Having treated many pregnant patients in my clinic in North Vancouver, I see firsthand the amount of pain and discomfort many pregnant women endure. It is not hard to imagine the amount of stress a women’s body goes through during the 9 months of pregnancy. These changes place tremendous loads on the body. Hence, pregnant women are always complaining of low back pain, hip/pelvis pain, groin pain, abdominal pain, shoulder and neck pain, etc., with low back pain being the most common complaint. In fact, many studies suggest that more than 50% of women experience low back pain during pregnancy.
There are many misconceptions and misinformation about what can be done about pain during pregnancy and if there are any effective treatment options. Majority of women think that pain and discomfort are just part of pregnancy and, unfortunately, they just have to deal with it (perhaps information passed down from the older generations). Moreover, many think that getting therapy especially in the low back or pelvis might be unsafe for the baby. Perhaps this is due to the limited amount of research on the safety and efficacy of different therapies during pregnancy.
Regardless, dealing with pain and discomfort can make the experience of pregnancy very discouraging and might make the 9 months seem like an eternity. In a previous blog titled CHIROPRACTIC & PREGNANCY (Part I): Post Pregnancy Issues – “What a pain in the neck!” I discussed the problems women face postpartum and touched on the treatment options that are available. However, there has been no discussion on pregnancy and pregnancy related issues. I believe, it is time to address this more in depth.
What causes low back pain and pelvis pain during pregnancy?
- Increase in weight (the average healthy weight gain is more than 30lbs)
- Hormonal changes (relaxin causing increased joint laxity)
- Change in centre of gravity due to abdominal size increase
- Postural changes and increased lordotic curve in the back
- Muscle overstretching and separation (rectus abdominus) in the abdominal area ultimately making the core weaker
- Pelvic expansion
- Other risk factors:
- previous history of low back pain prior to pregnancy
- strenuous work/job
Are there any modifications made to techniques used for pregnancy? What kind of modifications?
There are many different techniques that can be employed to help during pregnancy. Before anything, one must understand that the neuro-musculo-skeletal parts of a pregnant person are not that different than a non-pregnant person’s. Hence, the treatments are not that different. Their bodies are just under more load/stress, which are undergoing fast changes. Secondly, pregnant bodies are not as fragile as one might think. In fact, they’re not that fragile at all. The body can take quite a bit of “beating” during a treatment just like any other patient. That doesn’t mean that one must not be careful when dealing/treating a pregnant patient; of course, one has to especially for the safety of the baby. The practitioners need to be aware of the changes to the body and modify their treatments accordingly. As an example, because of the increased laxity of the joints from the hormone relaxin (released during pregnancy that is believed to increase laxity of joints, among other things), the amount of force in an adjustment/manipulation will be (and should be) much less than when compared to a non-pregnant patient.
Another great modification that can significantly help with the treatment is to lower the drop-away thoraco-lumbar piece (mid-low back portion) of the chiropractic table to accommodate the growing belly and allow the pregnant mom to lie prone or on her stomach. For obvious reasons, pregnant patients cannot lie on their stomachs; however, the moveable piece allows for this. In fact, many of my patients are extremely grateful and appreciative specifically because of this option because it allows them to lie on their stomachs, even for a few minutes during the treatment time, something that they have been missing and craving for weeks/months.
How does evidence-based chiropractic therapy help during pregnancy?
- Decrease pain by releasing tension in joints, muscles, ligaments, and nerves
- Realigning the joints
- Improving mobility
- Increasing flexibility
- Improving posture
- Decreasing pain during labour
What types of evidence-based chiropractic therapies are available for pregnancy?
Below are some of the therapies that I utilize in my clinic in North Vancouver in combination/conjunction to treat pregnancy related injuries and pain:
1. Chiropractic manipulative therapy
2. Joint mobilization
3. Active Release Technique (A.R.T.)
4. Proprioceptive Neuromuscular Facilitation (PNF) stretching
5. Kinesio Taping
6. Deep tissue massage
7. Graston soft tissue technique
8. At-home exercises/stretches (See Chiropractic & Pregnancy – Part III)
How effective is chiropractic therapy including chiropractic manipulation for pregnancy?
Very effective. Some research has shown that chiropractic manipulation of the low back and pelvic joints (SI joints) alone is a very effective means of relieving pain and decreasing symptoms. Now consider combining all the other techniques mentioned above in combination with manipulations. The effects can be magnified and multifold. In fact, majority of my patients feel the relief of pain almost immediately following just one treatment.
It should be noted, however, that there are many other variations and methods in techniques that can be employed and are also used by other chiropractors. In addition to chiropractic therapy during pregnancy, other treatments options such as physiotherapy, massage therapy, acupuncture, exercises/stretches (outlined in Part II of this blog), have shown to be effective in treating many symptoms. Dr. Khoshroo co-treats with many physiotherapists, massage therapists, and acupuncturists to provide the most effective, fastest, and most efficient relief of pain during pregnancy.
Is chiropractic therapy especially joint manipulation safe during pregnancy?
According to many studies, there are no contraindication to chiropractic therapy throughout pregnancy. Although the research is limited, there have been no shown cases of adverse effects with chiropractic manipulation during pregnancy. In fact, many studies suggest that chiropractic therapy can provide a safe, effective, and drug-free conservative care to relieve pain during pregnancy. More research is needed, however, to increase awareness and understanding of this topic.
What are some effective exercises, stretches, and proper postures/techniques during pregnancy?
For more information please refer to my other blog: Chiropractic & Pregnancy (Part III): Exercises & Stretches.
Where can you get evidence-based chiropractic therapy for pregnancy in North Vancouver?
Dr. Khoshroo provides evidence-based chiropractic care for pregnancy and pregnancy related pain in North Vancouver at QubeCore Sports & Rehab. He combines chiropractic manipulation and active release technique in conjunction with other techniques (as mentioned above) to provide a safe and effective care for the pregnant patient and the baby. For more information, questions, and concerns contact Dr. Khoshroo.
References & Sources:
- Cara L. Borggren. Pregnancy and chiropractic: a narrative review of the literature. J Chiropr Med. 2007 Spring; 6(2): 70–74.
- Anthony J. Lisi. Chiropractic Spinal Manipulation for Low Back Pain of Pregnancy: A Retrospective Case Series. Journal of Midwifery & Women’s Health. Volume 51, Issue 1, pages e7–e10, January-February 2006.
- Diakow PR, et al. Back pain during pregnancy and labor. J Manipulative Physiol Ther. 1991 Feb;14(2):116-8.
- Stuber KJ, et al. Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature. Chiropr Man Therap. 2012 Mar 28;20:8.
- Daly JM, et al. Sacroiliac subluxation: a common, treatable cause of low-back pain in pregnancy. Fam Pract Res J. 1991 Jun;11(2):149-59.
- Berg G, et al. Low back pain during pregnancy. Obstet Gynecol. 1988 Jan;71(1):71-5.
- Stacey Rosenberg. Care of the Pregnant Patient: Part 1. Why chiropractic, and how? Canadian Chiropractor.
- American Pregnancy Association: Chiropractic Care During Pregnancy.
- Canadian Chiropractic Association: Pregnancy & Back Pain.
- WebMD: Back Pain in Pregnancy.
- Spine-Health: What Causes Back Pain During Pregnancy?
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