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OsteopathicIntravaginal Treatment In Pregnant Women With Low Back Pain

1OsteopathiePrien, Prien, Germany, 2Osteopathie-Schule Deutschland,Hamburg, Germany, 3University Hamburg, Sports- andMovement Sci., Hamburg, Germany.

Introduction: 50 to 80% ofpregnant women suffer from low back pain (LBP) or pelvic pain (Sabinound Grauer, 2008). There is evidence for the effectiveness of manualtherapy like osteopathy, chiropractic and physiotherapy in pregnantwomen with LBP or pelvic pain (Liccardione et al., 2010).Anatomical, functional and neural connections support therelationship between intrapelvic dysfunctions and lumbar and pelvicpain (Kanakaris et al., 2011). Strain, pressure and stretch ofvisceral and parietal peritoneum, bladder, urethra, rectum andfascial tissue can result in pain and secondary in muscle spasm.Visceral mobility, especially of the uterus and rectum, can inducetension on the inferior hypogastric plexus, which may influence itsfunction. Thus, stretching the broad ligament of the uterus and theintrapelvic fascia tissue during pregnancy can reinforce theinfluence of the inferior hypogastric plexus. Based on above facts anadditional intravaginal treatment seems to be a considerable approachin the treatment of low back pain in pregnant women.
Objective:The purpose of this study was to compare the effect of osteopathictreatment including intravaginal techniques versus osteopathictreatment only in females with pregnancy-related low backpain.
Methods: Design: The study was performed as arandomized controlled trial. The participants were randomized bydrawing lots, either into the intervention group includingosteopathic and additional intravaginal treatment (IV) or a controlgroup with osteopathic treatment only (OI). Setting: Medical practicein south of Germany.
Participants 46 patients wererecruited between the 30th and 36th week of pregnancy suffering fromlow back pain.
Intervention Both groups received threetreatments within a period of three weeks. Both groups were treatedwith visceral, mobilization, and myofascial techniques in thecervical, thoracic and lumbar spine, the pelvic and the abdominalregion (American Osteopathic Association Guidelines, 2010). The IVgroup received an additional treatment with intravaginal techniquesin supine position. This included myofascial techniques of the M.levator ani and the internal obturator muscles, the vaginal tissue,the pubovesical and uterosacral ligaments as well as the inferiorhypogastric plexus.
Main outcome measures As primaryoutcome the back pain intensity was measured by Visual Analogue Scale(VAS). Secondary outcome was the disability index assessed byOswestry-Low-Back-Pain-Disability-Index (ODI), andPregnancy-Mobility-Index (PMI).
Results: 46 participantswere randomly assigned into the intervention group (IV; n = 23; age:29.0 ±4.8 years; height: 170.1 ±5.8 cm; weight: 64.2 ±10.3 kg;BMI: 21.9 ±2.6 kg/m2) and the control group (OI; n = 23;age: 32.0 ±3.9 years; height: 168.1 ±3.5 cm; weight: 62.3 ±7.9 kg;BMI: 22.1 ±3.2 kg/m2). Data from 42 patients wereincluded in the final analyses (IV: n=20; OI: n=22), whereas fourpatients dropped out due to general pregnancy complications. Backpain intensity (VAS) changed significantly in both groups: in theintervention group (IV) from 59.8 ±14.8 to 19.6 ±8.4 (p<0.05)and in the control group (OI) from 57.4 ±11.3 to 24.7 ±12.8. Thedifference between groups of 7.5 (95%CI: -16.3 to 1.3) failed todemonstrate statistical significance (p=0.93).Pregnancy-Mobility-Index (PMI) changed significantly in both groups,too. IV group: from 33.4 ±8.9 to 29.6 ±6.6 (p<0.05), controlgroup (OI): from 36.3 ±5.2 to 29.7 ±6.8. The difference betweengroups of 2.6 (95%CI: -5.9 to 0.6) was not statistically significant(p=0.109). Oswestry-Low-Back-Pain-Disability-Index (ODI) changedsignificantly in the intervention group (IV) from 15.1 ±7.8 to 9.2±3.6 (p<0.05) and also significantly in the control group (OI)from 13.8 ±4.9 to 9.2 ±3.0. Between-groups difference of 1.3(95%CI: -1.5 to 4.1) was not statistically significant(p=0.357).
Conclusions: In this sample a series ofosteopathic treatments showed significant effects in reducing painand increasing the lumbar range of motion in pregnant women with lowback pain. Both groups attained clinically significant improvement infunctional disability, activity and quality of life. Furthermore, nobenefit of additional intravaginal treatment was observed.
Trialregistration German Clinical Trials Register:DRKS00010416
References: Kanakaris, NK., Roberts, CS.,Giannoudis, PV. (2011). Pregnancy-related pelvic girdle pain: anupdate. BMC Med:9:15.
Liccardione, JC., Buchanan, S., Hensel, K.,King, H., Fulda, K., Stoll, S. (2010). Osteopathic ManipulativeTreatment of Back Pain and Related Symptoms during Pregnancy: ARandomized Controlled Trial. Am J Obstet. Gynecol:202 (1):43.e1-43.e.
Sabino, J., Grauer, JN. (2008). Pregnancy and low backpain. Curr Rev Musculskelet Med: 1: 137-141