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Chiropractic Care Can Help Pregnancy Related Back and Pelvic Pain

Introduction

During pregnancy there are numerous changes that occur to the mother's body. Unfortunately, some of these changes contribute to pain in the upper back, lower back and pelvis. Research estimates the prevalence of these aches and pains in pregnant women to be between 50 to 75% 1,2 , with up to 75% of women with back pain reporting never having it before pregnancy1 . This pain can affect sleep quality as well as participation in daily activities 1,3,4 . Furthermore, number of women may go on to develop chronic pain lasting years 3 .


Available Treatment

Despite this common complaint amongst pregnant women, quality research on treatment of pregnancy related back and pelvic pain is sparse. Many mothers-to-be prefer a natural non-pharmaceutical approach to treatment because of fears of possible serious side effects. However, most of the usual physical therapies (ultrasound, electrical stimulation, etc) are contraindicated due to the potential harm to the developing fetus 5 . Additionally, a scientific review published a few years ago of physical therapies (which involved research on mainly exercise and patient advice) concluded that there is no strong evidence to support the efficacy of these therapies for the treatment or prevention of pregnancy related low back or pelvic pain 6 .

Another alternative is chiropractic care. Chiropractors often treat women during pregnancy. Intervention starts with a thorough assessment, diagnosis, and development of an individualized treatment plan. Interventions included in chiropractic care may include things such as: joint mobilization; massage; therapeutic exercise; education on ergonomics, posture & body mechanics to help adjust to the pregnancy related changes the body is undergoing; reassurance; and recommendations with regards to self-management, lifestyle, and nutrition. However the treatment for which chiropractors are best known for is manual manipulation, otherwise known as chiropractic adjustments, which are a kind of therapy directed at the joints.

A scientific review of manual manipulation published this year concluded that, although the research is still “emergent”, the evidence suggests this is a safe and effective treatment for pregnancy related low back and pelvic pain 7 . For example, one case series in this scientific review reported on seventeen pregnant women suffering from low back pain 8 . These women initially rated their pain an average of 6-out-of-10 in severity, which reduced to 1.5-out-of-10 as a result of chiropractic care. On average, it took 2 visits (range from 1-5 visits) to the chiropractor over about a 5-day duration for a significant improvement in pain. Treatment lasted up to 2 months. No adverse effects were reported by any of the women. Although this case series does not have the strength of a clinical trial and cannot be interpreted to mean that treatment for all pregnant women will follow the same course, it nonetheless provides evidence that chiropractic treatment is effective for reducing the pain of pregnancy related low back pain. Furthermore, a joint committee of the American College of Physicians and the American Pain Society recommended manipulation (again only one aspect to chiropractic care) as a scientifically-based, non-pharmaceutical treatment that is safe and effective for both acute and chronic low back pain 9 (Link to previous BLOG article).


Modifications of Treatment for Pregnant Women

Contrary to what some might think, there are no chiropractic specialties or specialists in the fields of pediatrics or obstetrics in Toronto or, for that matter, Ontario (for a list of Chiropractic specialties, please see: http://www.cco.on.ca/site_documents/P-029%20Chiropractic%20Specialties.pdf).

However, modifications to the treatment of pregnant women with chiropractic adjustments have been published 10,11 and a list of contraindications for the use of joint manipulation during pregnancy have also been proposed 12 .

Modifications to treatment can be made depending on the findings of the assessment, the length of gestation, the size of the mother's abdomen and her comfort level. The use of pillows can help support the larger abdomen making side-lying adjustments of the lower back comfortable. Furthermore, as the joints are often more lax, especially in the later stages of pregnancy, adjusting is done in a more gentle fashion. Joint manipulations to the lower back reduce any restrictions in motion, decrease pain and relieve muscle tightness.

Adjustments to the thoracic spine (the upper back) are often done with the pregnant mother lying on her back. This way is usually more comfortable and allows her to relax as it minimizes pressure on her abdomen and breasts as the breasts are often tender during pregnancy.


Summary

During pregnancy the majority of women experience pain in the pelvic, lower back and upper back regions. And although there is a demand for drug-free, non-invasive therapy, the research of treatment of these complaints is limited. There is, however, emerging evidence that chiropractic care, including adjustments, can safely and effectively provide relief.


References

  1. Skaggs C, Nelson M, Prather H, Gross G. Documentation and classification of musculoskeletal pain in pregnancy. J Chiro Educ 2004;18:83–4.
  2. Kristiansson P, Svardsudd K, von Schoultz B. Back pain during pregnancy: a prospective study. Spine 1996;21(6):702-9.
  3. Mens JMA, Vleeming A, Stoeckart R, et al. Understanding peripartum pelvic pain: Implications of a patient survey. Spine 1996;21:1363–70.
  4. Wang SM, Dezinno P, Maranets I, Berman MR, Caldwell-Andrews AA, Kain ZN. Low back pain during pregnancy: Prevalence, risk factors, and outcomes. Obstet Gynecol 2004;104:65–70.
  5. Borg-Stein J, Dugan SA, Gruber J. Musculoskeletal aspects of pregnancy. Am J Phys Med Rehabil 2005;84:180 –92.
  6. Stuge B, Hilde G, Vollestad N. Physical therapy for pregnancy related low back and pelvic pain: A systematic review. Acta Obstet Gynecol Scand 2003;82:983–90.
  7. Khorsan R, Hawk C, Lisi AJ, Kizhakkeveettil A. Manipulative therapy for pregnancy and related conditions: a systematic review. Obstet Gynecol Surv. 2009 Jun;64(6):416-27.
  8. Lisi AJ. Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series. J Midwifery Women's Health 2006;51:e7–e10.
  9. Chou R, Huffman LH; American Pain Society; American College of Physicians. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007 Oct 2;147(7):492-504.
  10. Esch S, Zachman Z. Adjustive procedures for the pregnant chiropractic patient. Chiro Tech 1990;3(2):66-71.
  11. Bartol K.M Considerations in adjusting women. Top Clin Chiro 1997;4(3):1-10.
  12. Borggren CL. Pregnancy and chiropractic: a narrative review of the literature. J of Chiro Med 2007;6:70-4.

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