Pregnancy-Related Low Back Pain

Helge Franke et al. (2014) · BMC musculoskeletal disorders

This systematic review and meta-analysis pooled 15 randomized trials with 1502 adults to test whether osteopathic manipulative treatment (OMT), a hands-on approach in which osteopaths choose techniques to suit each patient, improves pain and function in nonspecific low back pain (back pain with no specific underlying cause such as a fracture, tumor or infection). Low back pain is common, disabling and costly. The review counted only "authentic" osteopathic care, where practitioners used clinical judgment rather than one technique or a fixed protocol, and it analyzed pregnant and postpartum women separately. The authors searched seven databases and a trial register in October 2013 without language limits and also included unpublished grey literature, finding 307 records. Trials could compare OMT with sham treatment, usual care, physiotherapy or no treatment. Studies were independently reviewed with a standardized form, and only patient-reported outcomes were evaluated. Pain and functional status were pooled at about three months after treatment, and each trial was checked for risk of bias and graded for quality of evidence. In acute and chronic nonspecific low back pain, OMT lowered pain by 12.91 points on a 0-100 scale (95% CI -20.00 to -5.82) and improved function (SMD -0.36, -0.58 to -0.14), based on moderate-quality evidence. In chronic back pain alone, pain fell by 14.93 points (-25.18 to -4.68). In pregnancy, low-quality evidence showed pain reductions of 23.01 points (-44.13 to -1.88) and function gains (SMD -0.80), while moderate-quality evidence in postpartum women showed a 41.85-point pain reduction (-49.43 to -34.27) and an SMD of -1.78 for function. Effects were larger for pain than function and met the Cochrane threshold for clinical relevance. The largest trial, with 455 people, supplied only medians, so its values were estimated, and results were nearly identical with or without it. Only four of 15 trials reported adverse events, which were minor (stiffness, tiredness) with no treatment-related serious events. Heterogeneity was considerable. The authors conclude that OMT had clinically relevant effects on pain and functional status at three months posttreatment and recommend larger, high-quality trials with robust comparison groups. Limitations include small samples, different comparison groups, heterogeneity, no long-term measurement, blinding problems in every trial, and fewer than 400 participants in the pregnancy and postpartum comparisons. The authors also say future studies should report adverse events and describe the treatment approach clearly. The search ran in October 2013, so later trials are not included.

Kendi L Hensel et al. (2015) · American journal of obstetrics and gynecology

This randomized, placebo-controlled trial of 400 pregnant women, called PROMOTE, explored whether osteopathic manipulative treatment (OMT), a hands-on approach in which physicians apply guided forces to muscles and joints, eases low back pain and protects back-related function late in pregnancy. Low back pain is reported by about 70% of pregnant women, and most pain medications are not recommended during pregnancy, leaving few safe options. Pregnancy changes posture and biomechanics through ligament strain, increased muscle tension and reduced range of motion. The study also checked whether OMT reduces meconium-stained amniotic fluid, a possible sign of fetal stress. Women aged 18 to 35 in their third trimester at three Texas clinics were randomly assigned to usual prenatal care only, usual care plus OMT, or usual care plus a placebo ultrasound treatment with the machine switched off. Across seven visits from week 30 to week 39, the OMT group received about 20 minutes of treatment to the neck, back, pelvis and hips. Pain was rated on a 0-100 scale combining four pain ratings, and back-related disability was scored on the 24-item Roland-Morris questionnaire. Pain and back-related functioning differed significantly across groups (p < .001 for both). Women receiving OMT improved or stayed stable, while women receiving usual care only had worsening pain and function. OMT did not differ significantly from placebo ultrasound, and both beat usual care. Only 99 of 400 women (25%) completed all seven visits, but results were consistent among the 357 who completed at least four. Meconium staining appeared in 18.5% of 329 deliveries with data and was not linked to treatment group (p = .611). Gestational age at delivery averaged 39 weeks 2 days in every group. About 12.5% of women were reclassified as high-risk during the study (OMT 11, placebo ultrasound 19, usual care 20), with no higher likelihood in any group (p = .141), which the authors used as an indirect safety measure. The authors conclude that OMT mitigated pain and functional decline compared with usual care alone, but its similarity to placebo ultrasound may reflect the placebo's own touch and attention. They describe OMT as a safe, effective add-on for third-trimester back pain. Baseline characteristics were similar across groups except pre-pregnancy BMI, which was lower in the OMT group. Limitations include the large share of women who missed visits, the lack of an attention-matched usual-care arm, and effect sizes that the stored text does not report.