Pregnancy and Low Back Pain: Physical Therapy for Back and Pelvic Pain During Pregnancy

During pregnancy, women often experience a large range of symptoms affecting their daily lives. A common issue that almost 50% of pregnant women face is back or pelvic pain¹. Katonis et al. (2011) describes how since the era of Hippocrates, women have been reporting this issue during pregnancy¹. Typically, back and pelvic pain in pregnant women arises due to weight gain causing a postural shift that increases stress on some parts of the body². This pain can extend postpartum, causing more long-term effects; however, these effects can be reduced through early intervention and therapies¹. Treatments may include physical therapy, yoga, acupuncture or pharmacological medication². Physical therapy is a fairly common treatment for this type of pain, and if it is started early in pregnant women, even before any symptoms of pain, the treatment has the potential to reduce the risk of developing severe back or pelvic pain¹. 

Kinser et al. (2017) recently conducted a systematic review of nonpharmacological treatments available for back and pelvic pain in pregnant women³. Looking mainly at physical therapy and yoga through fifteen different studies, the researchers concluded that these two therapies are promising for pain reduction during pregnancy, as well as in reducing depression and stress³. However, Kinser et al. (2017) were unable to come to a strong conclusion about this because much of the current literature is heterogeneous, making it difficult to conduct systematic comparisons³. More standardized literature on this topic is necessary to reduce the gaps in knowledge, especially because physical therapy shows a lot of promise³.  

Benten et al. (2014), on the other hand, found more positive support for using physical therapy in reducing back and pelvic pain during pregnancy⁴. Examining twenty two randomized controlled trials focused solely on physiotherapeutic interventions, the researchers found that in cases where patients were provided exercise therapy along with detailed patient education, there was a significant decrease in pelvic pain⁴. In addition, the researchers noted that sick leave also decreased when pregnant women were recommended exercise therapy⁴. Similarly, a review in the Journal of Orthopaedic & Sports Physical Therapy provides supporting evidence for physical therapy during pregnancy⁵. The authors provide a detailed overview of the benefits of physical therapy by discussing specific exercises that are useful in back and pelvic pain reduction, specifically in the long-term, as at least a third of pregnant women continue to experience this pain one year postpartum⁵. In particular, the authors note that muscle strengthening exercises that activate the spine or pelvis are especially beneficial in comparison to other therapies⁵. Water-based therapies like water aerobics are also said to have a positive effect on pain, but there is varied literature on this specific exercise^1,4,5. 

There is clearly some promising evidence that physical therapy can reduce pelvic and back pain during pregnancy. However, a lot of the literature is heterogeneous in that the methodologies and the types of therapies differ, making it difficult to compare therapies and draw strong conclusions. Research investigating specific exercises are thus necessary in order to make strong recommendations for dealing with back and pelvic pain during pregnancy.  

References: 

(1) Katonis P, Kampouroglou A, Aggelopoulos A, et al. Pregnancy-related low back  

pain. Hippokratia. 2011;15(3):205‐210.  

(2) Sabino J, Grauer JN. Pregnancy and low back pain. Curr Rev Musculoskelet Med.  

2008;1(2):137‐141. doi:10.1007/s12178-008-9021-8 

(3) Kinser PA, Pauli J, Jallo N, et al. Physical Activity and Yoga-Based Approaches for  

Pregnancy-Related Low Back and Pelvic Pain. J Obstet Gynecol Neonatal Nurs. 2017;46(3):334‐346. doi:10.1016/j.jogn.2016.12.006 

(4) Benten E, Pool J, Mens J, Pool-Goudzwaard A. Recommendations for physical  

therapists on the treatment of lumbopelvic pain during pregnancy: a systematic review. J Orthop Sports Phys Ther. 2014;44(7):464‐A15. doi:10.2519/jospt.2014.5098 

(5) Pregnancy and Low Back Pain: Physical Therapy Can Reduce Back and Pelvic  

Pain During and After Pregnancy. Journal of Orthopedic & Sports Physical Therapy. 2014;44(7):474-474. doi:10.2519/jospt.2014.0505