EFFECT OF KINESIO TAPING ON ALLEVIATING NORMAL LABOR PAIN

By

SHEREEN SHAKER MARZOUK

Submitted In Partial Fulfillment For Requirements Of Master Degree

Department Of Physical Therapy For Obstetrics And Gynecology

Faculty Of Physical Therapy

Cairo University

2013

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CHAPTERI

INTRODUCTION

Labor is a physiologic process during which the products of conception (the

fetus, membranes, umbilical cord, and placenta) are expelled outside of the uterus.

Labor is accompanied with changes in the biochemical connective tissue and with

gradual effacement and dilatation of the uterine cervix as a result of rhythmic

uterine contractions of sufficient frequency, intensity, and duration (ACOG, 2003).

The onset of labor is associated with regular, painful uterine contractions

resulting in progressive cervical effacement and dilatation. Cervical dilatation in

the absence of uterine contraction suggests cervical insufficiency, whereas uterine

contraction without cervical change does not meet the definition of labor (Norwitz

et al ., 2003).

Labor is divided into three separate stages, the first stage of labor starts from

the onset of labor till full cervical dilation and effacement. Because the early

cervical changes may be protracted and unpredictable in their course, the first stage

of labor is divided into early or latent- phase labor and active-phase labor. Between

these two phases of the first stage of labor, patients are generally considered in

latent-phase labor until cervical dilation reaches approximately 4 cm. The second

stage of labor begins with full cervical dilation and continues until delivery of the

infant. The third stage of labor begins with the delivery of the infant and is

complete with the delivery of the placenta. Although the duration of each stage is

highly variable, the duration tends to shorten with each subsequent pregnancy

(Geoffrey and Peter, 2000).

Low back pain during labor is a common complain. As most women will

feel a degree of achiness or slight cramping in the back at some point during labor,

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about a quarter of all women report experiencing severe discomfort in the lower

back that is most intense during contractions and often painful between

contractions, back pain can often be accompanied by an irregular contraction

pattern, labor that is slow to progress, and a prolonged pushing stage.

A frequent cause of back pain is the position of the baby. As occiput

posterior (when baby is facing the mother’s abdomen) can cause pressure from the

baby’s head to be applied to the mother’s sacrum (the tailbone), leads tointense

discomfort during labor.

It has been shown that a woman who experiences back pain during her

menstrual cycle may be more likely to experience back labor regardless of the

baby’s position (Sue moore, 1997).

Some degree of widening of the symphysis pubis is normal during

pregnancy and the sacroiliac joints become more mobile.

Occasionally, separation of the pelvic bones occurs during normal labor, this

is most common in the pubic symphysis, but may also involve the sacroiliac joints.

Patient may report pain over the joint, radiating down to the thight especially at

second stage of labor (Wayne and Emanuel, 2007).

During labor, pain occurs at different locations, intensity, and quality for

each woman. In addition, experience of pain changes throughout the delivery

process. Most women in thefirst stage oflaborfeel pain predominantly in the

lowerabdomen, whereas others experience severe low back pain. In approximately

30% of the cases, the pain iscontinuous and annoying (Melzack and Schaffelberg,

1992).

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The uterine cervix andcorpus are supplied by afferent neurons ending in

thedorsal horns of spinal segments T10-L1 (Bonica, 1995&Endler and Bhatia,

1990).

Sincecutaneous afferents from the lower back coverage tothe dorsal horns in

the same segments, there is anatomical support for the assumption that back pain

in labor and symphysis pubis are referred pain.

Based on the gate-control theory (Melzak and Wall, 1995).Various

attempts have been made to relieve labor pain by treating dermatomes having the

same nerve innervation with acupuncture(Hsu, 1996). OrTranscutaneous Electrical

Nerve Stimulation (Carrioll et al ., 1997).

In recent years, the use of Kinesio Taping has become increasingly popular.

Kinesio taping was designed to mimic the qualities of human skin. It has roughly

the same thickness as the epidermis and can be stretched between 30% and 40% of

its resting length longitudinally. (Kase et al.,2003), have several benefits

depending on the amount of stretch applied to the tape during application include

the following:

• To provide a positional stimulus through the skin.

• To align fascial tissues.

• To create more space by lifting fascia and soft tissue above area of pain or

inflammation.

• To provide sensory stimulation to assist or limit motion.

• To assist in the removal of edema by directing exudates toward lymph duct

(Kaseet al., 2003).

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Kinesio Taping, achieves rapid pain relief with overall improvement of the

range of motion and uninterrupted blood flow, also helps ingaining an optimal

healing process. An additional positive effect is that kinesio taping raises the skin

slightly, That provides additional opening of the vascular system and significantly

supports the lymph circulation (Kase et al., 2001).

Kinesio taping is unique in several respects when compared to most

commercial brands of tape. It is latex free and the adhesive is 100% acrylic and

heat activated. The 100% cotton fibers allow for evaporation and quicker drying.

This allows kinesio tape to be worn in shower or pool without having to be

reapplied to virtually any muscle or joint in the body (Halseth et al.,2004).

Statement of the problem:

Is kinesio taping effective on alleviating pain during normal labor ?

Purpose of the study :

This study will be conducted to investigate the effect of Kinesio taping on

normal labor pain at first and second stages.

Significance of the study :

The need of this study developes from the lack in the quantitative knowledge

and information in the published studies about the effect of kinesio taping on

normal labor pain.

Kinesio tape is theorized to have several functions including:

Restoring correct muscle function through supporting weakened muscles, reducing

congestion by improving the flow of blood and lymphatic fluid,decreasing pain by

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stimulating neurological system and correcting misaligned joints by retrieving

muscle spasm (Kase, 2001).

Also the effect of taping may be due to the cutaneous stimulation of the

sensorimotor and propriceptive systems (Simoneau et al., 1997).

Taping provides immediate sensorimotor feedback regarding functional

abilities, so this study is supposed to help physical therapists and pregnant women

that suffer from low back pain during labor to decrease pain and improve

functional activities through kinesio tape.

Delimitation of the study:

The study will be delimited by the following aspects:

• Pregnant women.

• Their age will be ranged from 20 to 40 years old.

• Their body mass index will be from 30-35 kg/m2.

• Not engaged in any other treatment programs.

Limitation:

This study will be limited by the following factors:

• Psychological status of the pregnant women may affect results of the

study.

• Individual difference in the patients and their ability to bear pain.

• Variation in economic , social and culture level may affect of the study.

Hypothesis:

It’s hypothesis is that :

There is no effect of kinesio taping on alleviating normal labor pain.

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Basic Assumption:

It will be assumed that:

-All participants will receive the same routine physical therapy.

-All participants will not receive any drug that can affect results.

-All participants will receive the same regular balanced diet.

-All participants will be cooperated during the assessment and treatment

procedures.

-Clinical methods of measurements will be reliable and valid.

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CHAPTER II

REVIEW OF RELATED LITERATURES

During labor the fetus, placenta and membranes are expelled from the uterus

through the birth canal. This event usually occurs after a normal pregnancy,

between 38 and 42 weeks of gestation, most commonly at about 40 weeks. By this

time the uterus is almost filling the abdominal cavity and the fundal height is 36-40

cm from the symphysis pubis (Geoffrey and Peter, 2000).

In the third trimester the lower uterine segment is much thinner than the

upper segment. At caesarean section it is easily recognized because the peritoneum

is only loosely attached. If the fetal head is fully flexed on the chest and the occiput

is lying anterior, then a circular aspect of the head is fully flexed on the chest and

the occiput is lying anterior, then a circular aspect of the head is presenting the

biparietal diameter (10cm) and the suboccipitalbregmatic diameter(10cm)

engaging in the pelvic brim. When this has actually passed through the pelvic brim,

the head is said to be engaged. In a primigravid this usually takes place around the

38th week of pregnancy, although in a multigravida it may not occur until labor

ensues. With the head fully flexed in the occipitoanterior position, that part of the

head which is lowest is known as the vertex, and lies midway between the anterior

and posterior fontanelles. The head now separates the uterine cavity into two

compartments. When the membranes are intact, a small amount of fluid is trapped

between the membranes and the fetal head- the fore- waters. The much larger hind-

waters lie above.

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During labor the process of thinning of the lower segment continues, so that

the cervix itself is pulled up and effaced in a dilating and thinning process. Once it

has been pulled up, then cervical dilatation occurs.

This sequence of events is seen most clearly in primigravid women, for

multigravida women effacement and dilatation may occur simultaneously, often in

late pregnancy. The onset of labor is not precisely timing, it is typified by the

presence of regular painful contractions occurring at least once every 5 min and the

presence of a show- a plug of blood and mucus indicating that the cervix is

beginning to dilate. Sometimes the membranes have ruptured prior to the show,

and in the presence of regular contractions this is also considered to be labor.

Otherwise, in the absence of these two signs, there must be evidence of progress

which means progressive dilatation of the cervix and descent of the presenting part

(Geoffrey and Peter, 2000).

Stages of normal labor:

Labor is divided into three stages, with very different duration:

• The first stage(from the onset to full dilatation),

• The second stage(from full dilatation to the delivery of the baby),

• The third stage (from the delivery of the baby to the expulsion of the

placenta and membranes) (Geoffrey and Peter, 2000).

The first stage of labor:

The first stage of labor is characterized by regular strong contractions lasting

often for a minute or more and occurring every 3-5 min. The contractions force the

presenting part against the internal cervical os, leading to its effacement and

dilatation. The fore-water probably have little part to play in this dilatation, for

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there seems to be little difference between the speed of dilatation wether they are

intact or not.

The first stage of labor is divided into two phases: the latent phase and the

active phase. The latent phase is fairly prolonged, and on average lasts for about 7h

in nulliparous women. Dilatation of the cervix may be to 4cm. The active phase is

much more rapid cervical dilatation, usually 1-2cm per hour (Geoffrey and Peter,

2000).

The second stage of labor:

The second stage of labor starts when the cervix is fully dilated to 10cm.

This stage of labor concerns the expulsion of the fetus, and often is diagnosed

when the presenting part is visible at the introitus. It is at this point that the mother

has the desire to bear down, for the fetal head is now pressing on the rectum and

pelvic floor, producing a desire to push. This is particulary acute during a

contraction (Geoffrey and Peter, 2000).

The position the mother adopts is largely left to her. It is commonest in the

UK for women to delivery in the propped-up, half sitting position with a large

rubber wedge to support them. This is probably the most comfortable for the

mother and gravity may assist in the expulsion of the baby. Some find squatting or

resting on the hands and knees a natural position to give birth. A very small

proportion make use of deep-water bath for comfort, and where it is available, a

birth chair can be used (Geoffrey and Peter, 2000).

As the mother pushes down, the vulva becomes progressively dilated by the

head of the baby. A pad should be placed over the anus to protect the baby from

faecal soiling, and the advancing head is controlled by the doctor. The aim is to

allow release of the head as smoothly as possible and with minimal perineal

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damage. However, if there is undue stretching or early signs of skin splitting of the

perineum, an episiotomy may be necessary. It is important that the head should be

flexed until the occiput appears beneath the mother’s symphysis pubis. After this

the chin is freed, and the head is allowed to rotate through 90 degree as the

shoulders negotiate the pelvis moving to the anteroposterior diameter. A check

should be made that there are no loops of umbilical cord around the baby’s neck

and with the next contraction the anterior shoulder should be delivered. This may

be assisted by gentle lateral extension of the fetal head in a backwards direction

(Geoffrey and Peter, 2000).

After the anterior shoulder is delivered, the baby is directed forwards

towards the mother’s abdomen, thus allowing the posterior shoulder to pass down

the posterior vaginal wall. Once this is delivered, the trunk and legs follow rapidly.

An oxytocic (syntometrine) is usually given intramuscularly to promote

contraction of the uterus and to minimize bleeding. The umbilical cord should be

divided between clamps, and the infant is given to the mother, wrapped in warm

blanket, as soon as possible after its nasopharynx has been cleared and respiration

is established (Geoffrey and Peter, 2000).

The third stage of labor:

The mother has an injection of syntometrin at the time of delivery of the

anterior shoulder to minimize the risk of postpartum haemorrhage and encourage

contraction of the uterus. The first sign of placental expulsion is that there is

lengthening of the cord with an accompanying amall loss of blood. It is usually

then to support the uterus by placing a hand immediately above the symphysis

pubis, so keeping the uterus in an extrapelvic position. The cord is grasped and

steady traction is applied. The placenta, which has separated when the baby was

born, slips out of the uterus into the vagina. The cord can then be released and

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delivery of the entire placenta ca gently be encouraged with maternal effort

(Geoffrey and Peter, 2000).

Labor Pain:

Pain in labor has a fairly predictable pattern and is associated with

contraction of the uterus. The location of pain sensation throughout labor is

continually varies- in duration, degree and frequency- as contraction of the uterus

increases. This predictability enables the woman to anticipate and prepare for the

arrival of the infant. Initially, pain alerts her to seek a safe place to give birth.

Increasing contractions of the uterus with associated pain signal progress

throughout the first stage of labor, as descent of the baby and dilatation of the

cervix occurs. At the end of the first stage of labor, transitional pain indicates

imminent onset of second stage, the actual birth.

It is at this stage that some women find pain extremely difficult to manage and

will often ask for pain relief. An understanding of the processes of labor will

enable the woman and her carers to cope with this characteristic and overwhelming

sensation. Powerful expulsive contraction give rise to a characteristic second stage

pain, as the uterus changed its activity to one which enables the woman to actively

push the baby into the world. This is an involuntary process and many women are

able to negotiate second stage with minimum of verbal encouragement to push

from the midwife. The woman was instructed to chin in chest and push” is

detrimental to mother and more particularly the fetus (Caldeyro, 1979

andSagaday, 1995).

Pain in the first stage of labor:

Bonica (1994) provides one of the most comprehensive reviews of the

physiological processes involved in labor pain, reporting that the pain in the first

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stage of labor is due mainly to dilatation of the cervix, as well as to distension and

stretching of the lower segment of the uterus. It is also suggested that pain is

caused by contraction of the uterus under isometric pressure, that is against the

obstruction presented by the cervix and perineum, which is the “adequate

stimulus” for provoking pain in hollow viscera. The uterus is a visceral organ and,

as such, (Melzack and Wall, 1900) suggest that it gives rise to pain only if it is

dilated or in strong contraction. Other suggestions include ischaemic changes of

the myomertrium and cervix, pressure on the sensory nociceptors of the body of

the uterus, and also inflammatory changes in the muscles of the uterus (Polden

and Mantle, 1992).

Bonica(1994) reports a longitudinal study carried out on 305 women in

childbirth. Using a discreet local anaesthetic block of nociceptive pathway during

labor, he demonstrated that spinal nerves T10, T11, T12 and L1 supply the uterus,

including the lower segment and the cervix. These findings contradict some

obstetric and anatomy texts which have in the past identified that the cervix was

supplied by sacral nerves.

A and C fibres supplying the uterus and cervix accompanied with

sympathetic nerves which supply the uterus in a particular sequence. Nociceptive

nerve fibres from the uterus and cervix pass to the spinal cord through the uterine

and cervical nerve plexuses (a network of nerves), the pelvic plexus, the middle

and then superior hypogastric plexuses. These nociceptive nerve fibres then pass

through the posterior roots of spinal nerves T10, T11, T12 and L1 to synapse at the

interneurons in the posterior horn of the spinal cord. Nerve fibres also travel from

perineal structures through the pudendal nerve to the spinal cord through spinal

root nerves S2, S3 and S4. The lumbar and upper sacral segments also supply

pelvic structures which are involved in the pain of childbirth (Bonica, 1994).

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As with other types of pain, labor pain is felt over dermatomes supplied by

spinal cord segments that receive their stimulation from the uterus and cervix. Pain

throughout the first stage of labor is referred to those dermatomes which are

supplied by the same spinal cord segments receiving the painful stimuli. In the

early first stage of labor, moderate pain is felt in the T11 and T12 dermatomes. In

established labor, more severe pain is felt in the T11 and T12 dermatomes and it

spreads to the T10 and L1 dermatomes (Bonica, 1994).

Pain in the second and third stages of labor:

Pain in the second and third stages of labor is different from the first stage.

The cervix is now fully dilated and neural stimulation from the cervix decreases,

however, contraction of the body of the uterus is maintained. As the presenting part

of the fetus descends through the pelvis, pressure on nociceptors throughout the

pelvic floor and perineum increase pain in those areas. Pain is further influenced

during the second stage by stretching of the pelvic peritoneum and uterine

ligaments, stretching of the bladder, urethra and rectum, and pressure on

lumbosacral nerve plexus. At the end of the first stage and in the second stage of

labor, pain is often described as cramping and burning and may be felt in the thighs

and legs (Bonica, 1994).

A retrospective study of 400 pregnancies and deliveries was undertakenby

interview of 170 consecutive female patients presenting to five chiropractic offices

in the Niagara Peninsula. Back pain was reported during 42.5% (170) of

the pregnancies and 44.7% (179) of the deliveries. There was a statistically

significant association between back pain during the two events (p less than.001).

Of the 170 pregnancies with reported back pain, 72% (122) also reported back

labor (Diakow et al., 1991).

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Kinesio Taping :

Kinesio Taping is a technique based on the body’s natural healing process.

The method uses a uniquely designed and patented tape,(Kinesio Text Tape), for

treatment of muscular disorders and lymphedema. Taping is defined as the

application of adhesive tape-elastic(stretch) or non elastic(rigid) in order to provide

support and protection to soft tissues and joints to minimize swelling pain after

injury (Macdonald, 1994).

Modern kinesio tapes are very flexible and achieve their effects without

restricting motion. Kinesio taping has a targeted influence on the patient or

athlete’s nervous system and metabolism. Kinesio taping consists of elastic nylon

fiber or of cotton with an adhesive layer of especially eudermic adhesive. By

applying different adhesive techniques(Kinesio taping), the therapist can achieve a

remarkable and best of all a rapid reduction of pain like bruises, strained joints or

of muscle problems. Additionally, it produces a lasting improvement in muscle

function and supports the joints. The lymph system is also stimulated and this in

turn stimulates the metabolism. Positive effects of kinesio taping resulting from

these uses have even been frequently reported for the internal organs (Kase et al.,

2003).

In the human body, there are different mechanisms with which it can react to

stimuli from its surroundings. If initial contact with applied kinesio taping irritates

the skin, this stimulus is rapidly transmitted to the brain through the nerve fibers.

The brain coordinates the possible responses to this stimulus. Painful stimulation

from a muscle that has already lasted for some time is transmitted much more

slowly. Rapidly and slowly transmitted (painful) stimuli may possibly overlap each

other in the brain and thus completely or partially cancel each other out (Oliveria,

1999).

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By using kinesio taping, one achieves rapid pain relief with overall

improvement of the range of motion and uninterrupted blood flow. This removes

any hindrances to an optimal healing process. An additional positive side effect is

that kinesio taping raises the skin slightly. This provides additional opening of the

vascular system and significantly supports lymph circulation (Kase and

Hashimoto, 2005).

Taping a joint increase mechanical joint stability directly, but also may

increase proprioceptive signals which are thought to be important in regulation of

the tone of muscles which helps to insure stability (Macdonald, 1994).

The kinesio taping technique reduces acute or chronic muscle spasm, edema

and pain (Kase, 2001).

For application of tape the patient is placed in position of stretch on the

muscle to be taped. Placing the muscle on a stretch will create convolutions in the

skin that may appear following the basic application or during normal joint motion.

Creation of convolutions aid in restoring of normal flow of blood and lymphatic

fluids resulting increase in the interstitial space that leads to pressure and irritation

are taken off the neural and sensory receptors, alleviating pain. Pressure is

gradually taken off the lymphatic system allowing it to channel more freely (Kase

et al., 2003).

After 15-20 minutes of exercise, the effects of taping may be due to the

cutaneous stimulation of the sensorimotor and proprioceptive systems(Simoneau

et al.,1997).

The kinesio Tex tape is more elastic compared to conventional rigid tape.

The non stretch rigid tape is used to used to limit unwanted joint movement or to

protect and support a joint structure (Grelsamerand McConnell, 1998).

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Selection of kinesio strip type:

A kinesio strip can be applied in the shape and cleaned of an “Y” , “I” ,

“X”,”Fan” and “web”. The shape selected depends upon the size of the targeted

muscle and desired treatment effect.

The Y technique is the most common method of application. It is used for

surrounding a muscle to either decrease or increase limits muscle stimuli. The

basic principle of therapeutic taping for weaken muscle is to wrap the tape around

the affected muscle.This is accomplished by using the Y strip. The Y strip should

be approximately two inches longer than the muscle measured from origin to

insertion.

The I strip can be used in place of the Y strip following an acutely injured

muscle. The primary purpose of tape is application following acute injury is to

limit edema and pain.

The X strip is used when a muscled origin and insertion may change

depending upon the movement pattern of the joint like rhomboid muscle.

The fan strip is used for lymphatic drainage which is an advanced

concept.The web is a modified fan cut, both base ends are left intact with strips

being cut in the mid-section of the kinesio strip. With any of the five strip types it

is helpful to round the ends of the tape prior to application the rounding limits the

square edges from catching and may increase the length of tape application (Kase

et al., 2003).

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CHAPTER III

SUBJECTS, MATERIALS AND METHODS

Subjects:

This study will be carried out on fourty women with pain during normal

labor, they will be recruited from gynecology and obstetric unit in El Shatpy

hospital in Alexandria during the onset of normal labor, their ages will be ranged

from 20 to 40 years and their body mass index will be ranged from 30-35 kg/m2.

Diagnosis will be made clinically by physician.

The purpose and nature of the study will be explained to all participants and

informed consent form will be signed from each woman practice in this study. The

participant will be randomly divided into two equal groups in number:

group (A): Consists of twenty women who will participate inkinesio taping at

lumber regionand anterior lower abdomen during normal labor, and also will

receive traditional medicine during normal labor like Oxytocin, Methergine and

Cytotec.

group(B): Consists of twenty women whom will receive traditional medicine

during labor like Oxytocin, Methergine and Cytotec.

Inclusive criteria:

The participants will be chosen under the following criteria:

• All participants will be pregnant women patients.

• Their ages will be ranged from 20 to 40 years old.

• All participants will haveback pain during first stage of labor andsymphysis

pubis pain during second stage of labor.

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• The cause of pain will be referred pain from uterus contraction, dilatation of

the cervix and the movement of the fetus down the birth canal.

• All participants who participated in this study read, signed and dated

informed consent from which required by the ethical committee of faculty of

physical therapy, cairo university (Appendix 1).

• They must delivery vaginally ( normal labor).

Exclusive Criteria:

The current study will exclude the following participants:

• Participant who have skin abnormalities (skin malignancy in the treated area

or burned).

• Participant who have acute viral disease, acute tuberculosis and mental

disorders.

• History of previous back surgery.

• Neuromuscular diseases like multiple sclerosis.

• Sensory disturbances.

• Evidence of previous vertebral fractures or major spinal structural

abnormality,spondylolisthesis or spinal stenosis.

• Systemic disease of muscloskeletal system.

• Viscerogenic cause of back pain.

• Cesarean section delivery.

Equipment:

Equipment in this study will be divided into two main categories: Evaluation

and Treatment methods.

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• Evaluation methods :

1-Visual analogue scale:

Pain will be assessed by the visual analogue scale to all participants in

the two groups (A,B).

2-cardiotocography (CTG):

It will be used to monitoring fetal heartbeat and uterine contractions at first

and second stages of normal laborto all participants in two groups (A,B).

3-Height and Weight scale:

Universal height and weight scale will be used to determined the subject’s

height and weight in order to calculate the body mass index to all participants in

the two groups (A,B) according to the following equation :

BMI= Mass (Kg) / (Height(m))2

B- Treatment methods:

The treatment protocol will be achieved by using the following equipment:

1-Kinesio taping:

Kinesio taping at lumbar region for back pain during first stage of normal

labor.

Kinesio taping at lower abdomen region for symphysis pubis pain during

second stage of normal labor.

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Procedures:

• Assessment procedures:

Prior to data collection, the purposes and procedures will be fully explained

to each participant. Each participant will be evaluated and treated individually

following, standard protocol. If the participant meets the inclusion criteria, she

will be enrolled in the study.

Initial assessment:

Each participant will pass through the following steps of evaluation (at first

and second stages of normal labor).

1-Visual analog scales:

Pain was assessed by the visual analogue scale. It is 10 cm horizontal line

with one end described as (no pain=0) and other end (worst pain=10). Visual

analog scale was considered a valid way of assessing pain, it allows graphic

representation and numerical analysis of collected data(Flandry et al., 1991).

2-Cardiotocography(CTG):

Is a technical means of recording (-graphy), the fetal  heartbeat (cardio) and

theuterine contractions (-toco-) during normal labor.

Two belts put across the abdomen during labor, one at the top to check for

any contracting of the uterus, and one at the place where babies Heartbeat is found.

3-Height and Weight scale:

Is a measure for human body shape based on an individual’s weight and

height.Body mass index is defined as the individual’s body mass divided by the

square of their height. The formulae universally used in medicine produce a unit of

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measure of kg/m2. BMI can also be determined using a BMI chart, which displays

BMI as a function of weight (horizontal axis) and height (vertical axis) using

contour lines for different values of BMI.

BMI= Mass (Kg) / (Height(m))2

Treatment Procedures:

-Kinesio taping:

Participants in group (A):

The participants in group (A) will receive the kinesio taping at lumbosacral

region on first stage of normal labor and at anterior lower abdomen region on

second stage of normal labor.

The kinesio taping is comprised of a ureter polymer elastic strand wrapped

by 100% cotton fibers. The cotton fibers allow for evaporation of the body

moisture and following application of water allows for quick drying. There is no

latex in the tape. The adhesive is 100% acrylic and is heat activated.

The skin should be free of oils and lotions and cleaned prior to the application.

Anything that limits the acrylic adhesive ability to adhere to the skin will limit both

effectiveness and length of application.

At lumbar region: Taping procedures will be H technique application,

application of bilateral kinesio strip with space correction for bilateral erector spine

muscle. Begin by placing the participant in a natural spine position and apply the

base of kinesio H strip in the T11 and T12 to S1 and S2.The third strip will a space

correction technique. Measure a kinesiotaping I strip long enough to extend

approximately two inches on either side of the previously applied kinesio I strips.

Tear the paper backing on one end of the kinesio I strip approximately 2 inches

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from one end. Apply 20-25% tension in the vertical tape and 100% tensin in the

horizontal tape. Place this zone of tension directly over the region of greatest pain.

At lower abdomen region: wrapping the tape from the left lateral side of the

last 3 ribs laterally towards the anterior lower abdomen then back ward, towards

the right lateral side of the last 3 ribs laterally by using I technique application.

Apply 25% tension in the tape.

To smoothly remove the paper after the delivery, The examiner hold the tape

vertically, placed the index finger on the top edge of the tape. Then by rolling back

the index finger towards the patient, the tape would peel from its backing.

Participants in group (B):

The participants in group (B) will not receive the kinesio taping during

normal labor.

Statistical procedures:

Data will be summarized using:

-The arithmetic mean.

-The standard deviation.

-The percentage ( for qualitative variables).

Differential statistics:

Statistical analysis will be used in the form of paired T-test to compare

between means in the same group. Unpaired T-test will be used to compare

between each first and second stages means between different groups.

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REFERENCE

ACOG: “Dystocia And Augmentation Of Labor. Clinical Management Guidelines

For Obstetricians,Gynecologists”. No 49. American College Of Obstetricans

And Gynecologists: Washington, DC; December, 2003.

Bonica, J.: “The Nature Of The Pain Of Parturition”. In: Bonica J., Mcdonald J.,

Editors. “Principles And Practice Of Obstetric Analgesia And Anesthesia”, 2nd

Ed. Baltimore: Williams& Wilkings, pp. 73-243, 1995.

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APPENDIXE I

I am ………………………… freely and voluntary consent to participate

in research study under direction of researcher/ Shereen Shaker

Marzouk. A through description of the procedure explained and I

understand thet I may withdraw my consent and discontinue

participation in this research at ant time without prejudice to me.

Date

…………………………..

Participant

………………………

اقرار

............. /....اقراناالسيده

اشراف تحت البحث هذا فى المشاركه على وتطوع بحريه موافقه باننى

الباحثه من وشرح / وتوجيه وصف خالل من وذلك مرزوق شاكر شيرين

اى بدون وقت اى فى المشاركه من انسحب ان يمكن باننى االختبارات

.ضررلى

/...........................التاريخ

/..........................التوقيع

26

حده التخفيفمن على الالصق تاثيرالشريطالطبيعيه الوالده االم

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