MT on Pregnant Population

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
Clinical Bottom Line:
 Diagnostics
 Manual therapy such as MET
o Differentiate between lumbar pain vs pelvic girdle
& mobilization have been a
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
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Texas State University, Dept of Physical Therapy
DPT 7539, 2013