Autotraction treatment for low-back pain in pregnancy: a pilot study

Back pain affects about 50% of pregnant women, for whom most of the conventional treatments may be contraindicated. We ran a pilot study to test safety and potential effectiveness of a modified version of autotraction (AT), a treatment combining active pulling efforts with the upper limbs and automatical mobilization of the spine.

We treated 16 women during weeks 13-26 of pregnancy (median 20), suffering from back and/or sciatica pain unremitting for 4-20 weeks (median 8). Treatment was given in three 25-minute outpatient periods, one every third day. During the first session heart rate and blood pressure were monitored: these never raised by more than 15 bpm and 20 mmHg, respectively. In three cases surface EMG signals recorded unilaterally from rectus abdominis and lumbar paraspinal muscles were compared during Valsalva manoeuvres and AT sessions, in order to obtain indirect information on changes of intra-abdominal pressure. Trunk muscles appeared to act to a comparable extent during both types of manoeuvre.

Self report of overall improvement, peak intensity of pain (0-100 score on 100 mm visual analogue scale [VAS]) and its qualitative severity (0-45 score on the short form of McGill Pain Questionnaire [MPQ]) were taken as outcome indicators. AT manoeuvres were always painless.

Thirteen out of 16 patients reported to be improved after treatment, whereas three were unchanged. In the responders, the median VAS and MPQ pain scores dropped, as a median, from 50/100 (range 25-77) to 19/100 (0-80) and from 8.5/40 (2-20) to 3.5/45 (0-14), respectively (p<0.001, Wilcoxon signed-rank test). One month after treatment 15 patients were pain free and one reported her improvement to be stable. The deliveries had been normal and the babies healthy.