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Pregnancy, Back pain, and Chiropractors – Oh My!
Did you know that less than half of women with low back pain seek prenatal chiropractic care?
Researchers estimate that between 45-75% of women will experience low back pain at some point during their pregnancy (1).
This makes prenatal low back pain one of the most common health issues that pregnant women face.
So what causes this increase in low back pain?
This question can be incredibly frustrating for women who have never experienced symptoms before their pregnancy.
Pregnancy-related low back pain can often be attributed to many factors that create the perfect storm, resulting in significant amounts of pain.
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The average woman gains anywhere from 20-40 lbs. during pregnancy.
Following a predominantly frontal weight gain, the center of gravity of pregnant women moves forward, and the lumbar lordosis is increased.
This causes a two-fold increase in the load which the intervertebral discs bear.
Once from the weight gain experienced with pregnancy, and additionally from the increased lumbar lordosis.
This accentuated spinal curve decreases the spine’s capacity to absorb forces that occur in day-to-day life properly.
Further adding to the complexity of pregnancy-related low back pain, the abdominal muscles will begin to stretch to accommodate a growing baby.
Increased stretching of these muscles compromises their ability to maintain posture and offer support to the spine (1-3).
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Pregnancy can also lead to changes in gait, causing overuse of muscles that are generally not active.
This overuse can lead to what many chiropractors refer to as a ‘functional strain’ where fatigued muscles and their tendons can become damaged.
Hormonal changes may also play a role by causing laxity in the ligaments which connect joints.
The combination of muscles, tendons, and ligaments being placed under more stress than usual can generate significant local and referred pain.
What’s a “Normal” Pregnancy?
Low back pain experienced during pregnancy typically localizes to the lumbosacral region, although some women report experiencing ‘radiating’ or ‘referred’ pain.
This is pain that travels, in some cases, to the buttocks or back of the thigh and in others as far as the calf.
Pregnant women can expect back pain to occur from various causes, and in the largest amount between months five and seven of pregnancy.
Everyday activities that can cause increases in back pain during pregnancy include prolonged standing or sitting and even small movements like coughing and sneezing.
Emotional stress can also lead to spikes in pain levels, and some women report sleep disturbances due to pain.
One in three women rates their back pain as severe, meaning it can have an enormous impact on their ability to complete daily activities.
Pregnancy-related low back pain is also reported as a pain that gets worse throughout the day, and some women described needing to miss work due to the pain severity.
Others note being unable to exercise and avoiding future pregnancies only due to the pain.
Additionally, back pain may recur in as many as 85-90% of patients who pursue multiple pregnancies (1-3).
If you are a woman with pregnancy-related low back pain or looking to pursue a pregnancy – don’t lose hope! Activity levels can play a role in the severity of low back pain.
Research shows a happy middle ground of activity is beneficial for low back pain; however, both activity levels’ extremes can have negative impacts.
Sedentary lifestyles can increase the risk of low back pain due to the underuse of supporting postural muscles.
On the opposite end, physically demanding lifestyles and occupations also can carry an increased risk of developing low back pain during pregnancy (4).
What to Expect at a Prenatal Chiropractic Appointment
Chiropractic clinicians can effectively examine and treat pregnancy-related low back pain.
An evidence-informed Doctor of Chiropractic will ask many questions to get a complete history of a patient before performing a thorough physical exam and reaching a preliminary diagnosis.
Some chiropractors are trained in what is called the Webster Technique.
This technique was founded by chiropractor Larry Webster, who developed a system to analyze the pregnant women’s pelvis.
Through this analysis and adjustment technique, chiropractors have reported establishing a balance of the pelvic ligaments and reducing unnecessary stress on the uterus and surrounding structures.
Additionally, some chiropractors use this technique to help assist babies who are presenting breech turn vertex (5,6).
While formal research is needed on the validity and reliability of the Webster Technique, in August 2002, an article in the Journal of Manipulative and Physiological Therapeutics reported an 82% success rate of babies turning from breech to vertex when Doctors of Chiropractic used the Webster Technique (7).
In clinical practice, both chiropractors and patients report this technique to reduce the discomfort associated with pregnancy-related low back pain (5,6).
When identifying whether or not the cause of a pregnant patient’s low back pain is related to the pregnancy, there are other essential conditions for a chiropractic clinician to rule out – primarily joint dysfunction.
As the word ‘dysfunction’ literally means an abnormality or an impairment, it would make sense that dysfunction of a joint in the body can lead to pain.
In pregnancy-related low back pain, a clinician’s most critical areas to examine for dysfunction are the lower lumbar spinal segments and sacroiliac joints.
Dysfunctions in both the lumbar spine and sacroiliac joints can cause patients tremendous amounts of local and referred pain when the parts of the joint are not moving correctly.
The second condition a chiropractor should rule out when determining if a patient’s back pain is related to pregnancy is a sprain or strain in the lower back muscles or ligaments.
A sprain in the low back involves an overstretching or tearing of the ligaments in the lumbar spine or sacroiliac joints.
This can occur from the smallest movements and cause significant amounts of pain.
A strain refers to associated muscles being overstretched too quickly, leading to pain and other dysfunction.
After taking a patient’s complete medical history and performing a thorough examination, a Doctor of Chiropractic should rule out the disc degeneration as a cause of low back pain.
Disc degeneration is not only a common condition as it relates directly to the aging process, but it is also an extremely common area for low back pain (1-4).
The Good Stuff – Prenatal Chiropractic Care!
There are some signs and symptoms which should not be ignored if experienced by a pregnant woman.
Commonly referred to as ‘red flags,’ these symptoms can indicate a much more severe problem.
More common ‘red flag’ symptoms experienced by pregnant women include unexplained chills, excessive cramping or bleeding, sudden pelvic pain, or sudden fever onset.
The most serious ‘red flags’ can include sudden and unexplainable light-headedness, chest pain, shortness of breath, and headaches.
An evidence-based chiropractic clinician should accurately and quickly recognize when these ‘red flags’ occur, making a timely and appropriate referral.
Once a chiropractor completes a thorough assessment and screens for ‘red flag’ conditions, they can determine if the cause of a patient’s low back pain is related to their pregnancy.
Prenatal chiropractic care may include any combination of spinal manipulation, myofascial therapies, the Webster Technique, or prescription exercise.
Spinal manipulation is an effective non-pharmacologic treatment option for low back pain and typically involves applying a rapid and purposeful load, or force, to specific structures.
The American College of Physicians recommends using spinal manipulation, exercise, and other non-pharmacologic therapies like yoga and tai chi for the relief of low back pain. In other words, the ACP thinks prenatal chiropractic care is a smart idea.
Nonpharmacologic treatment for low back pain can include any treatment that is not a drug, providing safe and beneficial options for pregnant women (8).
Manual therapies, including chiropractic manipulation, have shown superior outcomes with a lower disability than standard obstetric care.
Additionally, most prenatal health care providers report their willingness to recommend non-pharmacologic treatments, including alternative therapies.
A recent study showed that almost 75% of women who received prenatal chiropractic care said significant pain reduction and those treated throughout their pregnancy noted shorter labor times (5).
An estimated 40% of women who experienced pregnancy-related low back pain continue to report symptoms up to six months postpartum and 20% of women report experiencing low back pain three years later (1).
Prenatal chiropractic care has been shown to help postpartum low back pain and is recommended as a treatment option for short- and long-term low back pain.
Smart chiropractors can adjust the joints in the lower back to help decrease pain and improve functional ability.
Additionally, a Doctor of Chiropractic can evaluate and address any biomechanical factors that may be altered during pregnancy, including gait and postural changes.
Disclaimer: This article’s information is purely for educational purposes and is not intended to diagnose or treat any condition. Also, the information presented in this article should not be used in the place of medical care. If you are experiencing any of the ‘red flag’ symptoms described above, contact your doctor immediately.