Accessibility View Close toolbar

611 University Drive Ste 214

State College, PA 16801 USA

(814) 234-5271

Open mobile navigation

Pregnancy

Doctors of chiropractic can help pregnant women manage back pain through manipulation, modalities and exercise.
By Nataliya Schetchikova, PhD
Back pain is an inconvenience that often comes with the joy of expecting a child. While 57 percent to 69 percent of future mothers experience symptoms, research shows that only half of them report symptoms to their healthcare providers and only a quarter of physicians recommend treatment.1
Yet more than 60 percent of pregnant women and prenatal providers are open to trying CAM therapy for low-back pain management, considering massage (61.4%), acupuncture (44.6%), relaxation (42.6%), yoga (40.6%), and chiropractic (36.6%).2 In another survey, 57.3 percent of midwives reported recommending CAM therapies to more than 10 percent of their patients, ranking chiropractic as their third popular choice.3
Although studies on chiropractic care in pregnancy are limited, existing observational research shows promising results. A retrospective case series showed that 94.1 percent of pregnant women who underwent chiropractic care showed clinical improvement, without noted adverse effects.1 In an observational cohort study presented at ACC-RAC earlier this year, Donald Murphy, DC, DACAN, showed that of patients who underwent chiropractic care for low-back pain, 72.5 percent rated their improvement as “excellent” or “good”, with 51 percent of subjects also showing a clinically significant improvement on the Bournemouth Disability Questionnaire (BDQ).
Working With a Pregnant Woman
Some chiropractors are hesitant to treat pregnant patients, however. “There are no contraindications to adjustments above the lumbar area, but as a patient gets further along in pregnancy, the technique needs to be gentler,” says Marianne Gengenbach, DC, DACBSP, co-author of several textbooks on sports chiropractic. Having adjusted women into their third trimester, she recommends side-posture adjustments and very low-force techniques, but adds that she prefers to work more with muscles than with manipulation. Because of pregnancy hormones having a relaxing effect on ligaments, “adjustments don’t hold as well, especially in the second and third trimester,” she says. 
Adjusting a pregnant woman can be difficult, especially in the third trimester, agrees Steven Zaeske, DC, DABCI, a chiropractic internist in Northern Illinois whose clinic provides gynecology and infertility services. But this is where Activator, acupuncture, massage and other instruments and modalities come into play, he says. He advises against using electrical stimulation or ultrasound over a gravid uterus, however.
It’s very important to remember that back pain in pregnant women is not always pregnancy-induced; instead, it can be related to a problem with the pregnancy, says Dr. Murphy. “When taking the patient’s history, it’s most important to ask them about bleeding, spotting, unusual vaginal discharge, bouts of diarrhea, feeling like the baby is going to fall out, fever, chills, weight loss—these are red flags for problems with the pregnancy itself versus sacroiliac complaints,” he says.
When manipulating healthy pregnant patients, DCs may need to change manipulation “just to manage their changing shapes,” says Randy Hewitt, DC, CCSP, an Oregon chiropractor who has worked with pregnant patients for the past 20 years. He recommends using pregnancy pillows and tables with a spring-loaded abdominal piece that allows the patient to lie down. “Be sure to spend time working with the muscles—massage and stretching—and get them exercising,” he says. (For cardiovascular exercise in pregnancy, see the June issue of ACA News.)
Fighting Pain with Exercise
While pregnancy-induced changes—a shifted center of gravity and balance, increase in the lordotic curve, and loosening and shortening of ligaments and tendons—make exercising more challenging, exercises targeted for balancing the changes can help the body. “Because the pelvis naturally becomes unstable, you want to make sure the patients have optimum muscular compensation for the lack of ligamentous support,” says Dr. Murphy, clinical director of the Rhode Island Spine Center and a member of the faculty of Brown University School of Medicine.
To provide this compensation, Dr. Murphy recommends teaching pregnant patients to co-contract the muscles that stabilize the spine and pelvis. “The exercises are not unlike the stabilization exercises that we give to other back-pain patients—co-contracting the pelvic floor muscles with the trunk muscles,” he says.
Early on in pregnancy, the exercises are done while lying on the back, encouraging patients to hold the co-contraction as they go into a bridge position. To increase the challenge, patients are asked to raise one leg at a time. Anecdotally, the most benefit comes from training motor control in a weight-bearing position. To train the force-closure mechanism to stabilize the pelvis, Dr. Murphy recommends a “good morning” exercise—“stand and maintain a neutral lordosis in the lumbar spine and then flex forward from the hip, with the arms hanging forward.” As patients get more coordinated, the exercise can be done with a weight in each hand—or on a Roman Chair, slightly tilted to further the challenge, he adds.
For people whose trigger points in the piriformis muscles contribute to the pain, Dr. Murphy likes a simple exercise in which the patient holds the co-contraction while standing on one leg for 30 seconds, then on the other leg for another 30 seconds—twice a day for each leg.
For some patients, postural exercises may be a good idea, says Dr. Hewitt. “Their ligaments get loose and muscles get stressed.” To maintain an upright thoracic spine and prevent a sway back, he recommends hip extensions, sometimes with the help of elastic bands, to keep muscles from getting hypertonic.
Since back pain is common throughout pregnancy, it’s best to start patients on exercises early, says Dr. Murphy. “In the third trimester, because of the body size, increased body weight, and difficulty in the ability to maneuver, you are limited in what you can give them,” he says.
Ultimately, working with pregnant patients is extremely rewarding, says Dr. Murphy. “Pregnant ladies are some of the happiest patients you will see,” he says. “Back pain is very common and troublesome and puts a damper on a beautiful time in life. When you can help them with back pain, they are really grateful. I encourage chiropractors to work with pregnant ladies,” he concludes.


References
1. Lisi AJ. Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series. J Midwifery Womens Health. 2006 Jan-Feb;51(1):e7-10.
2. Wang SM, et al. Complementary and alternative medicine for low-back pain in pregnancy: a cross-sectional survey. J Altern Complement Med. 2005 Jun;11(3):459-64.
3. Allaire AD, et al. Complementary and alternative medicine in pregnancy: a survey of North Carolina certified nurse-midwives. Obstet Gynecol. 2000 Jan;95(1):19-23.

Additional Articles on Pregnancy and Chiropractic:

ACA: Advice for Expecting Moms-To-Be

ACA Today: Women Need Expanded Musculoskeletal Care During Pregnancy

Subscribe to our newsletter to receive latest updates.

Office Hours

Our Regular Schedule

State College Location

Monday:

8:00 am-6:00 pm

Tuesday:

8:00 am-6:00 pm

Wednesday:

8:00 am-6:00 pm

Thursday:

8:00 am-6:00 pm

Friday:

8:00 am-6:00 pm

Saturday:

Closed

Sunday:

Closed

Spring Mills Location

Monday:

2:00 pm-6:00 pm

Tuesday:

2:00 pm-6:00 pm

Wednesday:

8:30 am-6:00 pm

Thursday:

Closed

Friday:

8:30 am-5:00 pm

Saturday:

Closed

Sunday:

Closed

Locations

Find us on the map

Featured Articles

Read about interesting topics

  • Chiropractic and Breech Babies During Pregnancy

    If you are experiencing back pain during your pregnancy or have a breech pregnancy, chiropractic can help. ...

    Read More
  • Natural Remedies for Sciatic Pain

    Do you experience sciatica pain? Both chiropractic care and at-home remedies can help alleviate that pain in a natural way. ...

    Read More
  • Chiropractic Care For Pets

    You know how chiropractic can help you, but what about your pets? ...

    Read More
  • Should I Use Heat or Ice for Pain?

    When you're feeling pain, sometimes it's difficult to determine if heat or ice will treat that pain best. This article will help you learn which is best for different types of injuries and pain. ...

    Read More
  • Should I Use Ice or Heat for Pain?

    Did you hurt your knee during an intense game of pick-up basketball this weekend? Or do you deal with chronic pain? Learn whether you should apply heat or ice for particular kinds of pain. ...

    Read More
  • Relationship with Self

    The relationship you have with yourself and the journey to self-understanding is an important part of your overall wellness. ...

    Read More
  • Indoor Activities and Exercises

    Are you preparing for the winter months or looking for exercises to do when you can't make it to the gym? Follow these exercises to maintain a healthy fitness routine. ...

    Read More
  • Holiday Stress - Take a Deep Breath

    Most of us pay little attention, if any, to the daily functioning of our many physiological systems. Our hearts beat, our digestive systems digest, and our various hormones, such as those deriving from the thyroid gland, adrenal gland, and pancreas, do what they do. It's all good... until it's not. ...

    Read More
  • Proper Overindulgence Over the Holidays

    Proper Overindulgence Over The Holidays The term "overindulgence" is probably best assessed as a red flag, especially with respect to consistent overconsumption of high-calorie comfort food and desserts during the holiday season. An overall healthier perspective could be described as "indulgence" regarding ...

    Read More
  • The 5 Senses

    The 5 Senses The five senses, that is, the sense of sight, touch, hearing, taste, and smell, provide us with necessary information regarding the world around us.1 These precious capabilities enable us to navigate our environment with seemingly instantaneous feedback with reference to our actions and ...

    Read More

NEWSLETTER SIGNUP

Sign up for more articles