Women's Health| Volume 43, ISSUE 7, P714-731, September 2020

Download started.


Chiropractic Care for Adults With Pregnancy-Related Low Back, Pelvic Girdle Pain, or Combination Pain: A Systematic Review

Published:September 05, 2020DOI:



      The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of chiropractic care options commonly used for pregnancy-related low back pain (LBP), pelvic girdle pain (PGP), or combination pain for both experienced practitioners and students of chiropractic.


      We included procedures that were commonly used by chiropractors and not requiring additional certifications. Outcomes were self-reported changes in pain or disability. We used the Scottish Intercollegiate Guideline Network checklists to assess outcomes. For strength of evidence, we used the adapted version of the US Preventive Services Task Force criteria as described in the UK report.


      Fifty articles were included from 18 SRs, 30 randomized controlled trials (RCTs), and 2 cohort studies. Pregnancy LBP (7 SRs and 12 RCTs): moderate, favorable evidence for electrotherapy and osteopathic manipulative therapy; inconclusive, favorable strength for chiropractic care, exercise, and support devices; and inconclusive, unclear strength for spinal manipulative therapy. Pregnancy PGP (4 SRs and 4 RCTs): inconclusive, favorable strength for exercise; and inconclusive, unclear evidence for patient education, information, and support devices. Pregnancy LBP or PGP (13 SRs and 12 RCTs): moderate, unclear evidence for complementary and alternative medicine; moderate, unclear evidence for exercise; inconclusive, favorable evidence for multimodal care, patient education, and physiotherapy; and inconclusive, unclear strength for spinal manipulative therapy, osteopathic manipulative therapy, and support devices.


      Although there is a lack of conclusive evidence, many of the interventions have moderate or unclear but favorable evidence.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Manipulative & Physiological Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Malmqvist S
        • Kjaermann I
        • Andersen K
        • Økland I
        • Brønnick K
        • Larsen JP
        Prevalence of low back and pelvic pain during pregnancy in a Norwegian population.
        J Manipulative Physiol Ther. 2012; 35: 272-278
        • Kovacs FM
        • Garcia E
        • Royuela A
        • González L
        • Abraira V
        Prevalence and factors associated with low back pain and pelvic girdle pain during pregnancy: a multicenter study conducted in the Spanish National Health Service.
        Spine (Phila Pa 1976). 2012; 37: 1516-1533
        • Gutke A
        • Ostgaard H
        • Oberg B
        Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning.
        Spine (Phila Pa 1976). 2006; 31: E149-E155
        • Stapleton DB
        • MacLennan AH
        • Kristiansson P
        The prevalence of recalled low back pain during and after pregnancy: a South Australian population survey.
        Aust N Z J Obstet Gynaecol. 2002; 42: 482-485
        • Endresen E
        Pelvic pain and low back pain in pregnant women – an epidemiological study.
        Scand J Rheumatol. 1995; 24: 135-141
        • Lisi AJ
        Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series.
        J Midwifery Womens Health. 2006; 51: e7-e10
        • Sipko T
        • Grygier D
        • Barczyk K
        • Eliasz G
        The occurrence of strain symptoms in the lumbosacral region and pelvis during pregnancy and after childbirth.
        J Manipulative Physiol Ther. 2010; 33: 370-377
        • Fast A
        • Weiss L
        • Ducommun EJ
        • Medina E
        • Butler JG
        Low-back pain in pregnancy. Abdominal muscles, sit-up performance, and back pain.
        Spine (Phila Pa 1976). 1990; 15: 28-30
        • Kristiansson P
        • Savardsudd K
        • von Schoultz B
        Back pain during pregnancy. A prospective study.
        Spine (Phila Pa 1976). 1996; 21: 702-709
        • Mens J
        • Vleeming A
        • Stoeckart R
        • Stam H
        • Snijders C
        Understanding peripartum pelvic pain. Implications of a patient survey.
        Spine (Phila Pa 1976). 1996; 21: 1363-1370
        • Ostgaard H
        • Andersson G
        Postpartum low-back pain.
        Spine (Phila Pa 1976). 1992; 17: 53-55
        • Aas-Jakobsen E
        • Miller J
        Chiropractic care during pregnancy: survey of 100 patients presenting to a private clinic in Oslo, Norway.
        J Clin Chiropr Pediatr. 2010; 11: 771-774
        • Browning M
        Low back and pelvic girdle pain of pregnancy: recommendations for diagnosis and clinical management.
        J Clin Chiropr Pediatr. 2010; 11: 775-779
        • Brynhildsen J
        • Hansson A
        • Persson A
        • Hammar M
        Follow-up of pateints with low back pain during pregnancy.
        Obstet Gynecol. 1998; 91: 182-186
        • Turgut F
        • Turgut M
        • Cetinashin M
        A prospective study of persistent back pain after pregnancy.
        Eur J Obstet Gynecol Reprod Biol. 1998; 80: 45-48
        • Lindal E
        • Hauksson A
        • Arnardottir S
        • Hallgrimsson J
        Low back pain, smoking and employment during pregnancy and after delivery – a 3-month follow-up study.
        J Obstet Gynaecol. 2000; 20: 263-266
        • Mogren I
        BMI, pain and hypermobility are determinants of long-term outcome for women with low back pain and pelvic pain during pregnancy.
        Eur Spine J. 2006; 15: 1093-1102
        • Ostgaard HC
        • Roos-Hansson E
        • Zetherström G
        Regression of back and posterior pelvic pain after pregnancy.
        Spine (Phila Pa 1976). 1996; 21: 2777-2780
        • Vermani E
        • Mittal R
        • Weeks A
        Pelvic girdle pain and low back pain in pregnancy: a review.
        Pain Pract. 2010; 10: 60-71
        • Stuber KJ
        • Smith DL
        Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence.
        J Manipulative Physiol Ther. 2008; 31: 447-454
        • Gutke A
        • Lundberg M
        • Ostgaard H
        • Oberg B
        Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms.
        Eur Spine J. 2011; 20: 440-448
        • Gutke A
        • Sjodahl J
        • Oberg B
        Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial.
        J Rehabil Med. 2010; 42: 929-935
        • Sadr S
        • Pourkiani-Allah-Abad N
        • Stuber KJ
        The treatment experience of patients with low back pain during pregnancy and their chiropractors: a qualitative study.
        Chiropr Man Therap. 2012; 20: 32
        • Wang S-M
        • DeZinno P
        • Fermo L
        • et al.
        Complementary and alternative medicine for low-back pain in pregnancy: a cross-sectional survey.
        J Alternative Complement Med. 2005; 11: 459-464
        • Ranzini A
        • Allen A
        • Lai Y
        Use of complementary medicines and therapies among obstetric pateints.
        Obstet Gynecol. 2001; 97: S46
        • Yuen T
        • Wells K
        • Benoit S
        • Yohanathan S
        • Capelletti L
        • Stuber K
        Therapeutic interventions employed by Greater Toronto Area chiropractors on pregnant patients: results of a cross-sectional online survey.
        J Can Chiropr Assoc. 2013; 57: 132-142
        • Cunningham F
        • Leveno K
        • Bloom S
        • et al.
        Williams Obstetrics.
        23rd ed. McGraw Medical, New York, NY2010
        • Ray-Griffith S
        • Wendel M
        • Stowe Z
        • Magann E
        Chronic pain during pregnancy: a review of the literature.
        Int J Womens Health. 2018; 10: 153-164
        • Moher D
        • Liberati A
        • Tetzlaff J
        • Altman D
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Br Med J. 2009; 339: b2535
        • Gutke A
        • Betten C
        • Degerskar K
        • Pousette S
        • Olsen M
        Treatments for pregnancy-related lumbopelvic pain: a systematic reivew of physiotherapy modalities.
        Acta Obstet Gynecol Scand. 2015; 94: 1156-1167
        • Hawk C
        • Minkalis A
        • Khorsan R
        • et al.
        Systematic review of nondrug, nonsurgical treatment of shoulder conditions.
        J Manipulative Physiol Ther. 2017; 40: 293-319
        • Harbour R
        • Lowe G
        • Twaddle S
        Scottish Intercollegiate Guidelines Network: the first 15 years (1993-2008).
        J R Coll Physicians Edinb. 2011; 41 (163-138)
      1. Scottish International Guideline Network. Critical appraisal notes and checklists. Available at: Accessed December 2017.

        • Bronford G
        • Haas M
        • Evans R
        • Leininger B
        • Triano J
        Effectiveness of manual therapies: the UK evidence report.
        Chiropr Osteopat. 2010; 18: 3
        • Clar C
        • Tsertsvadze A
        • Court R
        • Hundt G
        • Clarke A
        • Sutcliffe P
        Clincal effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report.
        Chiropr Man Ther. 2014; 22: 12
      2. Higgins J, Green S, eds. Cochrane handbook for systematic reivews of interventions. Version 5.1.0. 2011. Available at: Accessed August 11, 2020

        • Ruffini ND’
        • Alessandro G
        • Cardinali L
        • Frondaroli F
        • Cerritelli F
        Osteopathic manipulative treatment in gynecology and obstetrics: a systematic review.
        Complement Ther Med. 2016; 26: 72-78
        • Hall K
        • Cramer H
        • Sundberg T
        • Ward L
        • Adams J
        • Moore C
        • Sibbritt D
        • Lauche R
        The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain. A systematic review with meta-analysis.
        Medicine. 2016; 95: e4723
        • Liddle SD
        • Pennick V
        Interventions for preventing and treating low-back and pelvic pain during pregnancy.
        Cochrane Database Syst Rev. 2015; 9CD001139
        • Khorsan R
        • Hawk C
        • Lisi AJ
        • Kizhakkeveettil A
        Manipulative therapy for pregnancy and related conditions. A systematic review.
        Obstet Gynecol Surv. 2009; 64: 416-427
        • Nascimento SL
        • Surita FG
        • Cecatti JG
        Physical exercise during pregnancy: a systematic review.
        Curr Opinion Obstetric Gynecol. 2012; 24: 387-394
        • Waller B
        • Lambeck J
        • Daly D
        Therapeutic aquatic exercise in the treatment of low back pain: a systematic review.
        Clin Rehabil. 2009; 23: 3-14
        • Stuge B
        • Hilde G
        • Vøllestad N
        Physical therapy for pregnancy-related low back and pelvic pain: a systematic review.
        Acta Obstet Gynecol Scand. 2003; 82: 983-990
        • Richards E
        • van Kessel G
        • Virgara R
        • Harris P
        Does antenatal physical therapy for pregnant women with low back pain or pelvic pain improve funtional outcomes? A systematic review.
        ACTA Obstet Gynecol Scand. 2012; 91: 1038-1045
        • Belogolovsky I
        • Katzman W
        • Christopherson N
        • Rivera M
        • Allen DD
        The effectiveness of exercise in treatment of pregnancy-related lumbar and pelvic girdle pain: a meta-analysis and evidence-based review.
        J Womens Health Phys Therap. 2015; 39: 12
        • Lillios S
        • Young J
        The effects of core and lower extremity strengthening on pregnancy-related low back and pelvic girdle pain: a systematic review.
        J Womens Health Phys Therap. 2012; 36: 116-124
        • Boissonnault JS
        • Klestinski JU
        • Pearcy K
        The role of exercise in the management of pelvic girdle and low back pain in pregnancy: a systematic review of the literature.
        J Womens Health Phys Therap. 2012; 36: 69-77
        • Close C
        • Sinclair M
        • Liddle SD
        • Madden E
        • McCullough JEM
        • Hughes C
        A systematic review investigating the effectiveness of Complementary and Alternative Medicine (CAM) for the management of low back and/or pelvic pain (LBPP) in pregnancy.
        J Adv Nurs. 2014; 70: 1702-1716
        • van Benten E
        • Pool J
        • Mens J
        • Pool-Goudzwaard A
        Recommendations for physical therapists on the treatment of lumbopelvic pain during pregnancy: a systematic review.
        J Orthop Sports Phys Ther. 2014; 44: 464
        • Verstraete EH
        • Vanderstraeten G
        • Parewijck W
        Pelvic girdle pain during or after pregnancy: a reveiw of recent evidence and a clinical care path proposal.
        Facts Views Vis Obgyn. 2013; 5: 33-43
        • Van Kampen M
        • Devoogdt N
        • De Groef A
        • Gielen A
        • Geraerts I
        The efficacy of physiotherapy for the prevention and treatment of prenatal symptoms: a systematic review.
        Int Urogynecol J. 2015; 26: 1575-1586
        • Ho SS
        • Yu WW
        • Lao TT
        • Chow DH
        • Chung JW
        • Li Y
        Effectiveness of maternity support belts in reducing low back pain during pregnancy: a review.
        J Clin Nurs. 2009; 18: 1523-1532
        • Granath A
        • Hellgren MSE
        • Gunnarsson RK
        Water aerobics reduces sick leave due to low back pain during pregnancy.
        J Obstet Gynecol Neonatal Nurs. 2006; 35: 465-471
        • Chaudry S
        • Rashid F
        • Shah S
        Effectivenss of core stabilzation exercises along with postural correction in postpartum back pain.
        Rawal Med J. 2013; 38: 256-259
        • Suputtitada A
        • Wacharapreechanont T
        • Chaisayan P
        Effect of the “sitting pelvic tilt exercise” during the third trimester in primigravidas on back pain.
        J Med Assoc Thai. 2002; 85: S170-S179
        • Morino S
        • Kajiwara Y
        • Ishihara M
        • et al.
        The relationship between the daily step counts and low back pain during pregnancy.
        Clin Exp Obstet Gynecol. 2016; 43: 192-197
        • Sedaghati P
        • Ziaee V
        • Ardjmand A
        The effect of an ergometric training program on pregnants’ weight gain and low back pain.
        Gaz Med Ital. 2007; 166: 209-213
        • Beyaz E
        • Ozcan E
        • Ketenci A
        • Beyaz M
        The effectiveness of pregnancy rehabilitation: effects on low back pain and calf cramps during pregnancy and pregnancy outcome.
        Nobel Medicus. 2011; 7: 67-74
        • Garshasbi A
        • Faghih Zadeh S
        The effect of exercise on the intensity of low back pain in pregnant women.
        Int J Gynaecol Obstet. 2005; 88: 271-275
        • Figueira HA
        • de Souza Vale RG
        • Guedes Rodrigues WF
        • Figueira AA
        • Figueira JA
        • Martin Dantas EH
        Pregnancy-related low back pain relief after maximum static flexibility program.
        Health. 2014; 6: 2966-2972
        • Kihlstrand M
        • Stenman B
        • Nilsson S
        • Axelsson O
        Water-gymnastics reduced the intensity of back/low back pain in pregnant women.
        Acta Obstet Gynecol Scand. 1999; 78: 180-185
        • Dumas G
        • Reid J
        • Wolfe L
        • Griffin M
        • McGrath M
        Exercise, posture, and back pain during pregnancy. Part 2. Exercise and back pain.
        Clin Biomech. 1995; 10: 104-109
        • Licciardone J
        • Buchanan S
        • Hensel K
        • King H
        • Fulda K
        • Stoll S
        Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial.
        Am J Obstet Gynecol. 2010; 202 (e1-8): 43
        • Hensel KL
        • Buchanan S
        • Brown SK
        • Rodriguez M
        • Cruser dA
        Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects: the PROMOTE study.
        Am J Obstet Gynecol. 2015; 212 (e1-9): 108
        • Keskin E
        • Onur O
        • Keskin H
        • Gumus I
        • Kafali H
        • Turhan N
        Transcutaneous electrical nerve stimulation improves low back pain during pregnancy.
        Gynecol Obstet Invest. 2012; 74: 76-83
        • Carr C
        Use of a maternity support binder for relief of pregnancy-related back pain.
        J Obstet Gynecol Neonatal Nurs. 2003; 32: 495-502
        • Thomas I
        • Nicklin J
        • Pollock H
        • Faulkner K
        Evaluation of a maternity cushion (Ozzlo pillow) for backache and insomnia in late pregnancy.
        Aust N Z J Obstet Gynaecol. 1989; 29: 133-138
        • Elden H
        • Ladfors L
        • Olsen MF
        • Ostgaard H-C
        • Hagberg H
        Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial.
        BMJ. 2005; 330: 761
        • Nilsson-Wikmar L
        • Holm K
        • Oijerstedt R
        • Harms-Ringdahl K
        Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain: a randomized clinical trial with 3, 6, and 12 months follow-up postpartum.
        Spine (Phila Pa 1976). 2005; 30: 850-856
        • Depledge J
        • McNair PJ
        • Keal-Smith C
        • Williams M
        Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts.
        Phys Ther. 2005; 85: 1290-1300
        • Kordi R
        • Abolhasani M
        • Rostami M
        • Hantoushzadeh S
        • Mansournia MA
        • Vasheghani-Farahani F
        Comparison between the effect of lumbopelvic belt and home based pelvic stabilizing exercise on pregnant women with pelvic girdle pain; a randomized controlled trial.
        J Back Musculoskelet Rehabil. 2013; 26: 133-139
        • Peterson C
        • Haas M
        • Gregory W
        A pilot randomized controlled trial comparing the efficacy of exercise, spinal manipulation, and Neuro Emotional Technique for the treatment of pregnancy-related low back pain.
        Chiropr Man Therap. 2012; 20: 18
        • George J
        • Skaggs C
        • Thompson P
        A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy.
        Am J Obstet Gynecol. 2013; 208 (e1-7): 295
        • Stafne S
        • Salvesen K
        • Romundstad P
        • Stuge B
        • Mørkved S
        Does regular exercise during pregnancy influence lumbopelvic pain? A randomized controlled trial.
        Acta Obstet Gynecol Scand. 2012; 91: 552-559
        • Mørkved S
        • Salvesen KA
        • Schei B
        • Lydersen S
        • Bø K
        Does group training during pregnancy prevent lumbopelvic pain? A randomized clinical trial.
        Acta Obstet Gynecol Scand. 2007; 86: 276-282
        • Kluge J
        • Hall D
        • Louw Q
        • Theron G
        • Grové D
        Specific exercises to treat pregnancy-related low back pain in a South African population.
        Int J Gynaecol Obstet. 2011; 113: 187-191
        • Haakstad L
        • Bø K
        Effect of a regular exercise programme on pelvic girdle and low back pain in previously inactive pregnant women: a randomized controlled trial.
        J Rehabil Med. 2015; 47: 229-234
        • Eggen MH
        • Stuge B
        • Mowinckel P
        • Jensen KS
        • Hagen KB
        Can supervised group exercises including ergonomic advice reduce the prevalence and severity of low back pain and pelvic girdle pain in pregnancy? A randomized controlled trial.
        Phys Ther. 2012; 92: 781-790
        • Miquelutti MA
        • Cecatti JG
        • Makuch MY
        Evaluation of a birth preparation program on lumbopelvic pain, urinary incontinence, anxiety and exercise: a randomized controlled trial.
        BMC Pregnancy Childbirth. 2013; 13: 154
        • Ozdemir S
        • Bebis H
        • Ortabag T
        • Acikel C
        Evaluation of the efficacy of an exercise program for pregnant women with low back and pelvic pain: a prospective randomized controlled trial.
        J Adv Nurs. 2015; 71: 1926-1939
        • Mahishale A
        • Patted S
        Effectiveness of tailor made exercise intervention for low back pain and pelvic pain during pregnancy - a randomized controlled trial.
        Indian J Physiother Occup Ther. 2014; 8: 143-148
        • Ostgaard H
        • Zetherström G
        • Roos-Hansson E
        • Svanberg B
        Reduction of back and posterior pelvic pain in pregnancy.
        Spine (Phila Pa 1976). 1994; 19: 894-900
        • Noren L
        • Ostgaard S
        • Nielsen T
        • Ostgaard H
        Reduction of sick leave for lumbar back and posterior pelvic pain in pregnancy.
        Spine(Phila Pa 1976). 1997; 22: 2157-2160
        • Kalus S
        • Kornman L
        • Quinlivan J
        Managing back pain in pregnancy using a support garment: a randomised trial.
        BJOG. 2008; 115: 68-75
        • Kaplan S
        • Alpayci M
        • Karaman E
        • et al.
        Short-term effects of kinesio taping in women with pregnancy-related low back pain: a randomized controlled clinical trial.
        Med Sci Monit. 2016; 22: 1297-1301
        • Wedenberg K
        • Moen B
        • Norling A
        A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy.
        Acta Obstet Gynecol Scand. 2000; 79: 331-335
        • Young G
        • Jewell D
        Interventions for preventing and treating backache in pregnancy.
        Cochrane Database Syst Rev. 2000; 2CD001139
        • Pennick VE
        • Young G
        Interventions for preventing and treating pelvic and back pain in pregnancy.
        Cochrane Database Syst Rev. 2007; 2CD001139
        • Pennick V
        • Liddle SD
        Interventions for preventing and treating pelvic and back pain in pregnancy.
        Cochrane Database Syst Rev. 2013; 8CD001139