Research Review by Dr. Shawn Thistle©

Date:

Apr. 2005

Study Title:

Effects of acupuncture and stabilizing exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomized single blind controlled trial

Authors:

Elden H, Ladfors L, Olsen MF, Ostgaard HC, Hagberg H

Publication Information:

British Medical Journal 2005; 330:761.

Summary:

Pelvic girdle pain is a common complaint among pregnant women. Roughly one third of pregnant women will experience severe pain. Previous studies have demonstrated that previous low back or pelvic pain and strenuous work increase a woman's risk of pelvic pain in pregnancy (PPP from this point on).

Further, almost 10% of women continue to experience pain after delivery, which can limit their ability to care from the baby, or effectively return to work.

Standard treatments for PPP have included advice to rest, home exercise programs, pelvic support belts, and patient education. The aim of this study was to examine whether the addition of acupuncture or specific stabilizing exercises to this standard treatment increases the efficacy of treatment. 386 healthy pregnant women at 12-31 gestation weeks were divided into three groups as follows:
  1. Standard treatment group - consisted of patient education, a pelvic belt, and a home exercise program to strengthen the abdominal and gluteal muscles.
  2. Acupuncture group - same treatment as the standard treatment group, plus 12 acupuncture treatments over 6 weeks utilizing 10 segmental points chosen by palpation for sensitive areas, and up to 7 extrasegmental points (for more detailed information on the points used, please see link to study above). Stainless steel needles were inserted intramuscularly at the selected points and left in for 30 minutes, being manually stimulated via twirling and pistoning every 10 minutes. Maternal and fetal heart rate and blood pressure were monitored during each treatment.
  3. Stabilizing exercise group - same treatment as the standard group plus specific stabilizing exercises aimed at correct activation and stabilization of the abdominal wall (tranverse abdominus, internal/external obliques, and multifidus - as per Hides, Richardson, Jull etc.). Six individual 60 minute treatments were administered over 6 weeks. Patients were encouraged to integrate theses exercises into their activities of daily living.
The primary outcome measure used in this study was current intensity of PPP marked on a 100 point visual analogue scale each morning and evening during the 8 week study period (1 week baseline, 6 week intervention, and 1 week follow-up). Each patient was also assessed by an independent examiner (physical therapist) to assess recovery from symptoms throughout the study.

Pertinent Results:

  1. both acupuncture and acupuncture added clear clinical advantages over standard treatment alone for women with PPP
  2. attenuation of pain and symptoms as assessed by the physical therapists was greatest in the acupuncture group
  3. the reduction in pain from the visual analogue scale was greatest in the acupuncture group in the evening
  4. in the standard treatment group, pain remained constant throughout the study
No serious complications occurred during any of the treatment sessions in any group.

Conclusions & Practical Application:

This study shows that the addition of acupuncture or a lumbopelvic stabilizing exercise program can significantly improve pain and functional outcomes in women with pelvic pain in pregnancy. Further, the lack of improvement in the standard therapy group supports previous research demonstrating the lack of efficacy for these commonly used interventions.

Although acupuncture was superior to stabilizing exercise in this study, I think it would have been interesting to add a fourth group to this study that received both the acupuncture and stabilizing exercise interventions to see if the combination of these approaches is more beneficial that each on its own.

Also, now that this evidence is emerging supporting the use of acupuncture and lumbopelvic stabilizing exercise for pelvic pain, it would be prudent to begin studying these treatments in patient with mechanical low back pain (i.e. non-pregnant subjects). I'm sure those of us who employ these techniques in practice would like to see this type of multi-modal approach be studied in more depth to help us decide which combination is most effective.