140 also successful in relieving low back pain in pregnant women. Water aerobics is another recommended strategy that has shown to reduce pain and, as a result, the need for sick leave in women with lumbar pain during pregnancy [30]. Back-pain-reducing programs involving exercise and education are often implemented early in pregnancy to combat occurrence or increased intensity of pain. Some studies show that such interventional therapy reduces intensity and anxiety, decreases the amount of sick leave taken, and prevents prolonged postpartum back pain [11, 31] and recurrence at 6-year follow-up [32]. However, other studies contradict these ﬁndings. Dumas et al. found no signiﬁcant difference in the prevalence of back pain or resulting functional limitations in pregnant women enrolled in an interventional exercise class and those who remained sedentary [16]. Studies have shown that complementary and alternative medicine therapies can be an effective means of decreasing back pain during pregnancy. One-third of the population of the United States use such alternative therapies, the majority of whom are women of childbearing age [33]. Consequently, it is no surprise that alternative therapies are a popular option for pain relief. The most popular therapies include massage, acupuncture, relaxation, yoga, and chi- ropractic procedures. Similarly, over 90% of prenatal health care providers would recommend some kind of nonpharmalogical treatment, including some alternative therapies. Midwives (93%) are more likely to recommend alternative treatments than physicians (64%) or prenatal nurse educators (57%) [34]. Support belts and corsets are another means to support the back. Pelvic girdle belts are used to press together the articular surfaces of the sacroiliac joints to provide stability and decrease laxity in the pelvis. Application of a pelvic belt in a high position was found to signiﬁcantly decrease pelvic laxity using Doppler imaging of vibration in the prone position [35]. Studies have shown that the use of pelvic belts have been effective in relieving pain [7, 36]. A pelvic belt is often the most prevalent therapy, although women do not rate it as the most effective therapy available [8]. Opoid medications can be prescribed for severe pain. Care must be taken to limit the dose to avoid opoid with- drawal in the newborn. In one case, physicians used an epidural administration instead of an oral route to minimize daily dosage in a woman with severe back pain due to multiple herniated discs [37]. Simple home remedies such as heating pads and over the counter pain medication can also ease pain. Acetamino- phen is an acceptable over the counter medication to relieve pain during pregnancy while aspirin and ibuprofen are not. Muscle relaxants can also be prescribed. Curr Rev Musculoskelet Med (2008) 1:137–141 Comfortable shoes without heels reduce symptoms and allow for more motility. Outcomes Persistent postpartum back pain, either recurrent or con- tinuous, is signiﬁcantly linked to symptoms during pregnancy. While most low back pain will relieve itself within 6 months of partum, some will cause lasting prob- lems. Mogren et al. found that of 464 subjects approximately 40% had pain 6 months post-pregnancy. The majority (36.2%) had recurrent pain while only 6.9% complained of continuous pain [38]. In a 3-year follow up study, 20% of women who reported back pain during pregnancy claimed that they still experienced pain [39]. A history of back pain, younger age, especially younger than 20 years, joint hyper-mobility, and an earlier onset of pain are associated risk factors for prolonged symptoms. A body mass index greater than 25 pre-pregnancy, end- pregnancy and 6 months after pregnancy is also a predis- posing condition for continuing low back pain [13, 40]. However, in a retrospective study only 10–25% of women with chronic back pain claim that their ﬁrst incidence of pain occurred during pregnancy, indicating that persistent problems after pregnancy are often linked to previous conditions [1, 36, 41]. Summary Low back is a common problem for all women but there is an increased incidence of back pain associated with preg- nancy. The most common complaint of pregnant women, low back pain can be the normal result of a multitude of mechanical, hormonal, and vascular changes associated with pregnancy. However, while usually regarded with a laissez-faire attitude, back pain during pregnancy should be taken seriously by patients and physicians. A number of serious pathological processes could be involved endan- gering both mother and fetus. Treatment options for low back pain consist mostly of postural education and rest. Physical therapy and ﬁtness programs are available to prevent back pain and alleviate pain if it already exists. Alternative therapies are becoming more and more popular in the pregnant population as a safe means to combat pain. More vigorous treatment is avail- able for serious problems. However, most women use an at home approach with support belts, heating pads, and pos- tural pillows. Whatever the cause, low back pain is a signiﬁcant distressing factor to pregnant women and should not be ignored as a normal consequence of becoming pregnant.