Reducing Low Back and Posterior Pelvic Pain During and After Pregnancy Using OMT

Franke H, Franke JD, Belz S, Fryer G. Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: a systematic review and meta-analysis. J Bodyw Mov Ther. 2017;21(4):752-762.

Low back pain (LBP) and posterior pelvic pain (PPP) are common issues in pregnancy and the postpartum period.¹ Both LBP and PPP may be musculoskeletal problems related to changes in body posture due to the added anterior weight of the fetus.^1,2 The hormonal and physical transformations that take place during pregnancy lead to multiple physiologic changes, such as anterior pelvic tilt during ambulation³ and increased joint laxity, especially in multigravida pregnancies,⁴ leading to multiple opportunities for somatic dysfunction. Most pain medications are contraindicated in pregnancy,⁵ but a growing body of evidence suggests osteopathic manipulative treatment (OMT) is beneficial for women with pregnancy-related LBP. In this meta-analysis, researchers in Germany updated the evidence for using OMT (including osteopathic manipulative therapy, which is manipulative care provided by foreign-trained osteopaths) to manage LBP and PPP during pregnancy and the postpartum period.

The studies included in this meta-analysis were published or unpublished randomized controlled trials (RCTs) with both OMT intervention and control groups. Participants were pregnant or postpartum women aged at least 18 years with nonspecific LBP or PPP. Eight studies met the inclusion criteria: 5 evaluated OMT for LBP in the third trimester of pregnancy and 3 evaluated OMT for LBP in the postpartum period. The 5 studies conducted during pregnancy showed a decrease in pain, with 3 reaching statistical significance, and no increase in adverse events. The 3 studies that evaluated the effects of OMT on LBP in postpartum women all showed significant decreases in pain.

Statistical analysis demonstrated that moderate-quality evidence suggests OMT has a significant medium-sized effect on decreasing pain and increasing function in pregnant women with LBP. The analysis also indicated that low-quality evidence shows OMT has a significant, moderate-sized effect on decreasing pain and increasing function in postpartum women. Mean differences and CIs favored OMT in all studies, although several of the studies showed nonsignificant results. Limitations of this review include the heterogeneity and small sample sizes of the limited studies available.

Despite these limitations, the review suggests that OMT provides clinically relevant benefits for pregnant and/or postpartum women with LBP and PPP. OMT continues to demonstrate no additional risk of adverse outcomes in the third trimester of pregnancy. Additional research should continue to focus on the safety and efficacy of OMT in managing LBP in pregnancy and the postpartum period, as well as long-term follow-up for the patients.