A Case Report on Low Back Pain in the Third Trimester of Pregnancy addressed with Osteopathic Treatment

Purpose: The objective of this case report is to document the use of osteopathic manipulative articulatory, myofascial, soft tissue, and muscle energy techniques as safe adjunctive treatments for low back pain in the third trimester of pregnancy. The author describes a case of worsening low back pain in an obstetrical patient who was a G1P0 33 year old female in the 36th week of gestation and constantly on her feet at her workplace. The patient complained of stiffness in her lumbar spine as well as pain in the area of the round ligaments in the anterior pelvis. Following two osteopathic manipulative treatment sessions in addition to the patient stretching at home and using a massage therapist, the patient gained increased pain relief in her lumbar spine and sacrum as well as her anterior pelvis along the pubic symphysis. This enabled the patient to continue working her regular job up until the time of a full term vaginal delivery at 39 weeks. Methods: The author employed the use of the PROMOTE study OMT protocol developed by Dr. Kendi Hensel in order to address the patient with third trimester low back pain in this case report. The patient was treated twice using a series of techniques found in the PROMOTE study with great overall improvement in the patient’s pain. The author used seated thoracic articulation, cervical soft tissue, occipito-atlantal decompression, thoracic inlet myofascial release, lateral recumbent scapulothoracic soft tissue, lateral recumbent lumbar soft tissue, abdominal diaphragm myofascial release, pelvic diaphragm myofascial release, sacroiliac articulation, pubic symphysis decompression, and frog-leg sacral release. These OMT techniques were used in sequence to address the patient with third trimester low back pain. Results: In this case report, a multimodal approach was taken to address the patient’s back pain in the third trimester. The patient utilized home stretches and also attended massage therapy in addition to undergoing OMT treatments twice at the doctor’s office. The techniques from the PROMOTE study were utilized with great success in the patient and greatly relieved the patient’s low back pain in the weeks leading up to delivery. Through the treatments the patient was able to continue working and also was able to improve her ability to stay active in an exercise program in the weeks leading up to delivery. Conclusion: This case study does not prove that osteopathic treatment is the sole factor responsible for the improvement in low back pain within the third trimester of pregnancy. However, the case study does show that osteopathic manipulation was a vital component to the improvement that was shown in the pain and function of the patient in this particular case study. Further studies are indicated to focus more on the aspects of preparing the pelvis for the labor and delivery process as well as addressing other postural factors and improving overall hemodynamic functioning.