A recent study found that more than 75 percent of pregnant women experience pregnancy-related low back pain, pelvic pain, or a combination; and that this pain increases as pregnancy progresses. (1) Chiropractic care is a safe, effective, and drug-free way to manage these and other musculoskeletal symptoms during pregnancy. (2,3)
Normal biomechanical changes during this time can result in discomfort and pain during pregnancy and labor. These changes include weight gain, an anterior shift in the center of gravity, increased lumbar lordosis, and laxity of lumbopelvic ligaments; as well as postural changes and altered gait pattern. (4) Many obstetric providers are unaware that the resulting musculoskeletal conditions and their related symptoms can be managed and improved with chiropractic care and patient education. (5) Following are some of the musculoskeletal conditions that occur:
Low Back Pain
Low back pain during pregnancy is caused by increased stress on the lumbar spine by an anterior shift in the center of gravity. Compensatory muscle tightness and altered gait patterns also contribute, and this pain ranges from mild to severe depending on the patient’s activity level, daily activities, and work duties. (2,6) Low back pain is also very common during the postpartum period. (7)
Sciatic Nerve Pain
Hypertonicity in the gluteal muscles and deep external rotators can irritate or compress the sciatic nerve during pregnancy. Some studies suggest the baby’s growth contributes to uterine pressure on supporting vasculature or direct compression of the sciatic nerve, which results in low back pain with radiation into the legs. (8)
Sacroiliac Pain
Ligament laxity caused by hormonal changes during pregnancy allows these traditionally stable and primarily weight-bearing sacroiliac joints to move and shift. This increased mobility puts stress on the surrounding ligaments and muscles, which may cause pain. (4) Patients sometimes incorrectly describe their discomfort as “hip pain,” however they indicate the sacroiliac joint as the area of complaint.
Pubic Symphysis Pain
During pregnancy, the hormone Relaxin allows the ligaments stabilizing the pubic symphysis joint to relax, and therefore allows the joint to move and separate. Also called Symphysis Pubis Dysfunction, or SPD, this condition produces pain and limitation of mobility. It also may contribute to instability of the bony pelvis. (9)
Round Ligament Pain
The round ligaments of the uterus contain contractile fibers and suspend and connect it to the anterolateral abdominal wall on either side. As the uterus grows, the round ligaments also stretch and can cause a sharp pain on either side of the abdomen or at the attachment sites of the ligaments near the pubic bones or labia. (10)
While there are no direct contraindications to chiropractic care during pregnancy (2,3), knowing the patient-reported warning symptoms of potentially serious prenatal complications and timely communication with the patient’s obstetric/midwifery prenatal care provider is very important. These symptoms include (11):
· Vaginal spotting, bleeding, or fluid loss
· Persistent and/or uncontrolled high-blood pressure
· Swelling or pitting edema in the hands, legs, feet
· Sudden, severe headache(s)
Chiropractic care and patient education as part of a comprehensive prenatal care team have been shown to hold greater benefit for pregnant patients than traditional obstetric care alone. (5) Educating these patients as a part of their treatment plan helps inform and empower them to better understand what is happening within their bodies, as well as allows them to better communicate this information with the providers of their prenatal care team during pregnancy, birth and postpartum.
Credit: Dr. Kochersberger , ACA
References
1. Weis CA, et al. Prevalence of Low Back Pain, Pelvic Girdle Pain, and Combination Pain in a Pregnant Ontario Population. J Obstet Gynaecol Can. 2018 Aug; 40(8): 1038-1043. https://www.ncbi.nlm.nih.gov/pubmed/30103876
2. Lisi AJ. Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series. J Midwifery Womens Health 2006; 51:7-10. https://www.ncbi.nlm.nih.gov/pubmed/16399602
3. Stuber KJ, Wynd S, Weis CA. Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature. Chiropr Man Therap. 2012; 20:8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348005/
4. Aldabe D, Ribiero DC, et al. Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. Eur Spine J. 2012 Sep; 21(9): 1768-1776. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459115/
5. George JW, Skaggs CD, Thompson PA, et al. A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy. Am J Obstet Gynecol 2013;208:295.e1-7. https://www.ajog.org/article/S0002-9378(12)01969-2/fulltext
6. Oswald C, Higgins CC, Assimakopoulos D. Optimizing pain relief during pregnancy using manual therapy. Can Fam Physician. 2013 Aug; 59(8): 841-842. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743693/
7. Franke H et al. Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: A systematic review and meta-analysis. J Bodyw Mov There. 2017 Oct; 21(4): 752-762. https://www.ncbi.nlm.nih.gov/pubmed/29037623
8. Al-Khodairy AW et al. Sciatic in the female patient: anatomical considerations, aetiology and review of the literature. Eur Spine J. 2007 Jun; 16(6): 721-731.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2200714/pdf/586_2006_Article_74.pdf
9. Scicluna, JK et al. Epidural analgesia for acute symphysis pubis dysfunction in the second trimester". International Journal of Obstetric Anesthesiology Jan 2004. 13(1): 50–52. https://www.obstetanesthesia.com/article/S0959-289X(03)00137-7/pdf
10.Chaudry SR, Chaudry K. Anatomy, Pelvis, Uterus, Ligaments, Round. StatPearls [Internet] 2018 Jan. https://www.ncbi.nlm.nih.gov/books/NBK499970/
National Institute of Child Health and Human Development. (2017). What are some common complications of pregnancy? (Office of Communications) Rockville, MD. https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/complications
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