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By Dr. Cynthia Durakis, Chiropractor
Few people need chiropractic care more than a woman who gains 20+ pounds over nine months, while her structural system shifts to accommodate a growing baby. Add the stresses of chores, child care, working and maybe a pre-existing spinal weakness and there is significant potential for difficulty through pregnancy and delivery.
The primary physiological changes that take place in the mother during pregnancy can be broken down into two categories: hormonal and mechanical. The two are integrally related, and it is useful to recognize that many of the biomechanical changes are actually brought about by the appropriate increases in the hormones of pregnancy. This is a normal and necessary physiological change, and allows for the pelvis of the mother to shift and expand for the growth and delivery of the child. Unfortunately, it is very common for many pregnant women to experience low back discomfort as a result.
In many cases of pain or injury during pregnancy, the sacroiliac (S-I) joint has shifted from its proper position, thereby creating misalignments and muscle spasm. The S-I joints are the two indentations right above both buttocks that mark the junction of the hipbones/pelvis and the sacrum (the triangular bone at the base of the spine). When the ligaments that stabilize these joints are over-stressed, a low back sprain is the result. While the pain may eventually dissipate, problems may continue throughout the pregnancy if the joint does not heal correctly or completely. Tension in the hip rotator muscles can lead to “piriformis syndrome,” another painful condition that causes back and leg pain.
It is not unusual that some women who consistently experience back pain prior to pregnancy experience relief of pain during pregnancy. Though it sounds implausible, the cause rests again in the hormonal changes that result in the softening of the muscles and ligaments throughout the body. For some women, chronically tense muscles relax more easily, resulting in a decrease in pain. However in other pregnant women, the shift may translate into a lack of support, resulting backache.
As the pregnancy continues, another common musculo-skeletal complaint arises – it is known as “sciatica,” and occurs when the nerve running from the low back, through the buttocks and down the leg becomes inflamed and painful. Because of the weight gain associated with the later stages of pregnancy it is inevitable that postural shifts will affect the spine. As the baby grows and the abdomen gets larger, a pregnant woman must lean backward slightly in order to maintain balance. This position places more strain on the joins of the lumbar spine, eventually irritating the surrounding soft tissues including spinal nerves. Occasionally the pressure will cause a spinal disc to swell (herniate), further irritating spinal nerves and causing acute pain.
Fortunately, most of the common structural complaints are not difficult for a chiropractor to effectively address and there is clinical evidence that chiropractic care during pregnancy is effective for treating back pain.1
An adjusting table in which the abdominal section drops away is usually employed to allow the pregnant mom to lay fay down, (this is particularly exciting for women who have been unable to lay on their stomachs for weeks!). This position allows the chiropractor to apply traction to the lower spine, which reduces pressure on the involved nerve roots. The pelvis and lumbar vertebrae can then be adjusted to restore proper motion and position.
There are several other fairly common conditions associated with pregnancy that a chiropractor can usually address.
Appropriate structural alignment is essential for normal function especially during pregnancy. There is some evidence that women under chiropractic care have faster labors and research supporting that the Webster Breech Turning Technique is very effective for safely turning breech pregnancies to allow for vaginal delivery.2
Back labor, though common, is not a normal occurrence during labor. If the baby is positioned incorrectly, excessive pressure on the sensitive nerves exiting the sacrum may result as the uterine contractions force the baby downward. In an effort to relieve the pain, the mother may instinctively contract the muscles of the pelvis as a means to pull the baby up and off the sacrum. This will prolong labor and result in abnormal pressure being applied to the delicate structures of head and spine. There are specific chiropractic techniques which, when applied to a women experiencing back labor will usually shift the pelvis, relax contracted muscles and allow the baby to shift into a more appropriate position.
There are many reasons why chiropractic care will effectively address some of the problems experienced during pregnancy. What is perhaps the most compelling is that conservative chiropractic intervention can decrease the need for a woman to take pain medication during her pregnancy and delivery. For expectant mothers who are diligent about their health habits, proper diet, exercise, and structural support all will work together to maximize the health of both mother and baby.