During pregnancy many women experience a range of unpleasant symptoms which are usually viewed as “par for the course”. While some of the woes of pregnancy will probably always be with us, one common issue – lower back pain is actually avoidable in many cases. Today lets looks at how chiropractic care can help reduce lower back pain during pregnancy.
Low back pain during pregnancy
Low back pain is one of the most commonly reported ailments during pregnancy – and is perhaps even more common after birth. European studies have reported the rate of low back pain during the 9 months of pregnancy to be from 46% to 76%[1][2]. Recent US studies have suggested similar numbers – from 57% to 69%.[3]
You might naturally wonder about the degree to which this back pain could actually be attributed to pregnancy though – It has been shown that among women with low back pain of pregnancy, 75% reported no low back pain at all before pregnancy.[4] Furthermore, in a study of women with chronic low back pain, up to 28% stated that their first episode of back pain occurred during a pregnancy.[5]
The exact cause of lower back pain during pregnancy is not certain – it has long been logically assumed that the cause is likely maternal weight gain and resulting biomechanical changes in the spine. Some research suggests that this many not be the case however – several studies have actually shown no relationship between onset of pain and the stage of pregnancy,[6][7][8]. Increased lumbar lordosis is another commonly considered a cause of low back pain during pregnancy – However, it has been shown that lumbar lordosis does not categorically increase in every pregnant woman; moreover, when lordosis does increase, it is not clearly related to severity of low back pain.[9][10][11]
During pregnancy, the body releases a compound known as Relaxin, which allows joints to become laxer in order to ease delivery. It is entirely possible that Relaxin plays a role in the onset of lower back pain, but its exact relationship to onset of low back pain remains unclear.[12] If Relaxin is the primary cause however, this would also go some way to explaining the prevalence of back pain in women after pregnancy – where much (often unnoticed) lifting takes place, stressing the spine.
Most women report a level of lower back pain which they would describe as moderate – but severe pain has been reported in 15% of cases[13][14]. Pain intensity often increases with duration and can result in significant disability.[15] Sleep disturbances have been reported by 49% to 58% of women and impaired daily living by 57% in women with low back pain during pregnancy.[16][17] While from a clinical perspective moderate back pain is not considered as problematic as severe pain, at Complete Chiropractic we appreciate that even moderate pain can be highly distressing during what can already be a difficult time!
Chiropractic care for pregnant women
It’s a sad fact that since so many people suffer with back pain of some sort today, we often take a less than enthusiastic approach to addressing the problem – many medical care providers just do not see back pain as a major problem, despite the considerable additional stress it can bring to a pregnancy. A study from 2004 found that just 32% of women reported their low back pain of pregnancy to their prenatal providers, and just 25% of these providers recommended a treatment.[18] A similar study showed that among women with low back pain of pregnancy, 80% thought that their providers had not offered treatment for their back pain.[19] The good news is chiropractic care can be effective in reducing and eliminating low back pain during pregnancy.
Unlike most healthcare professionals, Chiropractors manage low back pain and other musculoskeletal pain patients all day long, and are very well placed to assist in this instance – indeed, a survey of US chiropractors reported 76% of respondents were involved in the management of pregnant women.[20] A recent population-based survey of Australian women found that 11% of women with low back pain of pregnancy underwent chiropractic treatment.[21] A survey of North Carolina certified nurse-midwives found that 93.9% of respondents recommend complementary and alternative medicine to their pregnant patients, and more than half of these recommended chiropractic treatment, mostly for lower back pain during pregnancy.[22]
Perhaps due to our lacklustre response to the issue of lower back pain during pregnancy, relatively few studies have tried to establish how effective chiropractic care can be. A 2006 study did look at the issue however – During the study, 17 women who underwent chiropractic treatment during pregnancy for low back pain were considered. All of the women were treated by the same chiropractor – during the care program active care (for the women to apply themselves) consisted of reassurance and education, advice on body mechanics, and exercise instruction. Passive treatments (performed by the chiropractor) were manual myofascial release, manual joint mobilization, and manual spinal manipulation.
The overall average group Pain-Rating score decreased from 5.9 at the beginning of treatment, to 1.5 at termination of care. When considered individually, one of the 17 women did not demonstrate any clinically significant improvement. For an improvement to be significant according to the Numerical Pain-Rating Scale, there must be a decrease of 2 or more points.[23] After eight visits in 21 days, the Pain-Rating Scale in this woman had still decreased, although by just one point, from 6 to 5.
The remaining 16 of 17 (94.1%) women demonstrated clinically important improvement. The average time to initial clinically important pain relief was 4.5 (range 0–13) days after initial presentation, and the average number of visits undergone up to that point was 1.8 (range 1–5). At termination of care, the average Numerical Pain- Rating Scale score for these 16 women was 1.3 (range 1–4). The average time to termination of care was 24.4 days (range 5–62) after initial presentation, and the average number of total visits undergone was 5.6 (range 3–15). During the course of care, all women were questioned about the occurrence of adverse effects. None of the 17 women reported any adverse effects.
Is chiropractic care safe for pregnant women?
The short answer to this question is an unequivocal yes! The longer answer needs to address the fact that chiropractic care from a properly qualified chiropractor consists of a wide variety of approaches and mechanisms which can be used to achieve a desired outcome.
Spinal manipulation is the most well-known element of the chiropractic toolkit – although some people do have concerns about spinal manipulation during pregnancy. This is a relevant concern, since spinal manipulation is usually the most effective and direct way to address lower back pain. While it has been written that low back spinal manipulation should be avoided pregnant women[24][25] in fact, no data has ever been presented to support this finding. Despite this, some people still hold the view that chiropractic treatment is not safe for pregnant women.
It’s important to realise that Doctors of Chiropractic are highly trained experts who will never perform spinal manipulation unless they are sure that it poses no risk to mother or baby. What’s even more important to realise is that chiropractic care can be still be highly effective via many of the other available methodologies which do not involve spinal manipulation. This is especially the case with practitioners of chiropractic biophysics, who have a wide array of options at their disposal besides spinal manipulation.
As a lower-force alternative to manual spinal manipulation, the activator technique is often a good choice for pregnant clients. The Activator technique uses a small, hand-held instrument called the Activator Adjusting Instrument to deliver a gentle force to the spine with the goal of restoring motion to the targeted spinal vertebra or joint.
How to prevent lower back pain during pregnancy
The first step in preventing lower back pain during pregnancy is certainly to ensure that you are not suffering with back pain before becoming pregnant! It should be stressed that before becoming pregnant and after giving birth it is possible to rapidly and effectively treat lower back pain using spinal manipulation as normal. If at all possible, get booked in for a chiropractic check-up before becoming pregnant – doing so will give you the opportunity to correct any minor issues, such as subluxations, which may be aggravated by pregnancy and lead to back pain.
During pregnancy, work with your chiropractor to determine an appropriate treatment regime, tailored to the development of your baby. An experienced chiropractor can advise you on which supportive treatments are appropriate for you at each stage of the journey. Also, be sure to keep up with your treatment plan even if you don’t experience pain, as avoiding the development of back pain in the first instance is by far the best approach! Ask your chiropractor to assess your posture and gait from time to time and work together to develop any necessary stretching or exercise regimes to reduce uneven loading on the spine – which can lead to back pain, or even trips and falls.
After you have given birth, be sure to consult with your chiropractor and practice proper lifting technique. Many mew mothers in particular develop back pain from incorrect baby lifting! Many chiropractors are also able to offer advice on issues such as the best position for breastfeeding and devices which can help to protect your spine while caring for your baby.
[1] Ostgaard HC. Prevalence of back pain in pregnancy. Spine 1991;16:549 –52.
[2] Kristiansson P, Svärdsudd K, von Schoultz B. Back pain during pregnancy: A prospective study. Spine 1996;21:702– 8.
[3] 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.
[4] Skaggs C, Nelson M, Prather H, Gross G. Documentation and classification of musculoskeletal pain in pregnancy. J Chiro Educ 2004; 18:83–4.
[5] Mens JMA, Vleeming A, Stoeckart R, et al. Understanding peripartum pelvic pain: Implications of a patient survey. Spine 1996;21: 1363–70.
[6] Kristiansson P, Svärdsudd K, von Schoultz B. Back pain during pregnancy: A prospective study. Spine 1996;21:702– 8.
[7] 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
[8] Mens JMA, Vleeming A, Stoeckart R, et al. Understanding peripartum pelvic pain: Implications of a patient survey. Spine 1996;21: 1363–70.
[9] Franklin ME, Conner-Kerr T.
An analysis of posture and back pain in the first and third trimesters of pregnancy.
J Orthop Sports Phys Ther 1998;28:133– 8.
[10] Ostgaard HC. Influence of some biomechanical factors on low back pain in pregnancy. Spine 1993;18:61–
[11] Hirabayashi Y, Shimizu R, Fukuda H, Saitoh K, Furuse M. Anatomical configuration of the spinal column in the supine position. II. Comparison of pregnant and non-pregnant women. Br J Anaesth 1995;75:6–8.
[12] Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: Prevalence and risk factors. Spine 2005;30:983–91.
[13] 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.
[14] Skaggs C, Nelson M, Prather H, Gross G. Documentation and classification of musculoskeletal pain in pregnancy. J Chiro Educ 2004; 18:83–4.
[15] Kristiansson P, Svärdsudd K, von Schoultz B. Back pain during pregnancy: A prospective study. Spine 1996;21:702– 8.
[16] Skaggs C, Nelson M, Prather H, Gross G. Documentation and classification of musculoskeletal pain in pregnancy. J Chiro Educ 2004; 18:83–4.
[17] Skaggs C, Nelson M, Prather H, Gross G. Documentation and classification of musculoskeletal pain in pregnancy. J Chiro Educ 2004; 18:83–4.
[18] 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.
[19] Ibid.
[20] Christensen MG, Kerkhoff D, Kollasch MW. Job Analysis of Chiropractic 2000 Greeley (CO): National Board of Chiropractic Examiners, 2000.
[21] Stapleton DB, MacLennan AH, Kristiansson P. The prevalence of recalled low back pain during and after pregnancy: A South Australian population survey. Aust N Z J Obstet Gynaecol 2002;42:482–5.
[22] Allaire AD, Moos MK, Wells SR. Complementary and alternative medicine in pregnancy: A survey of North Carolina certified nurse-midwives. Obstet Gynecol 2000;95:19 –23.
[23] Farrar JT, Berlin JA, Strom BL. Clinically important changes in acute pain outcome measures: A validation study. J Pain Symptom Manage 2003;25:406 –11.
[24] DiMarco DB. The female patient: Enhancing and broadening the chiropractic encounter with pregnant and postpartum patients. J Amer Chir Assoc 2003;40:18 –24.
[25] Parsons C. Back care in pregnancy. Mod Midwife 1994;4:16–9.
