Additional or Comparative Efficacy of Pelvic Floor Muscle Training in Individuals with Low Back Pain:Systematic Review and Meta-analysis

This systematic review aimed to assess whether PFM training provides additional or comparative benefits to the standard physical therapy intervention for individuals with LBP. 

Studies providing PFM training in individuals with LBP were included. This study process was accomplished following PRISMA guideline. The relevant studies published up to October 2023 were searched from databases such as Ovid-Medline, Ovid-Embase, Cochrane library, CINAHL, Web of Science, and PEDro. The two researchers independently extracted data and assessed the risk of bias using the Cochrane Risk of Bias version 2. The quality of evidence was evaluated by using Grading of Recommendation, Assessment, Development and Evaluation. Meta-analysis was conducted using Review Manager software 5.4. This study was registered in the PROSPERO (CRD42023473707).

Eighteen randomised controlled trials were selected for the systematic review, and 13 were included in the meta-analysis. Participants with LBP who underwent PFM training showed improvements in pain (SMD=-0.86, 95% CI [-1.24, -0.49], I²=77%) and disability (MD=-5.34, 95% CI [-7.36, -3.32], I²=92%) compared with the control group; however, the heterogeneity was high. In the ‘adding’ subgroup, significant improvement was observed in pain (SMD=-0.94, 95% CI [-1.39, -0.49], I²=72%) and disability (MD=-5.91, 95% CI [-8.07, -3.76], I²=94%). However, in the ‘comparison’ subgroup, there was a significant improvement in pain compared with the control group (SMD=-0.74, 95% CI [-1.45, -0.03], I²=84%), whereas no significant improvement was noted in disability (MD=-7.27, 95% CI [-16.71, 2.17], I²=90%).

The high overall risk of bias was a limitation in this study. However, adding PFM training to standard physical therapy intervention synergistically improved LBP. PFM training should be included in the physical therapy for LBP.

Pelvic floor muscle training is recommended to include standard physical therapy in individuals with low back pain, as the additional effect of pelvic floor muscle training can synergistically improve low back pain and disability. Individuals with pregnancy-related low back pain can be more effectively improved by pelvic floor muscle training than individuals with non-specific low back pain.