Osteopathic Manipulation for Postpartum Pain

Postpartum pain is common and can affect several different areas of the body. Studies have shown, for example, that 90% of women experience perineal pain following childbirth, and more than 30% of women report back pain a week after giving birth.^1,2

Though oral analgesia, ice packs and anti-inflammatory suppositories are frequently used in these patients, such approaches may not work for some women or may have limited efficacy.¹

A new study reported in the Journal of the American Osteopathic Association explored the use of osteopathic manipulative treatment (OMT) as an adjunct to the usual treatment of postpartum pain. ³

OMT may be particularly appropriate for the treatment of pain during this time period because of the changes that women typically experience in pregnancy and childbirth, as well as “postural changes and emotional stress, which collectively lead to hyperirritability of muscles and increased pain,” wrote the authors. 

“Many OMT techniques are able to help relax contracted muscle tissue, relieve joint pain, and alleviate ligamentous strain, thereby reducing this pain,” they said. While the handful of studies on the use of OMT in postpartum pain have found promising results, these have focused on low back pain.

In the current study, osteopathic doctors from the New York Institute of Technology College of Osteopathic Medicine and the Department of Osteopathic Manipulative Medicine at St Barnabas Hospital in New York, examined the effects of OMT on pain in 59 women. The participants were patients who had given birth within the previous 24 hours and reported that they were experiencing pain.

Before and after OMT, patients completed the short-form McGill Pain Questionnaire and a screening questionnaire regarding details about their pain. A 20- to 30-minute session of OMT was provided in the indicated region of pain by resident physicians from the neuromusculoskeletal medicine and osteopathic manipulative medicine (NMM/OMM) residency program at St Barnabas Hospital.

“The most common OMT techniques used were balanced ligamentous tension, myofascial release, and facilitated positional release techniques, as these techniques are passive and easily performed at bedside,” the authors reported.

The findings show that OMT was associated with statistically significant pain reductions as follows:

• 57.6% vs 27.1% of patients reported back pain before and after OMT (P <.001)

• 54.2% vs 37.3% of patients reported abdominal pain before and after OMT (P <.001)

• 18.6% vs 8.5% of patients reported vaginal pain before and after OMT, respectively (P =.03)

In addition, the majority of patients described their pain prior to OMT as cramping, and this decreased from 45.8% to 30.5% after OMT (P =.02).

The most notable results from the short-form McGill Pain Questionnaire was the change in visual analogue scale (VAS) scores: before OMT, the mean score for the total sample was 5; the score was reduced to 2.9 after OMT (P <.001), and 22% of patients reported a score of 0 after treatment.

Mean differences in VAS scores post-treatment were similar between patients who had vaginal delivery and those who had cesarean delivery.

These findings lay the groundwork for further consideration of OMT as a supplementary approach to standard care. Randomized controlled trials should be conducted to extend this area of inquiry.

Look at a video demonstration of OMT in a postpartum patient by Sheldon Yao, DO:

Follow @ClinicalPainAdv

References

1. East CE, Sherburn M, Nagle C, Said J, Forster D. Perineal pain following childbirth: prevalence, effects on postnatal recovery and analgesia usage. Midwifery. 2012; 28(1):93-97.
2. Shemila Abbasi, M Hamid, Z Ahmed, and Fauzia Haq Nawaz. Prevalence of low back pain experienced after delivery with and without epidural analgesia: A non-randomised prospective direct and telephonic survey. Indian J Anaesth. 2014; 58(2): 143–148.
3. Hastings V, McCallister AM, Curtis SA, Valant RJ, Yao S. Efficacy of Osteopathic Manipulative Treatment for Management of Postpartum Pain. J Am Osteopath Assoc. 2016; 116(8):502-509.