Brad Bevil, Lisa Broll, Kassandra Bills, Jeffrey Bierman
April 15, 2013, PT 7539
Management of LBP During Pregnancy and
Role of Manual Therapy
A Clinical Management Guideline
LBP is a common problem during pregnancy and can lead to a reduction in ability to perform ADL’s and
work-related activities
 Etiology: Contributing factors include: hormonal changes,
biomechanical/musculoskeletal changes, and a vascular
component10
Clinical Bottom Line:
 Diagnostics
 Manual therapy such as MET
o Differentiate between lumbar pain vs pelvic girdle
& mobilization have been a
pain
part of successful treatment
o Key Tests: Posterior Pelvic Pain Provocation Test,
in multiple studies.
FABER, Active Straight Leg Raise, Modified
 Manual therapy should be
Trendelenburg’s, Long Dorsal SI Ligament Test3,14
followed up by a stabilization
 Prognosis: Generally considered good with LBP typically
exercise program.
declining during the first 3 months post-partum. Some pts
 Call for more research with
will continue to experience pain in the year post-partum4
consistent methods and
evaluative measures.
Evidence-Supported Interventions:
 Manual Therapy
o Joint mobilization
o Muscle Energy Teqniques (MET) with a focus on correcting sacral
torsion and malalignment & ligament laxity
o Spinal Manipulation
 Note: Limited evidence supporting the effictiveness of SMT,
consider if no contraindications are present
 Therapeutic Exercise/ HEP
o Stabilization Exercises to strengthen deep postural muscles
o Neuromusular re-education of TA & multifidus
o Hip add & abd isometrics
o Physioball exercises
o Stretching: hip flexors & piriformis
 Patient Education
o Posture
o Positioning:
 Perform exercise program in a semi-reclined
position to reduce compression of the vena cava
 Recommend the use of pillows/cushions to support different parts of body
 (e.g. lumbar roll when sitting, pillow in the shape of a nest to support the
abdomen when pt is in lateral recumbent position)
o Sacroiliac belt
Texas State University, Dept of Physical Therapy
DPT 7539, 2013
Brad Bevil, Lisa Broll, Kassandra Bills, Jeffrey Bierman
April 15, 2013, PT 7539
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Fabio R. Efficacy of Manual Therapy. Phys Ther. 1992. 72: 853-864.
Flynn T, Cleland J, Whitman J. Users’ Guide to the Musculoskeletal Examination. Buckner, KY: Evidence
in Motion. 2008.
Hall J, Cleland JA, Palmer JA, The effects of manual physical therapy and therapeutic exercise on
peripartum posterior pelvic pain: two case reports. J Man Manip Ther. 2005; 13(2): 94-102
Katonis P, Kampouroglou A, Aggelopoulos A, Kakavelakis K, Lykoudis S, Makrigiannakis A, Alpantaki
K. Pregnancy-related low back pain. Hippokratia. 2011; 15(3): 205-210.
Khorsan R, Hawk C, Lisi AJ, Kizhakkeveettil A. Manipulative therapy for pregnancy and related
conditions: a systematic review. Obstet Gynecol Surv. 2009;64(6): 416-27
Murphy DR, Hurwitz EL, McGovern EE. Outcome of pregnancy-related lumbopelvic pain treated
according to a diagnosis-based decision rule: a prospective observational cohort study. J Manipulative
Physio Ther. 2009; 32(8) 616-24.
Nilsson-Wikmar L, Holm K, Oijerstedt R. Harms-Ringdahl K. Effect of three different physical therapy
treatments on pain and activity in pregnant women with pelvic girdle pain: a randomized clinical trial with
3,6, and 12 months follow-up postpartum. Spine. 2005; 30(8): 850-856.
Peterson CD, Haas M, Gregory WT. A pilot randomized controlled trial comparing the efficacy of exercise,
spinal manipulation, and neuro emotional technique for the treatment of pregnancy-related low back pain.
Chiropractic and Manual Therapies. 2012; 20(18).
Requejo SM, Barnes R, Kulig K, Landel R, Gonzalez S. The Use of a modified classification system in the
treatment of low back pain during pregnancy: a case report. J Orthop Sports Phys Ther. 2002; 32: 318-326.
Sneag DB, Bendo JA. Pregnancy-related low back pain. Orthopedics. 2007; 30(10): 839-847.
Stuge B, Hilde G, Vollestad N. Physical therapy for pregnancy-related low back and pelvic pain: a
systematic review. Acta Obstet Gynecol Scand. 2003; 82: 983-990.
Stuge B, Holm J, Vollestad N. To treat or not to treat postpartum pelvic girdle pain with stabilizing
exercises? Man Ther. 2006; 11(4): 337-343.
Stuge B, Laerum, Kirkesola G, Vollestad N. The efficacy of a treatment program focusing on specific
stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine 2004;
29(4): 351-359.
Vermani E, Mittal R, Weeks A. Pelvic girdle pain and low back pain in pregnancy: a review. Pain Pract.
2010; 10(1): 60-71.
Vollestad N, Torjesen P, Robinson H. Association Between the Serum Levels of Relaxin and Responses to
the Active Straight Leg Raise Test in Pregnancy. Manual Therapy. 2012. 17(3): 225-230.
Whitman J. Pregnancy, Low Back Pain, and Manual Physical Therapy Interventions. Journal of Orthopedic
& Sports Physical Therapy. 2002. 32(7): 314-317.
Texas State University, Dept of Physical Therapy
DPT 7539, 2013