As the pregnancy progresses, weight gain and increased abdominal girth cause a shift in the centre of gravity (COG) more anteriorly, thereby leading to compensatory changes in spinal alignment and hence affecting posture.² In order to counteract these compensations, there is increase in the lumbosacral angle, increase lumbar lordosis or anterior shift of the pelvis, anteversion of pelvis, hyperextension at the knee joint and reduction in the plantar arch.³ These are brought about by a counterbalancing force by muscle activities of gastrocnemius and soleus, extension at the hip joint, posterior displacement of the upper trunk. However, the result of these compensations is an increased stress on the spine causing low back pain during pregnancy⁴. Various reports suggest that 68.6% women experience back pain at least once during their pregnancy.⁵

Pelvic girdle pain and lumbopelvic pain are the two different components of low back pain that are associated with pregnancy. Pelvic girdle pain is usually between the iliac crest and the gluteal fold. It is more of stabbing in nature, continuous, intense and might radiate down to posterior thigh and knee.⁶It has been shown that pelvic girdle pain increases with daily routine activities like standing, sitting, lying and as little walking as thirty min.⁷Lumbopelvic pain is more around the lumbar spine and above the sacral region, which differentiates it from pelvic girdle pain. It is usually seen with paraspinal muscle tenderness and aggravates more after prolonged hours of sitting.⁶It may or may not radiate down the leg.

Management of low back pain in pregnancy using medications is limited, with little data on safety of pain medications that can be used during pregnancy. The mainstay of treatment for most of the women is physiotherapy, chiropractic care, home remedies and rest.

In a study by Helen Hall et al on the effectiveness of complimentary manual therapies, like massage, spinal manipulation, osteopathy in pregnancy related low back pain it was found that there is limited evidence to the use of complimentary manual therapies and also its effect on low back pain during pregnancy.⁸

The conventional physiotherapy treatment methods for low back pain in pregnancy include use of corsets to reinforce the spinal and sacroiliac (SI) joints, use of superficial heating modalities, TENS and exercises to reduce the load on the spine, like pelvic tilting exercises in quadruped position and co-contraction of transversus abdominis and multifidus. It also includes ergonomic advice and modification of work techniques.

Corsets can become cumbersome and many women face issues with using them during daily activities. TENS parameters need to be modified for the patient’s use and is a good modality to use. However, there might be issues with accessing an obstetric unit to use at home and compliance to a current based modality during pregnancy might be less. Home remedies, like hot water fomentation, cause pain relief for a limited duration, with a resurgence in pain levels after the effect has worn off. Also, these techniques do not address the underlying issue causing pain and are more symptomatic in nature.

A recent technique being used to reduce pregnancy related low back pain is kinesiotaping, a method of improving body function while maintaining stability of the affected region developed by Kenzo Kase. An elastic bandage method using a waterproof material that allows aeration, it is thought to cause pain relief, improve blood and lymphatic circulation, increase segmental stability, improve fascia function and position and reduce the stresses on the muscle.^10,11,12

The various techniques of kinesiotaping, its application and effects have been mentioned in an article by Mariya Gramatikova et al in 2014.¹³ ‘I’ bands are used for focusing directly on the target tissue for stabilizing the joints. ‘Y’ bands are used to create tension under the bar and two ends of the connective tissue¹³, used for supporting ligaments, tendons and fascia. ‘X’ bands are used so tension is focused on the target tissue between the two double edges. It can be used in small areas like elbow, rhomboids etc.¹³ ‘Fan cut’ and ‘Web cut’ are the techniques used to reduce oedema and improve blood and lymph circulation. Also, different stretch rates are used to achieve results like mechanical corrections, ligament stability, oedema reduction, facilitating or inhibiting the myofascial structures.¹³

In a study by Pawel Kalinowski on pregnancy related low back pain, the therapeutic effect of kinesiotaping was seen on day two after application and continued even 2 days after removal of tape.¹⁴

The available literature on taping in pregnancy showed a variability of techniques of applying the tape. Hence, a need was felt to identify the better method of taping in this population.

Table1: It shows statistical analyses of pain scores pre and immediate after intervention using Wilcoxon signed rank test.

Graph1: It shows pain scores pre and immediate after intervention in all the three study groups.

Table 1: Statistical analyses of pain scores pre and immediate after intervention using Wilcoxon signed rank test

Graph 1: It shows pain scores pre and immediate after intervention in all the three study groups.

Table 2: It shows statistical analyses of pain scores pre and post 5 days of intervention in all the

three study groups using Wilcoxon signed rank test.

Graph 2: It shows pain scores pre and post 5 days of intervention in all the three study groups.

Table 3 : It shows statistical analyses of PMI scores pre and post 5 days of intervention

using Wilcoxon signed rank test.

Graph 3: It shows PMI scores pre and post 5 days of intervention in all the three study groups.

Table 4: Comparison in Control, TT1 and TT2

Kruskal Wallis Test was used for comparison among Control, TT1 and TT2. From above table we can observe that p-values are less than 0.05. Hence, we conclude that there is significant difference in Control, TT1 and TT2. Further we can observe that mean rank for TT1 is greater than Control and TT2 hence we conclude that effect observed in TT1 is more than Control and TT2

This study showed positive changes in pain levels and the PMI for all three groups. The PMI assesses the daily functioning of the woman and identifies the issues that she faces in these tasks. This index showed a significant reduction from baseline in all three groups. The NRS, assessed at baseline, immediately after and at the end of the study also showed a significant reduction in all three study groups.

As the pregnancy progresses there is increase in weight, abdominal girth and increased lordosis which shifts the COG anteriorly. The effect of relaxin increases as pregnancy progresses. The pelvic joints are most affected due to a need to create space for the growing foetus. Added to this, muscles act in subtly altered positions and hence, force production of these muscles can also be affected. The method in which forces on the spine are resolved can hence change, which causes abnormal stresses in the lumbosacral region.

Exercises, mainly core stabilization exercises and pelvic floor exercises, can change the length-tension relationship of the muscles in the low back and pelvic region, thus altering the force production of these muscles. As the transversus abdominis and the multifidus create an almost continuous corset around the abdomen, increased firing of these muscles can change the stability of the back. This, along with the taping techniques could have started realigning the structures and hence, provided stability in the lumbopelvic region.

When taping is given there is more stability given to the lumbosacral structures, relieving abnormal stresses on the paraspinal muscles thus relieving pain.¹¹ The other physiological reasons might be^17,18

Morrissey mentioned that when taping is applied to a less active muscle, it reduces in length and shifts the length tension curve towards left.¹⁷ This will pull the actin myosin chains closer together, leading to a contracted state of the muscle, thereby inhibiting the muscle.¹⁹Alexander et al said that the excitability of motor neurons is reduced if taping is done in the direction of muscle fibre, thereby reducing the firing rate of the muscle and excitability of the muscle.¹⁷ The possible effect of these changes could be on the inhibition of the overactive muscles, hence leading to a reduced stress on the lumbar region, thereby reducing pain.

In contrast Chen et al, Cools et al Fu et al found out that taping had no effect on the excitability of the muscles in healthy individuals¹⁷, results of which are supported by Lindsay Hagen et al (2015) , who found that there is no effect of therapeutic taping on back muscle endurance.²⁰Alpha and gamma motor neurons innervate the skeletal muscle and muscle spindle respectively. When the muscle contracts these are activated simultaneously causing alpha gamma co-activation. When the muscle spindle fibre contracts, the afferents group 1a and 2 sensitizations does not reduce but is maintained in the state of excitement. Thus, the excitability of motor neurons is neither decreased nor increased.¹⁷This could explain why kinesiotaping over the skin is not enough to cause changes in the muscle activity.

Two different methods of taping were used in this study, TT1 and TT2. A between group analysis, using Kruskal Wallis test, comparing the control, TT1 and TT2 groups, shows that the p values are less than 0.05 for all groups. Effect sizes calculated showed that TT1 group’s treatment was more effective.

The addition of taping to exercises could have been one reason for the significant change in the NRS and PMI values. The differences in the two types of taping were the stretch that was applied to the tape (fifty percent in TT1 and fifteen to twenty five percent in TT2), the number of tapes that were applied (four I bands in TT1 and three I bands in TT2) and the position in which they were applied (neutral spine for TT1 and maximum lumbar flexion for TT2)¹³. These differences could have resulted in TT1 stabilizing the spine better and hence caused more change in the pain and PMI scores. It has been seen that as the stretch rate increases more changes are seen in the fascia and muscles.¹⁸ The muscle layers lift up, creating a hollow space between fascia and muscle, allowing more lymphatic fluid and increased blood circulation, thereby providing pain relief.¹⁸ Taping stimulates mechanoreceptors which interfere with the painful stimuli and facilitate pain gate mechanism (Deleo 2006, Paolini et al 2011). It is also said keratinocytes stimulate the C fibres to initiate pain gate mechanism²¹ (Lumpkin and Caternia 2007). More number of mechanoreceptors could have been stimulated in the TT1 as compared to the other technique, which could explain the effects seen.

PMI was developed by Van de pol et al to assess the ability to perform daily routine household activities on a scale of zero (no problem at all to performing the task) to three (impossible to perform).¹⁶ Higher the score, more the difficulty to perform activities. We used this index in the present study to highlight the difficulty women face when performing daily tasks in an altered biomechanical state.

The present study shows that taping is a viable option in the treatment of low back pain occurring in pregnancy, in addition to exercises. Exercises can modify the length tension relationships in the muscles, which can be augmented by the type of taping and the method of taping. As the tape provides an immediate difference in the pain parameters, it can be a useful modality to control pain and improve function in the woman. A reduction in pain will also contribute in an improved sense of well-being in the woman, hence altering her quality of life. The compliance to taping can be potentially higher than other conventional methods of pain relief, probably as it is an external application. With medications being restricted in the pregnancy period, it falls to the thermal agents and techniques like taping to provide pain relief.

Amongst the two methods of taping that were explored in this study, the first method provided better relief of pain and improvement in quality of life. This could, hence, be considered the better option amongst the two, when deciding on the taping technique to be used.

From the present study it can be seen that there is a difference in the two types of kinesiotaping on NRS and PMI, with TT1 being considered better as compared to TT2.

I would like to acknowledge Dr. Deodhar, Dr. Parchure for permitting me to assess the subjects for my study. Mr. Khandagle for helping me with the statistics. I would like to acknowledge my friends who have helped me through the entire process.

This was a self-funded study.