Pregnancy low back pain is often considered to be a natural painful process during pregnancy and is a common condition during pregnancy [29, 30]. It usually occurs between the fifth and seventh months of pregnancy, and in some cases, pregnancy pain in the lower back can begin as early as eight to 12 weeks into the pregnancy. Women who have lower back problems before pregnancy are at higher risk for lower back pain, which can start early in pregnancy [31, 32]. A follow-up survey of 1131 pregnant women in the United States found that 0.4% of low back pain occurred in early pregnancy, 24.4% in the second trimester, and 75.1% in the third trimester. The incidence of low back pain increased with the increase of gestational weeks and reached a peak at 36 weeks of gestation, and with the increase of gestational cycles, the pain would gradually worsen [33, 34]. Therefore, early or early intervention is timely and necessary for the improvement of low back pain during pregnancy. The common treatment methods of low back pain during pregnancy include multimodal intervention (manual therapy, exercise, and health education), exercise therapy, and acupuncture. Among them, various forms of exercise therapy are the most commonly used intervention. However, a recent systematic review reported that the effect of exercise improvement is relatively low, and the improvement effect of acupuncture and intramuscular plaster is obvious [29, 35]. Since patients and clinicians tend to avoid drugs and invasive treatment during pregnancy, KT as a drug-free and safe alternative therapy provides a new treatment for low back pain during pregnancy. The improvement effect of functional movement is better than physical therapy, and it will not affect the fetus. It can minimize the occurrence and development of chronic pain and is simple, convenient, noninvasive, painless, and radiation-free.
To compare the treatment effect of KT on pregnant women's low back pain during pregnancy, this study selected the low back pain scoring scale commonly used in clinical practice, which can evaluate the degree of low back pain and lumbar injury, select the treatment plan and evaluate the treatment effect. At present, the scoring criteria commonly used in the world for lumbar dysfunction include Roland Morris Dysfunction Questionnaire (RMDQ), Oswestry Disability Index (ODI), Quebec Back Pain Disability Scale (QBPDS), JOA Low Back Pain Assessment Scale, Visual Analogue Scale (VAS), etc. Among them, the visual analogue scale of pain and Roland Morris dysfunction questionnaire are widely used as clinical outcome indicators in the study of the intervention of low back pain with KT during pregnancy, and they are also the most commonly used scale for the evaluation of low back pain in the world. The Roland-Morris Dysfunction Inventory was created by Roland and Morris in 1983. It can evaluate short-term changes before and after treatment of low back pain. It is a specific scale to evaluate lumbar dysfunction, with a minimum score of 0 and a maximum score of 24 [36–38]. Therefore, the visual analogue scale of pain and the Roland Morris Dysfunction Inventory was selected as clinical outcome indicators.
Careful assessment of pregnant women's low back pain during pregnancy, the clear purpose of treatment, accurate identification of target muscle sticking, these factors have an important impact on the success of treatment. In the included studies, 3 studies [24, 25, 27] used KT versus placebo patches, which proved that the application of KT alone had a positive effect on reducing pregnant women's low back pain and improving physical function during pregnancy; 2 studies [22, 26] used KT combined with routine rehabilitation training and routine rehabilitation training to confirm that KT can significantly improve the posture, pain and function of patients with low back pain during pregnancy; One study [23] used KT combined with analgesics, and the results showed that compared with paracetamol alone, KT combined with paracetamol effectively reduced pain and improved function, indicating that KT can be used as an adjuvant treatment to achieve effective control of low back pain during pregnancy. One study [28] adopted KT combined with psychotherapy, which effectively alleviated low back pain, anxiety, and depression of pregnant women during pregnancy.
At present, the pathophysiological mechanisms associated with low back pain during pregnancy are not clear. The main agreed factors are: First, weight gain, postural changes, and hormonal fluctuations during pregnancy, it may cause problems in the musculoskeletal system, destabilizing the spine and sacroiliac joint as well as connective tissue. Second, relaxation hormone, as a hormone secreted by the placenta, relaxes pelvic ligaments and the ligaments that support the spine, especially in late pregnancy, which may cause lower back pain [39]. In addition, pregnant women are generally less engaged in physical labor and sports, and more sedentary work, the lumbar and back muscles can’t be effectively exercised, and the core muscle strength is weak, which is also one of the reasons for low back pain during pregnancy. Aleksandra et al, based on a study of 1,510 pregnant women, found that the main risk factors for low back pain during pregnancy were onset of low back pain before pregnancy or menstruation, younger age, and lack of physical activity [4]. Therefore, the main goal of treatment is to reduce the intensity of pain, restore function and prevent the pain from becoming chronic. For pregnant women with low back pain, there is a tendency to avoid medication for fear of side effects and a preference for non-invasive and non-invasive treatment. Treatments focus on maintaining proper postures, movement adjustments, and health education.
The results of the current study show that the KT intervention significantly improved low back pain and dysfunction in pregnant women compared to other treatments in the control group, which is consistent with the results of previous studies [17, 25]. Possible mechanisms by which intramuscular tape improves low back pain during pregnancy include improved lower-back stability and increased proprioception, which in turn improves postural control [40, 41]; In addition, the KT can effectively adhere to the skin and exert pressure, increase the space under the skin or between the dermis and epidermis, promote subcutaneous blood circulation and lymphatic return, and accelerate the healing of the injured site through its tension, thus helping to eliminate substances that cause pain; Kinesio taping also provides a continuous neurosensory input to the skin receptors, thereby relatively suppressing the sensory input of pain and improving their ability to reduce mechanical stimulation of soft tissue during lumbar spine movement [42, 43]. Pain relief is the most important criterion in treatment because pain can seriously affect a pregnant woman's daily life. The key to using KT to relieve pain is how to choose the appropriate location, adjust the appropriate tension and determine the time of adhesive. Senbursa's study found that KT was very effective in improving low back pain in a short period, and could immediately show pain relief during activity and relaxation without other adverse reactions [44]. However, some studies have found that the KT can significantly improve the pain, range of motion, and injury of patients with low back pain in the short term, and maintain the improvement of range of motion and injury in the long term, but there is no long-term effect on the improvement of pain [45]. Therefore, the long-term effects of KT on low back pain during pregnancy still need to be further studied. In addition, in the United Kingdom and the United States, treatment of low back pain during pregnancy usually includes health education on low back pain, postural and body mechanics education starting in the first trimester, such as the type of pillow to sleep on, and physical therapy [10]. Education and guidance for pregnant women, popularize the knowledge of health care related to low back pain, to reduce the occurrence of low back pain during pregnancy, which is also the content of health education for pregnant women by obstetrics and gynecology and related medical personnel.
This meta-analysis study suggested that after KT intervention for low back pain during pregnancy, the improvement degree of low back pain and dysfunction in the experimental group was better than that in the control group, and the differences were statistically significant, suggesting that intramuscular effect patch intervention had a good effect on the improvement of low back pain and dysfunction during pregnancy. The results of the subgroup analysis showed that, according to the classification of pregnancy cycle, compared with the control group, KT intervention had statistically significant differences in the improvement of waist pain in the second and third trimesters of pregnancy. According to the classification of intervention cycle, compared with the control group, there were statistically significant differences in the improvement of lumbar pain in the KT group after intervention for one week, less than one week, and greater than one week. In the KT group, the intervention was less than or equal to one week, and the improvement difference of lumbar dysfunction was statistically significant. However, when the intramuscular effect patch group was treated for more than one week, there was no statistically significant difference in the improvement of lumbar function, and there was great heterogeneity. The analysis reasons might be as follows: There was no gold standard for the application of KT and there were differences among treatment regimens, which might lead to different therapeutic effects; The measurement of outcome indicators is affected by subjective factors, which leads to the deviation of data; There is no unified standard of routine rehabilitation training, and its intervention measures are inconsistent, which may also lead to heterogeneity; The specific measures taken by different control groups were not completely the same, which may be the source of heterogeneity.