Soft Tissue Mobilization for Lumbopelvic Pain in the Third Trimester of Pregnancy
Condition: Low Back Pain; Pregnancy
MeSH terms: Low Back Pain
Study type: Interventional

Summary: 
      Back pain is one of the most common complaints in pregnancy. It is caused by the growing
      pregnant abdomen which then strains the lower back and pelvis. Often Obstetricians recommend
      rest, Tylenol, pelvic support belts, or exercise. Typically, these do not provide the patient
      much relief. A physical therapy treatment known as soft tissue mobilization (tSTM) has been
      shown to be helpful in treating various types of pain. This study will explore whether tSTM
      can improve back pain in pregnancy.
    

Detailed description: 
      Context: Lumbopelvic pain is one of the most common complaints in pregnancy, as increasing
      hormone levels cause joint laxity and the gravid uterus weakens abdominal muscles and
      increases lumbar muscle strain. Obstetricians often recommend rest, exercise, heating pad
      application, acetaminophen, or pelvic support belts. Patients often complain of minimal
      relief from these recommendations. Many experience recurrent lumbopelvic pain in a subsequent
      pregnancy. Additionally, lumbopelvic pain can contribute to disability and sick leave during
      the pregnancy. This is the first study to investigate whether soft tissue mobilization
      improves lumbopelvic pain in the third trimester.

      Objective: To investigate whether a physical therapy intervention known as transverse
      friction massage or soft tissue mobilization improves third trimester pregnancy related
      lumbopelvic pain.

      Design: Randomized pre-test and post-test comparison group design. Setting: Texas Tech
      University Health Sciences Center, Center for Rehabilitation Research, Lubbock, TX, USA.

      Participants: 48 subjects between the 18-45 years of age with a singleton gestation in the
      third trimester with pregnancy related lumbopelvic pain.

      Methods: Subjects consented for the study will be diagnosed by the Obstetrician with PRLPP by
      clinical tests, including the posterior pelvic pain provocation test, active straight leg
      raise test, and the long dorsal sacroiliac ligament test. Subjects will be randomized to one
      of three groups: no manual treatment (noManRx), superficial massage (sMass), and soft tissue
      mobilization (tSTM). All groups will receive standard care, which includes acetaminophen,
      heating pad application, and/or rest. Subjective questionnaires including the numeric pain
      rating scale (NPRS), the Oswestry Disability Index (ODI), and the Global Rating of Change
      (GROC) will be administered for baseline prior to allocated intervention. The Pressure Pain
      Threshold (PPT) will be measured via algometry. Those receiving sMass and tSTM will receive
      prescribed standard care as well as sMass or tSTM every 1-2 weeks by an investigator as well
      as daily sMass or tSTM at home.

      Main outcome measures: (1) Pain using NPRS, (2) disability using ODI, (3) overall change in
      pain pre- and post-treatment using GROC, (4) pressure pain threshold via algometry.

      Expected results: It is anticipated that this soft tissue mobilization technique known as
      transverse friction massage will decrease lumbopelvic pain in the third trimester of
      pregnancy.
    

Intervention name(s): Soft Tissue Mobilization; Soft Tissue Massage
Intervention type(s): Procedure; Procedure
Intervention description(s): The technique has been described previously in other descriptions. However, the main goal of this treatment is to address the LDSIL in the manner described previously in order to mobilize the soft tissue in the area.; For sMass, the subject will be positioned on her side opposite to the most painful side of the lumbosacral spine with the hips flexed to 45 degrees and knees flexed to 90 degrees (with a pillow positioned between them). The investigator will perform superficial (light stroke) massage to the painful side of the lumbosacral region for 5 minutes
Allocation: Randomized
Intervention model: Sequential Assignment
Masking: None (Open Label)
Primary purpose: Treatment