Back pain is one of the most reported symptoms in pregnant women, with 50% of pregnant women estimated to experience back pain (1). In some cases, women experience severe lower back pain (LBP), which interferes with their daily routines. While LBP during pregnancy is common, it is crucial to differentiate the back pain to treat it effectively. Two common types of LBP during pregnancy are pelvic girdle pain (PGP) and lumbar pain (LP) (1). Both of these conditions have similar symptoms but are treated differently. Physiotherapy and the use of biofeedback units have been shown to relieve LBP during pregnancy (2,5).
While LBP’s etiology during pregnancy is not confirmed, some studies suspect weight gain and hormone changes to be the cause (1,3). Another study investigated the relationship between muscular function and LBP in pregnancy (2). In this study, a group of pregnant women was categorized into types of LBP experienced. Patients with combined PGP and LP had lower endurance in their back flexor and hip extension muscles and slower gait speed than those with no PGP or LP (2). PGP has also been associated with pelvic floor dysfunction, a common condition during and after the gestation period (4).
The overbearing weight on the pelvic floor muscles causes pelvic floor dysfunction during pregnancy (6). Physicians commonly use a biofeedback unit to exercise the pelvic floor muscle (PFM) effectively. In a study to evaluate a biofeedback unit’s effectiveness, 19 pregnant women’s PFM contractions were recorded throughout multiple sessions (6). The results showed an increasing amplitude of contractions, improving the muscle function of the PFM with each session (6). The study concluded the biofeedback unit to be a possible factor in improving PFM contraction. Another paper presents a case study of a woman two weeks postpartum with severe back pain. The subject’s pain and core muscle performance progress was compared during conventional exercises and while using a pressure biofeedback unit (PBU). Using the Oswestry disability index, the patient initially had a 96% disability. After the baseline treatment (without PBU), the patient’s disability was 70% and after interventional treatment (with PBU), the patient’s disability was 12%. With a significant change in the disability percentage, the PBU proved to increase efficiency in contracting the core muscles and reduced pain (5).
Although symptoms of back pain regress after delivery, some women continue to experience back pain one year postpartum (7). Long-term pain can be due to performing irregular exercises in an attempt to reduce pregnancy-related pain, which can lead to a burden on muscle and joints (5). Instead, learning to maintain correct posture and performing physiotherapy during early pregnancy will decrease the LBP risk in the future (1).
Esurgi’s product, the Biostabilizer, is an automated PBU that can provide clear and digital feedback. This digital PBU provides real-time graphical readings (terminal feedback) and automatic auditory and light (concurrent) feedback on a patient’s exercise session’s efficiency. This digital unit also has automated setup and test guidance, so in pilot studies physical therapists push a button and walk away to attend to their other responsibilities. A digital system will help patients achieve maximum core engagement and reduce the risk of injury during activities, especially for patients at high risk, such as pregnant women.
What is your experience and needs with using PBUs for effective pain management in pregnancy-related LBP?
- Katonis, P., Kampouroglou, A., Aggelopoulos, A., Kakavelakis, K., Lykoudis, S., Makrigiannakis, A., & Alpantaki, K. (2011). Pregnancy-related low back pain. Hippokratia, 15(3), 205–210.
- Gutke A, Ostgaard HC, Oberg B. Association between muscle function and low back pain in relation to pregnancy. J Rehabil Med. 2008;40(4):304-311. doi:10.2340/16501977-0170
- Casagrande, Danielle MD; Gugala, Zbigniew MD, PhD; Clark, Shannon M. MD; Lindsey, Ronald W. MD Low Back Pain and Pelvic Girdle Pain in Pregnancy, Journal of the American Academy of Orthopaedic Surgeons: September 2015 – Volume 23 – Issue 9 – p 539-549 doi: 10.5435/JAAOS-D-14-00248
- Pelvic Floor Dysfunction: Symptoms, Causes & Treatment. (2020). Cleveland Clinic.https://my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction#:%7E:text=Does%20pregnancy%20cause%20pelvic%20floor,labor%20was%20long%20or%20difficult.
- Senthil Kumar, N. S., & Rajalakshmi, D. (2012). Strengthening Transversus Abdominis in Pregnancy Related Pelvic Pain: The Pressure Biofeedback Stabilization Training. Global Journal of Health Science, 4(4), 2–5. https://doi.org/10.5539/gjhs.v4n4p55
- Batista, Roberta L. A., Franco, Maira M., Naldoni, Luciane M. V., Duarte, Geraldo, Oliveira, Anamaria S., & Ferreira, Cristine H. J.. (2011). Biofeedback and the electromyographic activity of pelvic floor muscles in pregnant women. Brazilian Journal of Physical Therapy, 15(5), 386-392. Epub October 14, 2011. https://dx.doi.org/10.1590/S1413-35552011005000026
- Padua, L., Caliandro, P., Aprile, I., Pazzaglia, C., Padua, R., Calistri, A., & Tonali, P. (2005). Back pain in pregnancy: 1-year follow-up of untreated cases. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 14(2), 151–154. https://doi.org/10.1007/s00586-004-0712-6