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Intervention Review

Interventions for preventing and treating pelvic and back pain in pregnancy

  1. Victoria Pennick1,*,
  2. Gavin Young2

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 18 APR 2007

Assessed as up-to-date: 7 FEB 2006

DOI: 10.1002/14651858.CD001139.pub2


How to Cite

Pennick V, Young G. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD001139. DOI: 10.1002/14651858.CD001139.pub2.

Author Information

  1. 1

    Institute for Work & Health, Toronto, Ontario, Canada

  2. 2

    Temple Sowerby Medical Practice, Penrith, Cumbria, UK

*Victoria Pennick, Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, Ontario, M5G 2E9, Canada. vpennick@iwh.on.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 APR 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Abstract
  5. Plain language summary

Background

More than two-thirds of pregnant women experience back pain and almost one-fifth experience pelvic pain. The pain increases with advancing pregnancy and interferes with work, daily activities and sleep.

Objectives

To assess the effects of interventions for preventing and treating back and pelvic pain in pregnancy.

Search methods

We searched the Cochrane Pregnancy and Childbirth Review Group's Trials Register (February 2006).

Selection criteria

Randomised controlled trials of any treatment to prevent or reduce the incidence or severity of back or pelvic pain in pregnancy.

Data collection and analysis

Two authors independently assessed trial quality and extracted data.

Main results

We found no studies dealing specifically with prevention of back or pelvic pain. We included eight studies (1305 participants) that examined the effects of adding various pregnancy-specific exercises, physiotherapy, acupuncture and pillows to usual prenatal care.

For women with low-back pain, participating in strengthening exercises, sitting pelvic tilt exercises (standardised mean difference (SMD) -5.34; 95% confidence interval (CI) -6.40 to -4.27), and water gymnastics reduced pain intensity and back pain-related sick leave (relative risk (RR) 0.40; 95% CI 0.17 to 0.92) better than usual prenatal care alone.

The specially-designed Ozzlo pillow was more effective than a regular one in relieving back pain (RR 1.84; 95% CI 1.32 to 2.55), but is no longer commercially available. Both acupuncture and stabilising exercises relieved pelvic pain more than usual prenatal care. Acupuncture gave more relief from evening pain than exercises. For women with both pelvic and back pain, in one study, acupuncture was more effective than physiotherapy in reducing the intensity of their pain; stretching exercises resulted in more total pain relief (60%) than usual care (11%); and 60% of those who received acupuncture reported less intense pain, compared to 14% of those receiving usual prenatal care. Women who received usual prenatal care reported more use of analgesics, physical modalities and sacroiliac belts.

Authors' conclusions

All but one study had moderate to high potential for bias, so results must be viewed cautiously. Adding pregnancy-specific exercises, physiotherapy or acupuncture to usual prenatal care appears to relieve back or pelvic pain more than usual prenatal care alone, although the effects are small. We do not know if they actually prevent pain from starting in the first place. Water gymnastics appear to help women stay at work. Acupuncture shows better results compared to physiotherapy.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Abstract
  5. Plain language summary

Interventions for preventing and treating pelvic and back pain in pregnancy

Many women experience back or pelvic pain during pregnancy. This pain generally increases as pregnancy advances and it interferes with daily activities (like carrying, cleaning, sitting and walking), can prevent women going to work and sometimes disturbs sleep. Suggestions to help manage the pain are varied and include special pregnancy exercises, frequent rest, hot and cold compresses, a supportive belt, massage, acupuncture, chiropractic, aromatherapy, relaxation, herbs, yoga and Reiki. Sometimes drugs like acetaminophen have also been suggested. No studies were found dealing with the prevention of back and pelvic pain. For treatment, the review of trials found eight studies, involving 1305 participants, that examined the effects of various pregnancy-specific exercises, physiotherapy programs, acupuncture and using special pillows added to usual prenatal care. They were compared to usual pregnancy care or other treatments. The quality of the studies was not the best, and so the findings should be treated with caution. The review found that specifically tailored strengthening exercise, sitting pelvic tilt exercise programs and water gymnastics all reported beneficial effects. The Ozzlo pillow seemed to be effective but is no longer available. In addition, acupuncture seemed more effective than physiotherapy. Adverse effects, when reported, appeared minor and transient. More research is needed on this widespread problem of pregnancy.

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Abstract
  5. Plain language summary

Postupci za sprječavanje i liječenje boli u zdjelici i leđima tijekom trudnoće

Background

More than two-thirds of pregnant women experience back pain and almost one-fifth experience pelvic pain. The pain increases with advancing pregnancy and interferes with work, daily activities and sleep.

Objectives

To assess the effects of interventions for preventing and treating back and pelvic pain in pregnancy.

Search methods

We searched the Cochrane Pregnancy and Childbirth Review Group's Trials Register (February 2006).

Selection criteria

Randomised controlled trials of any treatment to prevent or reduce the incidence or severity of back or pelvic pain in pregnancy.

Data collection and analysis

Two authors independently assessed trial quality and extracted data.

Main results

We found no studies dealing specifically with prevention of back or pelvic pain. We included eight studies (1305 participants) that examined the effects of adding various pregnancy-specific exercises, physiotherapy, acupuncture and pillows to usual prenatal care.

For women with low-back pain, participating in strengthening exercises, sitting pelvic tilt exercises (standardised mean difference (SMD) -5.34; 95% confidence interval (CI) -6.40 to -4.27), and water gymnastics reduced pain intensity and back pain-related sick leave (relative risk (RR) 0.40; 95% CI 0.17 to 0.92) better than usual prenatal care alone.

The specially-designed Ozzlo pillow was more effective than a regular one in relieving back pain (RR 1.84; 95% CI 1.32 to 2.55), but is no longer commercially available. Both acupuncture and stabilising exercises relieved pelvic pain more than usual prenatal care. Acupuncture gave more relief from evening pain than exercises. For women with both pelvic and back pain, in one study, acupuncture was more effective than physiotherapy in reducing the intensity of their pain; stretching exercises resulted in more total pain relief (60%) than usual care (11%); and 60% of those who received acupuncture reported less intense pain, compared to 14% of those receiving usual prenatal care. Women who received usual prenatal care reported more use of analgesics, physical modalities and sacroiliac belts.

Authors' conclusions

All but one study had moderate to high potential for bias, so results must be viewed cautiously. Adding pregnancy-specific exercises, physiotherapy or acupuncture to usual prenatal care appears to relieve back or pelvic pain more than usual prenatal care alone, although the effects are small. We do not know if they actually prevent pain from starting in the first place. Water gymnastics appear to help women stay at work. Acupuncture shows better results compared to physiotherapy.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Abstract
  5. Plain language summary

Postupci za sprječavanje i liječenje boli u zdjelici i leđima tijekom trudnoće

Postupci za sprječavanje i liječenje boli u zdjelici i leđima tijekom trudnoće

Mnoge žene tijekom trudnoće pate od boli u leđima ili zdjelici. Bol se općenito pojačava kako trudnoća napreduje i ometa svakodnevne aktivnosti (kao što su nošenje tereta, čišćenje, sjedenje i hodanje), a može spriječiti žene da odu na posao i ponekad im ometa san. Postoje razni prijedlozi kako se može ublažiti ova bol, a uključuju različite vježbe tijekom trudnoće, često odmaranje, hladne i vruće obloge, potporni pojas, masažu, akupunkturu, kiropraktiku, aromaterapiju, opuštanje, različite biljke, jogu i reiki. Ponekad se predlažu i lijekovi kao što je acetaminofen.Cochrane sustavni pregled istražio je učinkovitost različitih postupaka za sprječavanje i liječenje boli u zdjelici i leđima tijekom trudnoće. Nije pronađena nijedna studija koja je istražila postupke za sprječavanje ovih bolova. Za liječenje je pronađeno 8 kliničkih ispitivanja, s ukupno 1305 ispitanica, u kojima su ispitani učinci različitih vježbi koje se preporučuju posebno za trudnice, programa fizioterapije, akupunkture i korištenje specijalnih jastuka uz uobičajenu prenatalnu skrb. Ovi su postupci uspoređeni s uobičajenom skrbi u trudnoći ili s drugim terapijama. Kvaliteta studija nije bila najbolja i stoga rezultate treba uzeti s oprezom. Zaključak je sustavnog pregleda da vježbe za jačanje, koje su individualno osmišljene, vježbanje zdjelice u sjedećem položaju i gimnastika u vodi svi imaju blagotvoran učinak za ublažavanje boli u zdjelici i leđima tijekom trudnoće. Ozzlo jastuk se također pokazao korisnim, ali viša ga nema na tržištu. Osim toga, akupunktura se pokazala učinkovitijom od fizioterapijeNuspojave, kad su i prijavljene, bile su blage i prolazne. Potrebno je više istraživanja o ovom učestalom problemu u trudnoći.

Translation notes

Translated by: Croatian Branch of the Italian Cochrane Centre