Welcome back to SpineIQ’s Back Blog! This week, we will continue our month-long focus on women- led research for Women History month. Low back pain in pregnancy has been understudied considering the burden and prevalence. A recent study led by Dr. Carol Ann Weis, (with a majority of women co-authors!), titled “Chiropractic care for adults with pregnancy-related low back, pelvic girdle pain, or combination pain: a systematic review”1 attempted to address this gap by increasing the clinician’s understanding of low back pain in pregnancy. If you treat people who experience pregnancy-related low back pain (or experiencing this condition yourself), read below to learn more about treatment considerations!
Objective
Low back pain during pregnancy is common with 30% of women experiencing their first episode of low back pain during pregnancy and approximately 90% of pregnant women having an episode of low back pain.2 The specific cause of pregnancy-related low back pain is likely to be multifactorial, including maternal weight gain, biomechanical changes, and hormonal changes.
There is a need for guidance on best practices in treating pregnancy-related low back pain. This is especially important since many believe that low back pain is normal during pregnancy, resulting in less care-seeking by pregnant women and less attention by clinicians. This systematic review summarizes the available evidence for treatments commonly delivered by chiropractors for pregnancy-related low back pain.
Results
In order to provide comprehensive recommendations for care, study authors focused on treatments that the majority of chiropractors are taught in chiropractic educational programs. They found 50 studies reporting on chiropractic care for pregnancy-related low back pain. While there is some uncertainty in the evidence, the following table summarizes the strength of the evidence for treatments commonly delivered by chiropractors for pregnancy-related low back pain:
| Treatment | Treatment effect (positive, negative, or unknown) | Strength of evidence (low, moderate, high, or inconclusive) |
| Manipulative therapy | Positive | Moderate |
| Electrotherapy | Positive | Moderate |
| Exercise | Positive | Inconclusive |
| Support devices (pillow and belts) | Positive | Low |
| Patient education and information | Unknown | Inconclusive |
| Multimodal care (manual therapy, exercise, and patient education) | Positive | Inconclusive |
Conclusion
While there is a need for more high-quality research regarding chiropractic treatment for pregnancy-related low back pain, there are numerous evidence-based treatments options available. This includes manipulative therapy, electrotherapy, exercise, and support devices. Patient education and information may also be helpful to some patients. Considering the benefit of non-pharmacological care for this specific patient population, chiropractic care can be an important first-line option for pregnant women experiencing low back pain.
References:
- Weis CA, Pohlman K, Draper C, daSilva-Oolup S, Stuber K, Hawk C. Chiropractic Care for Adults With Pregnancy-Related Low Back, Pelvic Girdle Pain, or Combination Pain: A Systematic Review. J Manipulative Physiol Ther. 2020;43(7):714-731. doi:10.1016/j.jmpt.2020.05.005
- Ostgaard HC, Andersson GBJ. Postpartum Low-Back Pain. Spine. 1992;17(1):53-55.