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Letters to the Editor  |   September 2010
OMT Relieves Low Back Pain During Pregnancy
Article Information
Neuromusculoskeletal Disorders / Obstetrics and Gynecology / Osteopathic Manipulative Treatment / Pain Management/Palliative Care / Low Back Pain
Letters to the Editor   |   September 2010
OMT Relieves Low Back Pain During Pregnancy
The Journal of the American Osteopathic Association, September 2010, Vol. 110, 555. doi:10.7556/jaoa.2010.110.9.555
The Journal of the American Osteopathic Association, September 2010, Vol. 110, 555. doi:10.7556/jaoa.2010.110.9.555
To the Editor:  
Hoorah! While reading the December 2009 issue of the JAOA—The Journal of the American Osteopathic Association, I discovered in “The Somatic Connection”1 a discussion of an article on osteopathic manipulative treatment (OMT) and low back pain during pregnancy. Researchers at the University of North Texas Health Science Center—Texas College of Osteopathic Medicine in Fort Worth reported the results of the first randomized, placebo-controlled clinical trial2 of OMT for low back pain during uncomplicated pregnancy. 
Evidence-based literature on the safety and efficacy of OMT for low back pain is necessary and laudable. As an old-time rural osteopathic general practitioner, I had many obstetric patients under my care. In the study,2 patients were treated from the 30th week at regular intervals until parturition. My patients were seen and treated with OMT at each visit, every 2 weeks, until week 36, then weekly until delivery. Although the study2 did not use high-velocity, low-amplitude on patients, it was my main OMT technique—with other methods such as muscle energy and soft tissue when necessary. Also, our clinic charged a flat fee for prenatal care, postnatal care, and delivery, which enabled me to tell patients that if back ache or any problems arose between scheduled visits, they should come in immediately—not wait for the next visit. This understanding worked out well and enabled the patients and I to head off minor problems, whether musculoskeletal or physiologic, before they became major problems. 
Of course, I was not doing research but rather giving care to the women who were carrying their precious burden of new life. During each visit I was able to take the time while administering OMT to become physically aware of changes, to answer questions, to allow me to make each woman aware of what to expect during labor and delivery, and to let her get to know and trust me. 
It is only hearsay evidence, but all of these women appreciated the OMT. The primiparous patients really just thought that “this is the way it's supposed to be” while the multiparas patients, especially those who had “normal” obstetric care elsewhere, always commented that it was “so nice to go the whole 9 months without a backache.” 
When I taught Family Practice Obstetrics at the West Virginia School of Osteopathic Medicine, I started a “Lying in Facility” program at the school. We took carefully screened obstetric patients and, at delivery time, used some especially prepared rooms at the school (not the hospital) and with a closely supervised student assigned to each patient, conducted labor and delivery procedures right there. Each patient had received OMT throughout her pregnancy under supervision at each visit. My purpose for this program was to show our students that most pregnancies were `normal' and could and should be handled by a well-trained family physician. Not being one to write down numbers, I didn't record these facts, but our mortality rate was zero and our maternal and fetal morbidity rate was close to that. 
Osteopathic physicians must not forget postnatal care and the use of OMT. We must not forget that the woman's pelvic structures are rear-ranged by the passage of a new 6-lb to 9-lb human being passed through over a period of hours. Structure needs to be normalized as function may return to normal. 
Let us do more research studies to prove to the world that the “thing we do” is safe, efficacious, and should be a major part of “normal” obstetric care. 
 Dr Klemen died February 26, 2010.
 
Seffinger MA. OMT relieves low back pain during pregnancy [the somatic connection] [abstract of Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. Am J Obstet Gynecol. Published online ahead of print September19 , 2009]. J Am Osteopath Assoc. 2009;109(12):627 .
Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial [published online ahead of print September 19 , 2009]. Am J Obstet Gynecol. 2010;202(1):43.e1-8.