Soft Tissue Mobilization for Lumbopelvic Pain in the Third Trimester of Pregnancy
Soft Tissue Mobilization for Lumbopelvic Pain in the Third Trimester of Pregnancy
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.
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.
Inclusion Criteria:Inclusion Criteria:

 -  Subjects 18-45 years old

 -  singleton gestation in the third trimester (28 weeks and on)

 -  pregnancy-related lumbopelvic pain

 -  capable of following basic instructions.

 Exclusion Criteria:

 -  Subjects with a history of lumbopelvic pain that required healthcare management within
 a year prior to pregnancy

 -  acute infectious or inflammatory process

 -  diagnosed mental health disorder

 -  substance abuse

 -  documented diagnosis of fibromyalgia.