Back pain is a commonly reported symptom among pregnant women, especially those in the third trimester. This pain can lead to a temporary disability, sleep-disturbance, and may affect daily living and quality of life. Many women seek physical therapy, chiropractic care, massage therapy, and acupuncture treatment to manage their symptoms. The researchers in the study, Osteopathic Manipulative Treatment of Back Pain and Related Symptoms During Pregnancy: A Randomized Controlled Trial, looked at the effects of osteopathic manipulative treatment (OMT) on pain and function in pregnant women during the third trimester.
Materials and Methods
144 pregnant women between 28- and 30-weeks gestation were enrolled in the study and randomly assigned to one of three groups. The first group was usual obstetrical care (UOBC), the second group was usual obstetrical care and OMT (UOBC+OMT), and the third was usual obstetrics care and sham ultrasound treatment (UOBC+SUT). Each treatment group received seven, thirty-minute treatments spanning nine weeks in addition to their regularly-schedule obstetrics care. The two outcome measures utilized in this study included back pain, as measured on ascale from 0 to 10 and back-related function, measured by the Roland-Morris Disability Questionnaire.
The subjects assigned to the UOBC only group did not receive any treatments beyond conventional obstetrical care; however, they were expected to complete data collection forms on the same schedule as all other trial subjects. In group two, the OMT was performed by a licensed physician and included soft tissue, myofascial release, muscle energy, and range-of-motion mobilization. The physician performed these interventions to treat somatic dysfunction of the cervical, thoracic, and lumbar spine; thoracic outlet and clavicles; ribcage and diaphragm; and pelvis and sacrum. The study protocol prohibited use of high velocity, low amplitude (HVLA) techniques because the increasing ligamentous laxity that occurs in late pregnancy may pose a theoretical risk in performing such maneuvers. In group three, SUT used a nonfunctional ultrasound therapy unit that was modified for research purposes to provide both visible and auditory cues that could potentially elicit a placebo response.
A total of 49, 48, and 49 subjects were randomized to the UOBC+OMT, UOBC+SUT, and UOBC only groups, respectively. Subjects in the UOBC only group had the highest appointment attendance rate, while those in the UOBC +SUT group had the lowest appointment attendance rate.
Although there were no statistically significant differences in pain levels among treatment groups, mean pain levels decreased in the UOBC+OMT group, remained unchanged in the UOBC+SUT group, and increased in the UOBC only group. There were significant differences in back-related function among treatment groups. Back-related function deteriorated less in the UOBC+OMT group than in the UOBC only and UOBC+SUT groups. These outcomes suggest OMT could offer a clinical benefit when provided as complementary therapy to usual obstetrical care.
The study results indicate that OMT lessens or halts the deterioration in back-related function that often characterizes the third trimester of pregnancy. While there is evidence that OMT may provide an important clinical benefit in reducing back pain, the results are not as conclusive as they are for back-related function. Thus, taken together, these findings suggest that the beneficial effects of OMT on physical functioning during the third trimester of pregnancy may not be related simply to an analgesic effect on back pain, but may possibly involve other mechanisms.
There were a few limitations in this study. The first was the method of blocked randomization which did not adequately randomize subjects based on illicit drug use, vaginal bleeding, and race/ethnicity. In addition, the OMT protocol was limited to the third trimester of pregnancy. Theoretically, in clinical practice, it would be desirable to implement OMT earlier in the pregnancy to prevent or slow the progression of somatic dysfunction and back-related symptoms. Finally, the OMT protocol involved a standardized approach to treatment which may not adequately reflect the potential benefits seen in clinical practice, where there is a more individualized treatment approach for each patient.
Conclusions and Physical Therapy First Implications
The study results indicate that a larger Phase III trial with greater statistical power and better control of potential confounders is warranted to better assess the effects of OMT on back pain and related physical functioning during the third trimester of pregnancy. At Physical Therapy First, our therapists are proficient at performing the interventions used in this study including soft tissue, myofascial release, muscle energy, and range-of-motion mobilization. If you are pregnant and have experienced back pain at any point during your pregnancy, physical therapy is a great intervention for managing pain and improving function.
Licciardone, John., Buchanan, Steve., Hensel, Kendi., King, Hollis., Fulda, Kimberly., Stoll, Scott (2010). Osteopathic Manipulative Treatment of Back Pain and Related Symptoms during Pregnancy: A Randomized Controlled Trial. American Journal of Obstetrics and Gynecology. 202(1): 43.e1–43.e