Pregnancy-related back pain (PRBP) is a common musculoskeletal disorder that significantly
affects functional capacity and quality of life in pregnant women. Conservative and
non-pharmacological interventions are preferred due to safety concerns associated with
pharmacological treatments. The McKenzie Protocol (MP) has shown effectiveness in
managing mechanical back pain; however, high-quality randomized evidence in pregnancy
with pain-type stratification remains limited. To evaluate the effectiveness of the McKenzie
Protocol combined with standardized usual care compared with standardized usual care
alone in managing pregnancy-related back pain, with subgroup analysis based on pain type.
A prospective, parallel-group randomized controlled trial was conducted among pregnant
women diagnosed with PRBP. Participants were stratified into low back pain (LBP), high
back pain (HBP), and pelvic girdle pain (PGP) groups and randomly allocated to either MP
plus standardized usual care or standardized usual care alone. Pain intensity and functional disability were assessed using the Numerical Rating Scale (NRS) and Modified Roland–Morris Disability Questionnaire (MRMDQ) at baseline, 6 weeks, and 12 weeks. The MP group demonstrated significantly greater reductions in pain intensity and disability scores compared with controls across all pain types \((p < 0.001)\). Subgroup analysis revealed that LBP and HBP exhibited the greatest responsiveness to MP, while PGP showed moderate but clinically meaningful improvement. The McKenzie Protocol, when combined with standardized usual care, is an effective and safe intervention for pregnancy-related back pain. Pain-type stratification enhances treatment precision and supports individualized physiotherapy management during pregnancy.
