Intervention for Pregnancy Related Pain

The long-term goal of this project is to develop an effective conservative treatment protocol that is easily accessible. The objective of this application is to determine if patients who are treated with Mulligan Concept manual therapy experience immediate and significant changes in pain and function. Our specific aims are: In women with PPGP, 1.) Determine if Mulligan Concept treatment produces immediate changes in pain and function, 2.) Determine whether the Mulligan Concept immediately restores or alters dysfunctional gait characteristics and pelvic girdle motor control, and 3.) Identify factors that mathematically predict treatment outcome. Our central hypothesis is that restoration of lumbopelvic positioning will result in immediate decrease in pain, increase in function, and improved gait mechanics.

Volunteers in the 20th-34th week of pregnancy, ages 20-45 years, who are experiencing PPGP will be screened and randomly assigned into treatment or placebo group based on age, weight, height, gestational week and number of pregnancies. All participants will undergo a standardized examination, complete patient reported outcome measures, and perform a walking gait, sit to stand, and active straight leg raise tasks. Kinematic, kinetic, and EMG recordings will be taken during performance of the tasks. The participants of the treatment group will receive a Mulligan Concept evaluation and treatment. Participants in the placebo group will receive only the Mulligan Concept evaluation. Participants will then repeat the same tasks and measures. The study will be conducted under a randomized triple blinded placebo trial design; the patients, researchers, and treating clinician will be blinded to group assignment. Independent sample t-tests will be conducted to determine if significant differences exist between the intervention and placebo group across several dependent variables. Regression analysis will be conducted in order to determine if intake factors mathematically predict treatment outcome.

Inclusion criteria

• reported pregnancy-related lumbopelvic pain

Exclusion criteria

• orthopaedic or neurological problems with walking
• prior surgery of the lumbar spine, pelvis, hip, or knee
• fracture
• known malignancy
• active inflammation in the lumbar spine or pelvis
• ankylosing spondylitis, Scheuermann's kyphosis, active polyarthritis, or severe osteoporosis
• any pulmonary, cardiac, visual, auditory, or cognitive disorders
• any other multi/co-morbidities that limit the volunteers ability to complete a gait and sit-to-stand task
• does not receive consent from their maternity care provider
• pain is associated with something other than pregnancy, or is experienced outside of pregnancy prior to the first pregnancy