Influence of postoperative adhesions after caesarean section on chronic lower back pain – A pilot study of osteopathic manipulative treatment.

Abstract

Background: Despite the prevalence of abdominal adhesions after a caesarean section, there exist few postoperative treatment approaches which specifically target adhesions or establish their connection with chronic lower back pain (cLBP).<br> <br> Aims: To investigate if the osteopathic approach of treating adhesions after a caesarean section reduces existing cLBP symptoms and alleviates associated pain.<br> <br> Methods: The subjects received two 30-minute treatments with a one week pause between treatments. The intervention group A (n=18), those who received osteopathic treatment, were compared to a control group B (n=16), who received scar treatment using traditional physiotherapy. The evaluation of subjective (pain intensity with a numeric rating scale, or NRS) and objective (symptom evaluation using the Oswestry Low Back Pain Questionnaire) parameters was accomplished using questionnaires before and after the treatments.<br> <br> Results: Pain intensity reduced clinically relevant in group A by MA21=-2.6; SDA21=1.33 on the NRS. The average Oswestry Disability Index (ODI) in group A decreased from M1=18.3%; SD1=7.8 to M2=6.2%; SD2=6.2. In group B, the decrease from M1=19.1%; SD1=11.1 to M2=14.0%; SD2=10.1 was significantly smaller (p=0,005). Conclusions: Postoperative adhesions could cause cLBP. Treatment of adhesions using oste-opathy results in a significant reduction of pain symptoms for cLBP. Due to the sample size calculation, further studies addressing adhesions and chronic lower back pain would be rec-ommended. <br> Keywords: peritoneal adhesions; visceral adhesions; caesarean section; chronic lower back pain (cLBP)