Osteopathy in Postpartum Lumbopelvic Pain

Postpartum lumbopelvic pain is a common musculoskeletal condition experienced by women after childbirth. Pain may be localized in the lumbar spine, pelvic girdle, or both regions, and can persist for several months after delivery. This condition may affect physical function, mobility, daily activities, sleep quality, psychological well-being, and quality of life. Difficulties in caring for the newborn, reduced participation in social activities, and limitations in occupational and household tasks are frequently reported among women with postpartum lumbopelvic pain.

The etiology of postpartum lumbopelvic pain is considered multifactorial. Hormonal changes during pregnancy, altered biomechanics, increased ligamentous laxity, changes in muscle function, reduced trunk stability, and physical demands associated with pregnancy and childbirth may contribute to the development and persistence of symptoms. In addition, psychosocial factors and individual pain responses may influence symptom severity and recovery.

Conservative management is generally recommended as the first-line approach for postpartum lumbopelvic pain. Common treatment strategies include patient education, therapeutic exercise, stabilization programs, and manual therapy interventions. Exercise-based rehabilitation aims to improve trunk muscle function, enhance lumbopelvic stability, and reduce pain-related disability. Core stabilization exercises are frequently used to improve neuromuscular control and functional capacity in women with postpartum lumbopelvic pain.

Osteopathic Manipulative Treatment (OMT) is a manual therapy approach that utilizes a variety of hands-on techniques to address musculoskeletal dysfunctions, improve mobility, and optimize body function. Previous studies have reported beneficial effects of OMT on pain intensity, physical function, disability, and quality of life in different musculoskeletal conditions. OMT has also been investigated in women during pregnancy and the postpartum period, with findings suggesting potential improvements in pain and functional outcomes. However, the available evidence remains limited, and further high-quality randomized controlled trials are needed to clarify its effectiveness in postpartum lumbopelvic pain.

Exercise-based rehabilitation has been reported to influence inflammatory responses and is commonly used in the management of postpartum lumbopelvic pain. In addition to its clinical effects on pain and function, Osteopathic Manipulative Treatment may also influence inflammatory biomarkers and stress-related hormonal responses. However, evidence regarding the effects of Osteopathic Manipulative Treatment on inflammatory biomarkers and cortisol levels in women with postpartum lumbopelvic pain remains limited. Further research is needed to better understand both the clinical and biological effects of Osteopathic Manipulative Treatment in this population.

The primary aim of this randomized controlled trial is to investigate the effects of Osteopathic Manipulative Treatment on pain intensity in women with postpartum lumbopelvic pain. Secondary aims are to evaluate the effects of treatment on functional status, quality of life, inflammatory biomarkers, and stress-related hormone levels.

A total of 45 women with postpartum lumbopelvic pain will be recruited for this study. Participants will be randomly allocated to one of three groups: (1) education and core stabilization exercises, (2) education and core stabilization exercises combined with Osteopathic Manipulative Treatment, or (3) education and core stabilization exercises combined with sham Osteopathic Manipulative Treatment. Exercise interventions will be performed three times per week for six weeks, while Osteopathic Manipulative Treatment and sham Osteopathic Manipulative Treatment will be administered once every two weeks for a total of four sessions over eight weeks. Outcome measures will be assessed before treatment and one week after completion of the final treatment session.

• Change from Baseline in Pain Intensity at Rest Measured by Visual Analog Scale (VAS) [Time frame: Baseline and Week 9]
• Change from Baseline in Pain Intensity During Activity Measured by Visual Analog Scale (VAS) [Time frame: Baseline and Week 9]
• Change from Baseline in Night Pain Measured by Visual Analog Scale (VAS) [Time frame: Baseline and Week 9]
• Change from Baseline in Pelvic Girdle Questionnaire (PGQ) Score [Time frame: Baseline and Week 9]
• Change from Baseline in SF-12 Physical Component Score [Time frame: Baseline and Week 9]
• Change from Baseline in SF-12 Mental Component Score [Time frame: Baseline and Week 9]
• Change from Baseline in Edinburgh Postnatal Depression Scale (EPDS) Score [Time frame: Baseline and Week 9]
• Change from Baseline in C-Reactive Protein (CRP) Level [Time frame: Baseline and Week 9]
• Change from Baseline in Interleukin-6 (IL-6) Level [Time frame: Baseline and Week 9]
• Change from Baseline in Interleukin-10 (IL-10) Level [Time frame: Baseline and Week 9]
• Change from Baseline in Tumor Necrosis Factor-Alpha (TNF-α) Level [Time frame: Baseline and Week 9]
• Change from Baseline in Serum Cortisol Level [Time frame: Baseline and Week 9]