Decreased Risk of Low Back Pain During Pregnancy Associated With the Use of Orthopedic Manual Therapy: A Nested Case-Control Study.

Background: Recent evidence suggests that the use of orthopedic manual therapy (OMT) may lessen the subsequent risk of low back pain (LBP), but this association has not been examined among pregnant women who are at higher risk of LBP. This study aims to determine whether the addition of OMT to conventional LBP treatment before pregnancy could decrease the subsequent risk of LBP during pregnancy. Methods: From Taiwan's National Health Insurance Research Database, we identified 68,960 women, 20-55 years of age, with first pregnancy between 2001 and 2012. We then performed a nested case-control study in which 3,846 women with newly diagnosed LBP were matched to 3,846 controls according to age and cohort entry year. Multivariate conditional logistic regression was employed to estimate the association between OMT use before pregnancy and LBP during pregnancy. Results: OMT users had a lower risk of LBP than did non-users, with an adjusted OR of 0.86 (95% CI, 0.78-0.93). Subgroup analysis showed that women with high intensity use of OMT treatment prior to pregnancy reported the lowest level of LBP during pregnancy by nearly 30%. Conclusion: The pre-pregnancy use of OMT treatment significantly decreased LBP risk during pregnancy, especially with high-intensity use. Thus, clinicians may consider recommending OMT for pregnant women to avoid possible obstetric complications during the pregnancy.