invaluable
guidance throughout this research. His dynamism, vision, sincerity, and motivation

VII
have deeply inspired and helped me to complete this research. He has taught me the
methodology to carry out the research and to present the research work as clearly as
possible. I am also grateful to DR. TOUQEER AHMED (Head of Department,
Islam College of Physical Therapy) for providing us this excellent opportunity at
this platform. I would like to express my sincere thanks to volunteer researchers for
sharing their pearls of wisdom and efforts to implement this project in a limited
period. I am extremely grateful to my parents for their love, prayers, caring and
sacrifices for educating and preparing me for my future.

Dated: ____________________

Aisha Siddiqa
Syeda Aiza Bukhari
Faryal Tariq
Hira Asghar
Rameesha Mazhar
Rimsha Islam

VIII
 RESEARCH COMPLETION CERTIFICATE
It is certified that research work contained in this project titled,
“PREVALENCE OF MUSCULOSKELETAL DISORDERS IN
MULTIPAROUS WOMEN" has been carried out by Name as per
requirement for the award of degree DOCTOR OF PHYSICAL THERAPY
(DPT) under my supervision.

DECLARATION OF ORIGINALITY
WE Aisha Siddiqa (9200)
Syeda Aiza Bukhari (9202)
Faryal Tariq (9201)
Hira Asghar (9198)
Rameesha Mazhar (9203)
Rimsha Islam (9199)

IX
 Registration No. 15-US-SMC-

Student of Doctor of Physical Therapy during session 2015-2020 hereby declare that
this project is entirely my work other than the counsel of my Supervisor and it has
not been submitted for any academic award or part thereof, at this or any other
educational establishment

Author:

LIST OF ABBREVIATIONS

X
Serial Abbreviation Description

1 WHO World health organization

2 DPT Doctor of physical therapy

3 PT Physiotherapist

4 SPSS Statical packages of social sciences

5 Pt Patient

LIST OF TABLES

NO. TABLES PAGE-NO

XI
1 Education 11

2 Average income 12

3 Number of children 13

4 Breast feeding their children 16

5 Food groups consume 19

LIST OF FIGURES

XII
 S-NO. FIGURES PAGE NO.

1 Age 10

2 Menstrual cycle 15

3 Positioning during breast feeding 17

4 Duration of MSK problems 20

5 Previous treatement of MSK problems 21

6 Region of body have MSK pian 22

TABLE OF CONTENTS
Titles

XIII
 1
Introduction

3
Literature review

6
Objectives

7
Methodology

9
Result

24
Discussion

26
Limitation

26
Recommendation

30
References

ABSTRACT

Background:

XIV
The study examined the prevalence of musculoskeletal disorders among multiparous
women. Multiparity triggers a wide range of changes in women body leading to
musculoskeletal disorders. Musculoskeletal pain was present among 83% women,
some researchers reported 99% prevalence and most common complaint was low
back pain.

Objective:

This study aims to investigate the prevalence of musculoskeletal disorders in

multiparous women of Sialkot and to show the most effective region of body with
parity.

Methodology:

An observational study was carried out to determine the prevalence of

musculoskeletal disorders in multiparous women in hospitals of Sialkot, Punjab
Pakistan. 100 consenting multiparous women from age 29-48 years, were
participated in this study. A standard questionnaire, Cornell musculoskeletal
discomfort Questionnaire that sought information on maternal socio-demographics,
duration of the pain, region of the pain was employed in the study. Data was
analyzed using descriptive statistics SPSS version 26.0.

Results:

The results regarding the prevalence shows that there is high occurrence of
musculoskeletal disorders (83%) in multiparous women in different hospitals of
Sialkot: most common is low back pain (22.9%) and then knee pain(17.6%),
shoulder pain(14.7%), wrist pain(6.9%), neck pain(6.9%), upper back pain(3.9%),
foot pain(3.9%), lower leg(2.9%), hip pain(2%).

Conclusion:

The descriptive analysis shows that there was high occurrence of musculoskeletal
disorders in multiparous women at different hospitals of Sialkot, most common is
low back pain, shoulder pain and neck pain. The greater the number of deliveries’
the greater the musculoskeletal disorders.

Key words:

Musculoskeletal disorders MSDs, Multiparous women.

XV
 CHAPTER 1

INTRODUCTION:
Musculoskeletal disorders are major health problems in case of number of
pregnancies. Musculoskeletal disorder is define in old literature as the combined
term as musculoskeletal conditions i.e. pain and injuries that affect body joints,
ligaments, muscles and other soft tissues(1).Musculoskeletal disorders are most
frequently present in multiparous women. Parity can be defined as earlier
pregnancies of greater than twenty-eight-week gestation. Parity is categorized on
basis of levels as nulliparous –who has not given birth previously, primiparous –
who has given birth to one child, multiparous–who has given birth to more than
one child(2) and grand multiparous (3).
Some articles reported that multiparous women are those who have children
greater than two(4). These structure play important role in limbs, neck and back
support(1). Low back pain is the massive problem in multiparous population. A
lot of studies related to back pain said that pain in lumbar region occur due to
decrease abdominal endurance and spinal support by increasing number of
pregnancies(5). Musculoskeletal pain is 3-4 times more common in cesarian
female as compared to vaginal deliveries (6).Evidence support that
musculoskeletal disorders most commonly occur in feeding mothers. Mothers
adopt different positions during lactation to feed her baby have negative effect on
posture. Most common troubles including cervical pain, brachialgia, kyphosis,
lordosis and sciatica(7). Women experience biomechanical changes throughout
pregnancies that cause postpartum changes, increase chances of osteoarthritis for
woman(8).During pregnancy several hormones release included estrogen,
Progesterone and relaxin. Relaxin hormone releases from corpus leuteum which
cause the relaxation of soft tissues i-e ligaments and muscles. Relaxation of
structures affect the biomechanics of posture(9). Joint laxity of wrist and
shoulder increases during and after pregnancy. Shoulder stiffness and wrist pain
reported in great prevalence. After pregnancy women perform multiple tasks
such as caring of children, feeding of newborn baby and perform daily task that
increase the musculoskeletal demand(10).
Low back pain is most reported complain of women after childbirth. Prevalence
of the back pain is different between parous and nulliparous women. women

1
reported LBP even after 3 years after deliveries due to the persistence of
muscular insufficiency.
Additional studies suggested that multiparous woman have less Bone Mass Index
and more weight gain as compared to woman with no delivery(11). One of the
study stated that obesity increase the chances of knee osteoarthritis(12)and
increase the severity of neck pain(13). The chance of osteoarthritis increases in
multiparous women due to the hormonal factors. The risk of knee replacement
increases by 8% in multiparous women after every birth. One of the risk factors
of the occurrence of cervical cancer is the multiparity. According to Ogenbode et
al cervical cancer occur in women in third and fourth decade of life (14).
Decrease level of bone mineral density have positive relation with number of
deliveries in underdeveloped countries. Bone mass index decreases especially in
femur and lumber spine(15).
Multiparous women who carry high perceived barrier are less physically active.
Highly educated women are more physically. Women involve in the household
activities include bending and twisting of different regions of body. Abdominal
muscle strength decreases due to remodeling of the connective tissues(5)increase
the stress on back and cause low back issues. Carpal tunnel syndrome is common
peripheral neuropathy related to pregnancy. The severity of Carpal tunnel
syndrome increase by number of children (16).

CHAPTER 2

2
LITERATURE REVIEW:
Hanneke A.H et al reported pain at anatomical pain site present in high prevalence
in women without affected by duration of pain(17). Marc J Heronemus et ali. in feb
2021 conducted a study. The aim of this study was to show the association of parity
with dynamic foot pronation. Total 1177 number of women were involved for
study. Women were had children from 0 to 5. Population based sample of female
was collected. History of female was collected and X-pedobarographic was used to
measure the dynamic function of foot of every participant. In the history of
participants was included information related to weight, height, age, race and
number of children. Women inform to researcher about musculoskeletal pain due to
hip, foot, and back pain. Changes in foot structure during pregnancy elaborate the
reason behind the multiparous women prone to musculoskeletal issues as compared
to nulliparous women. Conclusion of study show that parity have positive relation
with foot pronation .Dynamic foot pronation of women increases by increases the
number of children(18).
Sadia Rani and Um-e-Habiba et al carried out a study in April 2019. The aim of
their study was to find out the association between the different position during
feeding and muscular and bony issues in mothers. The study was population based.
The sample size of the study was 400 lactating mothers between 20 to 40 years.
From this study they concluded that position adopted during breastfeeding have
strong effect on whole body of mother especially on cervical muscles and least on
lower legs. In 36.8% population was seen by mechanical neck pain and 22% was
seen by low back pain(7).Stein, Bekah P in 2020 conducted a study to show the
impact of parity on gait biomechanics. The study revealed that laxity of knee
ligaments continue after pregnancy greater than four months.

Fatima Begum, Fatima Jesmin et al carried out a study on 2 July 2015. The motive
of the study was to explore the effect of parity on bone mineral density in women
that were fertile. The members selected for study were female of reproductive age.
Age of population between 15 to 49. The data collected from female of reproductive
age of group included height, weight, history of number of children. The test DEXA
scan was used to determine the bone mineral density at L2-L4 and femoral neck of
all group members. Authors from this study founded that when the numbers of
children increase the BMD decrease in women especially in lumbar spine and
femoral neck.

3
The BMD was lower in multiparous as compared to nulliparous women(3).

A study was conducted by A-Gu, R.sellamathu,E.Himes et al. Effect of parity on

middle age women was studied in 10 July 2017. The objective of the study to find
out the effect of parity on bone formation in middle-aged women. Women mice
were used for this study. Total 63 female mice were used to determine the effect of
births. Mice were divided into groups according to number of parity. Calcium,
Protein and Alkaline phosphate level were measured of each member of group.
They concluded that number of parity inversely proportional to Bone mineral
density. Observation show that parity affect the bone homeostasis and osteoblast
enzymatic activity. The study of A-Gu et al revealed that those mothers who have
5 pregnancies have effect on trabecular bone formation and no changes seen in
cortical bone (19).

A study was directed by Khadgi, Karki, Achary et al. They studied in 31 Dec 2019.
The purpose of study was to describe the effect of parity on abdominal endurance in
nulliparous, primiparous and multiparous women. Abdominal endurance is the
ability of abdominal muscles to work for prolong period. Total 100 women were
evaluated to find out the effect of parity on abdominal endurance. 100 women were
distributed into three groups first nulliparous, second primiparous and third
multiparous. Nordic musculoskeletal questionnaire used as screening tool of MSK
disorders. Benefits, Risk, and purpose of study were described to each member of
groups. Result of this study showed that as numbers of birth increase, the abdominal
endurance decrease 45.5% in nulliparous, 48 .5% in mother deliver child first time
and 52.9% in multiparous women (5).

A study was conducted by Am-J, Obstet Gynecole et al studied in Nov 2018. The
plan of study was to determine the alternation in strength of pelvic floor muscles
over time in women. Women selected for research were over 40 years old give birth
to more children. Prospective cohort study of parous women was done to determine
the influence of number of children births on mother. Priton perineometer was use
as tool to measure the strength of muscles. Pritron perineometer represent the
strength of muscles. Prospective cohort study of parous women was performed.
Pelvic floor muscle strength decreased in participant with c-section as compared to
participants increased in strength with vaginal delivery. Researchers revealed that
fatty women

4
had low strength in contrast with those women who have normal weight. Weight
gaining and method of delivery affect the strength of pelvic floor muscles(20).

A study was conducted by Ingrid Heuch, Ivar Hagen, Knut Hagen et al to determine
the relationship of parity with low back pain in women have the children. A cross
sectional study was studied on 15 October 2020. Researchers intend to measure the
relationship between parity, age at delivery and prevalence of chronic lower back
pain. Those women who give birth to child at age less than 25 to 29 years have less
prevalence of musculoskeletal problem as compared to women who give childbirth
at age greater than 30 years. As parity increase the chances of lower back pain
increase. Numbers of hormones release during pregnancy. Progesterone, Estrogen,
and relaxin are the most important hormones. Hormones release during pregnancy
increases the laxity of ligaments and joints. places the excessive stress on the spine.
Excessive strain place on spine by increasing parity(21).

A study was conducted by Mesule Kisle et al. studied in department of Numan

hospital studied in 16 May 2018.In retrospective study, the purpose of study was to
reveal the association of number of birth with CTS occurrence in women after child
birth(16). Carpal tunnel syndrome is the most common nerve entrapment
syndrome(22) . total 1150 number of women were selected for this purpose.
Demographic data and obstetric history obtained from patient to assess the CTS
after recurrent pregnancies. Nerve conduction test was also recorded from all
participants. Women were followed up for 6 to 12 months. Follow up of selected
parous women showed that CTS persist after 6 to 12 months after delivery. Women
showed that Electromayography test was use for the diagnosis of carpal tunnel
syndrome in every member. CTS common in female population as compared to
male population. This study yield that no variation occur with number of birth in
carpal tunnel syndrome
(16).

Saionara Maria Aires, Catherine Pirkle et all studied on 5 August 2015. In low
socioeconomic countries the parity is common cause of early onset of physical
functioning .The result showed that physical activities decreases in result of
multiparity in those areas who have low income status(4).

5
 1.2 - OBJECTIVE:

This study aims to investigate the prevalence of musculoskeletal disorders in

multiparous women of Sialkot and to show the most effective region of body with
parity.

To determine the impact of multiparity and musculoskeletal disorder related to MSK

in postnatal multiparous women.

CHAPTER 3

6
METHODOLOGY:
3.1 STUDY DESIGN:
Cross Sectional Survey
3.2 STUDY SETTING:
This study was conducted in some selected hospitals of Sialkot; Islam Teaching
Hospital, Govt. Allama Iqbal Memorial Teaching Hospital, Sialkot, Model Town
area, Barth
3.3 DURATION:
Study was completed 6 months after the approval of synopsis
3.4 SAMPLING TECHNIQUE: Convenient Random Sampling 3.5
SAMPLE SIZE: sample size was 100 with 5% margin of error and
95% confidence interval.
3.6 SAMPLE COLLECTION:
Cornell musculoskeletal discomfort Questionnaire 3.7
DATA ANALYSIS:
Data was analyzed using SPSS version 26.

INCLUSION CRITERIA:
1 Females between 30 – 49 years age group were
included in our study
2 Fertile females were included in our study

3 Females having more than 3 to 4 children

EXCLUSION CRITERIA:
1 No pregnant females

2 Above 50 years

3 Have one or two children

4 Autoimmune disease

5 Diabetic women

6 Woman having hepatic disease

7 Malignancy

CHAPTER 4

7
RESULT:
The results regarding the prevalence shows that there is high occurrence of
musculoskeletal disorders(83%) in multiparous women in different hospitals of
Sialkot: most common is low back pain(22.9%), knee pain(17.6%), shoulder
pain(14.7%), wrist pain(6.9%), neck pain(6.9%), upper back pain(3.9%), foot
pain(3.9%), lower leg(2.9%) and the risk factors are poor diet, lack of education,
steroid therapy, menopause age before 45 years, mode of delivery(C-sections). The
greater the number of deliveries, the greater the musculoskeletal problems (women
with 3-5 children=79%), (6-8 children=85%) (greater than 8=100%) (6-8
children=85%). 14% women were those who were not breast feeding. Others who
feed their child reported position side lying(49%) and cross
Cadel(21.6%).Musculoskeletal disorders are one of the common hazards for general
activity, walking ability, and mood were much interfered by pain among
multiparous women.

8
This pie chart show that greater % of respondents fall in age 40-49 and less fall in
age 29-39.

9
 EDUCATION
Frequenc Valid
y Percent Percent Cumulative Percent
Valid Matriculation 24 23.5 24.0 24.0

Intermediate 22 21.6 22.0 46.0

25.5 26.0 72.0
Graduation 26
Uneducated 28 27.5 28.0 100.0

Total 100 98.0 100.0

2.0
Missing System 2
Total 102 100.0

This table represents the educational level of participants. This table shows that 24%
of the participants are matriculated,21% of participants are intermediate, 26% of the
participants are graduated, 29% of the participants are uneducated and 100% are the
total participants.

10
Sample description on basis of average income
Average Income
Cumulative
Frequenc Valid Percent
y Percent Percent

Valid 10,000 to 20,000 15 14.7 15.0 15.0

20,000 to 40,000. 33 32.4 33.0 48.0

40,000 to 60,000 33 32.4 33.0 81.0

Above 60,000 19 18.6 19.0 100.0

Total 100 98.0 100.0

Missing System 2 2.0

Total 102 100.0

This table represents the average income of the participants. This table shows that
15% of the participants have 10,000 to 20,000 income, 33% of the participants have
20,000 to 40,000 income, 33% 0f the participants have 40,000 to 60,000
income,19% of the participants have above 60,000 income and 100% are the total
participants.

11
 How Many Children do you have?

How Many Children do you have?

Frequency Percent Valid Percent Cumulative Percent

Valid 3-5 70 68.6 70.0 70.0

6-8 26 25.5 26.0 96.0

8-11 4 3.9 4.0 100.0

Total 100 98.0 100.0

Missing System 2 2.0

Total 102 100.0

This table represents the total number of children of the participants.

This table shows that 70% of the participants have 3-5 children,26% of the
participants may have 6-8 children, 4% of the participants may have 8-11 children
and 100 are the total participants.

12
This graph represents the delivery history of the participants.
This graph shows that 40 of the women have vaginal delivery,16 women have C
sectional delivery,8 of the total women having complicated delivery about 36 of the
women may have both vaginal and C sectional delivery.

13
This graph represents the menstrual history of the participants.
This graph shows that 48%of the women have regualar menstrual history,32% of the
women have irregular menstrual history,12% of the total women have menstration
more than 7 days and about 8% of the women have menstration less than 3 days.

14
 Have Mother Breastfeed Their Children

Frequenc Valid Cumulative

y Percent Percent Percent

Valid Yes,to all 52 51.0 52.0 52.0

No one 26 25.5 26.0 78.0

To some children 22 21.6 22.0 100.0

Total 100 98.0 100.0

Missing System 2 2.0

Total 102 100.0

This table represents the total number of the mother that have breastfeed their
children. This table shows that 52% of the participants have breastfeed to all of
their children,26% of the participants have not breastfeed to any children, 22% of
the participants have breastfeed to some of the children and 100 are the total
participants

15
This graph represents the mother positioning during breastfeeding.
This graph shows that 22 of the women have cross cadel posistion,36 women have
side-lying position,16 of the total women have football hold and about 26 of the
total women have not feed their child..

16
This graph represents the BMI of the participants.
This graph shows that 27of the women have normal BMI, 39 are underweight,30 of
the total women are overweight and about 4 of the total women are obese.

17
 How Many Food Group You Consume Daily ?
Cumulative
Frequenc Valid Percent
y Percent Percent
Valid 2 Food groups(cereals, 1 1.0 1.0 1.0
meat)
19 18.6 19.0 20.0
3 Food (Cereals, Meat,
Fruits)
4 Food groups (Meat, 46 45.1 46.0 66.0
Fruits,
Vegetables, Fat)
5 Food product (dairy 34 33.3 34.0 100.0
product, cereals , meat,
fruits,
vegetable)
98.0
Total 100 100.0

Missing System 2 2.0

Total 102 100.0

This table represents the total number of food groups that the mothers consume
daily. This table shows that 1% of the participants have consumed 2 food
groups,19% of the participants have consumed 3 food groups, 46% of the
participants have consumed 4 food groups , 34% of the participants consume 5 food
products and 100 are the total participants

18
This graph represent that 17 members never have MSK problem,13 have MSK
disorder from 1-6 months, 16 members from 7-12 months and 42 from more than 1
year.

19
This graph show that 43 participant got Medical treatment,13 participants got
Physiotherapy treatment, 16 got Other and 28 got no treatment of MSK pain.

20
This graph show the total percentage of specific body region have MSK
pain.17% people have no pain.7% have neck ,15% have shoulder, 4% have
upper back,23% have low back,7% have wrist,2% have hip,18% have knee,3%
have lower leg,4% have foot pain.

21
22
 CHAPTER 5

Discussion:
This study reported that 83% of sample size complain musculoskeletal disorders.
MSK risk factors are lack of education, menopause age before 45 years, parity more
than 3, steroid therapy, poor diet, mode of delivery.
In 2014, a study was conducted by Preetha Ramachandra et al. They concluded that
low back pain in first trimester was 3.3%, in 2 nd trimester was 42% and in 3rd
trimester was 7%.
The prevalence of neck pain in first trimester was 0%, in 2 nd trimester was 6.2% and
in third trimester was 2.5%. The prevalence of hip pain in first trimester was 0%, in
2nd trimester was 4.7% and in third trimester was 12.1%. The prevalence of shoulder
pain throughout the pregnancy was 0%. The prevalence of knee pain in first
trimester was 3.3%, in 2nd trimester was 7.7% and in 3rd trimester was 7.8%. The
prevalence of ankle pain in first trimester is 3.3%, in second trimester is 6.2% and in
third trimester is 5.8%. The prevalence of low back pain in first trimester is 3.3%,
second trimester 42%, and in third trimester 33%. The findings of our study show
that 16.7% multiparous women do not have MSKD. Neck pain were present in
8.7%, shoulder pain in 14.7% , lower back pain in 22.5%, wrist pain in 6.9%, hip
pain in 2%, knee pain in 17.6%, lower leg pain in 2.9% and foot pain in 3.9%
respondent multiparous women.
After comparing both studies, we concluded that prevalence of low-back pain is
22.5%, in the previous study the prevalence of the low back pain was 3.3 in the first
trimester, 42 in second trimesters and 33 in third trimesters. Our prevalence of low
back pain is less due to the small sample size and post-natal women because they do
not have elevated relaxin and progesterone level which plays an important role of
low back pain.

The prevalence of the neck pain in third trimester was 2.5%, but in our study 7%
women experience neck pain. In previous study the shoulder pain was not reported
during pregnancy. We observed that shoulder pain was reported in 14.7%
multiparous women because of overhead activities and work-related prolonged
posture.

23
 CHAPTER 6

Conclusion:
The descriptive analysis shows that incorrect positioning during lack of education,
menopause before 45years, mode of delivery (SVD,C-Section), steroid therapy, poor
diet, breast feeding, fatigue, exertion and prolonged activities are the major factors
causing musculoskeletal disorders. Multiparity causes biomechanical and
physiological changes that may be responsible for a wide spectrum of
musculoskeletal disorders in the women. With the history of grand parity, the
magnitude of trabecular bone deterioration is associated with number of deliveries.

24
 Chapter 7
Limitation and recommendation:
Limitations:
Within the limitations of the study, there is high prevalence of MSDs (low back
pain) experienced by multiparous women. More research is needed on
musculoskeletal problems with multiparous women with an emphasis on large
sample sizes and correlating other factors such as age, activity and working
environment for working women. Certain limitations were faced during this research
work. The literature related to finding the prevalence of MSKD in multiparous
women is limited and our topic is rare. The sample size in this study was very small
which was limited to 100 multiparous women. Different women have different
occupations and household activities so symptoms may vary. The questionnaire
which we have used in this study describes the functional limitations and regions of
the pain but limited to identify the type of pain.

Recommendations:
Considering the findings of this study, there are some important suggestions, further
research should be on musculoskeletal problems with multiparous women conducted
in which the questionnaire should be personally administered, with an emphasis on
large sample size and correlating other factors such as age, physical activity and
working environment for working women. There should be clinical development
programs and courses to educate the multiparous women regarding musculoskeletal
problems and risk factors. It is highly recommended that relaxation period during
work should be encouraged, and women should involve their selves in the physical
activities lessens the pain

25
 Ethical considerations:
We carried out this research procedure with honesty and truthfulness. We took a
great care of ethical limits by maintaining the confidentiality of the collected data.
We got consent form signed from each person who was included in our sample.
There was a clear random sampling without any biasness, and we made personal
information completely confidential.

Data collection procedure:

Data collection was done by using the standard questionnaire Cornell
musculoskeletal discomfort Questionnaire. Data was collected by using an informed
consent form by telling the people about the objectives and aims of the study
regarding this research. Questionnaires was distributed among different citizens of
Pakistan. Nordic questionnaire were distributed among different citizens of Sialkot.

26
 ANNEX – I
INFORMATIONAL SHEET FOR GENTLY CONSENT

TITLE OF PROJECT:
Prevalence of musculoskeletal disorder in multiparous female

PURPOSE OF THE PROJECT:

This study aims to investigate the prevalence of

musculoskeletal disorders in multiparous women of Sialkot and to show the most
effective region of body with parity.

TIME REQUIRED FOR PARTICIPATION:

6 months

CONFIDENTIALITY:

By signing this form I am attesting that I have read and understand the

information above and I freely give my consent to participate in this research

study.

Date & Signature: _______________________

27
 ‫تحقیق میں شرکت کا دعوت نام‬

‫نقصانات اور تکلیف‪ :‬اس تحقیق سے کسی قسم کے نقصان یا تکلیف کا اندیشہ نہیں‪ e‬ہے ۔‬

‫ممکنہ فوائد‪ :‬آپکو ایک اہم تحقیق میں حصہ لینے کا موقعہ دیا جاۓ گا۔‬

‫رازداری کا تحفظ‪ :‬ہم آپ کی معلومات کے تحفظ کے لیے وه سب کچہ کریں گے جو ہم کر سکتے‬

‫ہیں۔ تحقیق کے متعلق اکڻہی کیی گیی تمام معلومات کو انتہا ئی خفیہ رکھا جاے گا۔ ڈیڻا انڻری اور‬
‫تجزیے کے‬
‫دوران آپ کے متعلق وه تمام معلومات جن سے آپ کی شناخت ہو سکتی ہو کو ختم کر دیا جاے گا۔ اس‬
‫تحقیق کے نتیجے میں شائع ہونے والی کسی بھی اشاعت میں آپ کی شناخت کو ظاہر نہیں کیا جاے گا۔‬

‫رضاکارانہ شمولیت‪ :‬اس تحقیقی مطالعہ میں آپ کی شرکت رضاکارانہ ہے۔ آپ کو شرکت نہ کرنے اور‬
‫کسی بھی وقت پغیر وجہ بتانے اس تحقیق میں شمولیت کو چھوڑنے کا اختیار ہے۔ شرکت نہ کرنے یا اس‬
‫میں شمولیت کو چھوڑنے کی صورت میں آپ کے خالف کوئی کاروایی نہیں کی جاے گی‬

‫درجذیلمعلوماتتحقیقمینشاملہونےوالونکےلیےپڑھیناورانکاجوابدی‬
‫ےگیےخانونمیندرجکریں‬

‫‪‬‬ ‫میں نے معلوماتی شیٹ جو کہ تحقیق کی وضاحت کر رہی ہے کو سمجھ لیا ہےاورمجھے تحققیق‬
‫کے سواالت کرنے کا موقع دیا گیا تھا۔ میں سمجھ گیا‪/‬گیی ہوں کہ میری شرکت رضاکارانہ ہے اور یہ کہ‬
‫میں کسی بھی وقت اپنا اراده ‪ ‬بدل سکتا‪/‬سکتی ہوں اور تحقیق سے دستبردار ہو سکتا‪/‬سکتی میں سمجھ‬
‫گیا‪/‬گیی ہوں کہ میرے جوابات خفیہ رکھے جاءیں کے۔ میں محقیقیین کو اس بات کی اجازت ‪ ‬دیتا‪/‬دیتی‪e‬‬
‫ہوں کے وه جوابات کو جانچ سکیں۔‬
‫میں سممجھ گیا‪/‬گی ہوں کے معلومات میرے نام کے بجاے نمبر کی صورت میں محفوط کی جائیں گی۔ تا‬
‫‪‬کہ میں نتائج کی اشاعت کے دوران کسی بھی طرح سے شناخت نہ کیا جا سکوں۔ میں اس بات سے‬
‫رضامند ہوں کے جو معلومات مجھ سے لی جائہیں گی وه تحقیق میں استعمال ہوں گی۔ میں اوپر بتایی گی‬
‫تحقیق میں شامل ہونے کے لیے رضامند ہوں اور محقیقین کو اپنا پتہ تبدیل ہونے کی ‪ ‬صورت میں مطلع‬
‫کروں گا‪/‬گی۔‬

‫رضا مندی‪:‬میں نے یہ اجازت نامہ پڑھا ہے اور مجھے سوال پوچھنے کا موقع دیا‬
‫گیا ہے۔ میں اس سڻڈی میں شرکت کے‬
‫راضی ہوں۔‬

‫شرکت کننده کا نام __________________ دستخط____________________ تاریخ‬

‫___________‬

‫‪28‬‬
‫اجازت لینے والے کا نام ________________ دستخط ____________________تاریخ‬
‫____________‬
‫اس اجازت نامہ کی ایک نقل آپکو دی جانی چاہے۔‬

‫‪29‬‬
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Cornell musculoskeletal discomfort quetionnaire

32