Chiropractic during Pregnancy

Did you know?
​90% of pregnant women experience pregnancy related low back pain with 35% describing it as moderate to disabling

• LBP is defined as pain between the costal margins and the inferior gluteal folds. This pain is often described as dull and may be exacerbated by forward flexion. Palpation of the lumbar erector spinae muscles may intensify symptoms. 
• PGP is defined as pain in the symphysis pubis and/or between the posterior iliac crest and gluteal folds
• When these occur simultaneously this should be referred to as “combination” or “combined” pain
• Pregnancy related back pain often resolves after delivery although some may experience pain up to 3 years postpartum 

Side Effects can be mild...

• Mild and transient side effects have been reported after lumbar spine Spinal Manipulation Therapy (SMT) and, although rare, serious adverse events have been reported following cervical spinal manipulation therapy in a few case reports. If red flags are identified during pregnancy and early postpartum, clinicians should fully discuss the risks of SMT in each of the spinal regions they are considering adjusting.

Pain Patterns:

• Pain can start at almost any time during pregnancy but is often reported to starts around 18th week of gestation (peaking between the 24th and 36th weeks).
• LBP occurs in the lumbar region, between the lower rib and the iliac crests.
• LBP is not as common as PGP during pregnancy; how-ever, it is more prevalent in the postpartum period
• 5 classifications of PGP

1. Anterior pain at the symphysis pubis (best prognosis for recovery)
2.  Unilateral sacroiliac joint pain
3.  Bilateral sacroiliac joint pain
4.  Pain in all 3 areas
5.  Miscellaneous pain (daily pain from one or more pelvic joints, but inconsistent objective findings from the pelvic joints)

Diastasis Recti of the Abdominal Muscles 

• Diagnosis of DRAM is rendered if horizontal palpation of the linea alba is greater than 2 fingerbreadths (or>2.5 cm) as they perform an abdominal crunch

Treatment Interventions 

• Self-care: remain active and continue normal activities, if possible, follow individualized exercise program, ergonomic advice, pillow recommendations 
• Patient education on anatomy, biomechanics and reassurance that back and pelvic pain are common and not dangerous, water or land based exercises 
• Adapt SMT and soft tissue techniques to the comfort level of the patient 
• High velocity SMT may be appropriate for some pregnant and postpartum women with LBP, PGP or combined 
• High-velocity SMT for the pregnant and postpartum patients can be considered safe and may have only minor side effects occurring with lumbar SMT. Regarding cervical SMT, adverse events are extremely rare in the pregnant and postpartum populations with only a few case reports.
• STT, Taping, activator, drop piece adjusting, graston or other IAT and pelvic/abdominal belts have limited evidence, but a trial of care may be reasonable. Belts for PGP should be worn just below the anterior superior iliac spine rather than at the level of the symphysis pubis.
• There are no known adverse events to the mother or fetus associated with electrostimulation when being used as an adjunct modality to relieve pregnancy-related back pain. If treatment options including advice for activities of daily living, exercises, and/or manual therapies do not provide pain relief for the pregnant or postpartum patient, and the alternative may be medication that would cross the placental barrier, a trial of TENS care could be considered. Current density should be kept low and avoid acupuncture points used to induce labour.

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