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The Somatic Connection  |   July 2014
Chiropractic Treatment of Pregnant Patients Supports Reduction in Low Back Pain
Author Affiliations
  • Hollis H. King, DO, PhD
    University of California, San Diego School of Medicine
Article Information
The Somatic Connection   |   July 2014
Chiropractic Treatment of Pregnant Patients Supports Reduction in Low Back Pain
The Journal of the American Osteopathic Association, July 2014, Vol. 114, 589-590. doi:10.7556/jaoa.2014.116
The Journal of the American Osteopathic Association, July 2014, Vol. 114, 589-590. doi:10.7556/jaoa.2014.116
Peterson CK, Mühlemann D, Humphreys BK. Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1 year follow-up. Chiropratic Man Ther. 2014;22:15.  
Women receiving osteopathic manipulative treatment during their third trimester of pregnancy have been shown to have statistically significantly less functional deterioration and less back pain than women receiving standard obstetrical care and standard care plus sham ultrasound.1 Expanding on this body of research on manual therapy for pregnant women, Swiss researchers recently conducted a prospective cohort study to assess reports of low back pain in pregnant women receiving chiropractic treatment. 
Of 143 recruited pregnant patients, 115 completed the yearlong study. Patients were included if they were aged 18 years or older, had a history of low back pain, pelvic pain, or both, and had not received chiropractic or manual therapy in the previous 3 months. Patients were excluded if they had a history of tumors, infections, inflammatory spondylarthropathies, acute fractures, Paget disease, or severe osteoporosis. Patients were recruited from the practices of 15 different chiropractors. Chiropractic treatment was not standardized and included methods at the discretion of the provider. However, the authors noted that high-velocity, low-amplitude spinal manipulative therapy is the most common method used by chiropractors in Switzerland. 
Primary outcome measures were a numeric rating scale, with 0 indicating no pain and 10 indicating worst pain imaginable, and the Oswestry pain and disability questionnaire. Also collected was the patient's global impression of change, rated on a scale ranging from “much worse” to “much better.” All data were collected at baseline and 1 week, 1 month, 3 months, 6 months, and 1 year after the initiation of treatment. 
Results showed statistically significant progressive reductions in pain from baseline at every follow-up point for the numeric rating scale and Oswestry questionnaire. On the patient's global impression of change scale, patients reported progressively feeling “better” to “much better” at each data collection point. The authors point out that because this study was not a randomized controlled trial, the reported reductions in pain and reports of feeling much better could be attributed to factors other than the chiropractic treatment. However, they note that these results are very similar to a recent randomized controlled trial that showed similar levels of improvement and reduced pain.2 
This study was selected for review because its design has elements that could be used in prenatal osteopathic manipulative treatment research and because it shows another professions' approach to using manual therapy in pregnant patients. 
References
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 September 20, 2009]. Am J Obstet Gynecol. 2010;202(1):43.e1-43.e8. doi:10.1016/j.ajog.2009.07.057. [CrossRef]
George JW, Skaggs CD, Thompson PA, Nelson DM, Gavard JA, Gross GA. A randomized controlled trial comparing a multimodal intervention and standard obstetric care for low back and pelvic pain in pregnancy [published online October 23, 2012]. Am J Obstet Gynecol. 2013;295:e1-e7. doi:10.1016/j.ajog.2012.10.869.