LITERATURE REVIEW Current evidence supporting physiotherapy treatment for women with low back pain or lumbopelvic pain during pregnancy
Estimates suggest that 50% of women experience problems with lumbopelvic pain during pregnancy. Previous cross-sectional reviews have suggested that most musculoskeletal physiotherapists lack confidence when treating this patient group. The existing physiotherapy treatment protocols for this condition are based on evidence derived from systematic reviews published in 2015. Since then, new evidence has been published, but it has not been comprehensively appraised. Consequently, an updated review and clear guideline for the management of low back pain has potential value. The main databases were searched for studies published from 2014 onwards, and the reference lists were checked. Six randomized controlled trials were identified and appraised using the Critical Appraisal Skills Programme tool. There is low-quality evidence to support the use of kinesiology tape (K-tape) and progressive muscle relaxation (PMR) in a low-risk pregnancy population. There is moderate- and good-quality evidence for, respectively, supervised land-based exercise, and unsupervised water-based exercise and acupuncture in this specific group. These findings differ from previous updates published in 2015, which did not contain data on either PMR or K-tape. The evidence regarding exercise is unchanged, and there has been no new evidence about the effect of belts. However, it must be noted that research is applicable only to the low-risk pregnancy group, who may not accurately reflect the whole population. Further high-quality studies are required to determine optimal practice in both low- and, especially, high-risk pregnant patients. It is anticipated that this review, which is based on contemporary evidence, will help to guide physiotherapy treatment pathways and increase practitioners’ confidence when treating pregnant patients with lumbopelvic pain.
Keywords: low back pain, lumbopelvic pain, pelvic girdle pain, physiotherapy, pregnancy