Pregnancy-related Pain and Chiropractic

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org
Jump to:    Low Back and Pelvic Pain                      Pregnancy-related Headaches

                       Other Management Approaches

Results for Pregnancy-related Low Back and Pelvic Pain

	Infertility and Chiropractic Care A Chiro.Org article collection This page contains a variety of reports about improvements in fertility after receiving chiropractic care.
	Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process J Manipulative Physiol Ther 2021 (Nov 23); S0161 ~ FULL TEXT This best-practice recommendations article is a synthesis of the current evidence and collective expert opinion about a reasonable clinical approach for chiropractic care and management of pregnant and postpartum populations. This article provides an initial framework for chiropractors who wish to manage these populations and to help chiropractic researchers determine and examine the gaps in the literature to implement a robust research program that informs future clinical guidelines. As the first best-practices recommendations document for pregnant and postpartum patients, it is expected to evolve as new evidence emerges.
	Chiropractic Care for the Pregnant Body Clinical Obstetrics and Gynecology 2021 (Sep 1); 64 (3): 602–610 ~ FULL TEXT Chiropractic care is a commonly used treatment modality for musculoskeletal pain in pregnancy. Low back pain, pelvic pain, and other neuromuscular complaints are prevalent in pregnancy and contribute to significant maternal discomfort in many women. Nonpharmacologic therapies to relieve pain are increasingly important during pregnancy because of the opioid epidemic. Chiropractic treatment is one of the potential therapies that offers intervention without medications. This article provides an evidence-based review of the epidemiology of chiropractic use in obstetrics, commonly treated conditions, related physiology of pregnancy, and safety of spinal manipulation.
	Chiropractic Care for Adults With Pregnancy-Related Low Back, Pelvic Girdle Pain, or Combination Pain: A Systematic Review J Manipulative Physiol Ther 2020 (Sep); 43 (7): 714–731 ~ FULL TEXT Chiropractic care is a commonly used treatment modality for musculoskeletal pain in pregnancy. Low back pain, pelvic pain, and other neuromuscular complaints are prevalent in pregnancy and contribute to significant maternal discomfort in many women. Nonpharmacologic therapies to relieve pain are increasingly important during pregnancy because of the opioid epidemic. Chiropractic treatment is one of the potential therapies that offers intervention without medications. This article provides an evidence-based review of the epidemiology of chiropractic use in obstetrics, commonly treated conditions, related physiology of pregnancy, and safety of spinal manipulation.
	Can a Bothersome Course of Pelvic Pain From Mid-pregnancy to Birth be Predicted? A Norwegian Prospective Longitudinal SMS-Track Study BMJ Open. 2018 (Jul 25); 8 (7): e021378 ~ FULL TEXT If both active straight leg raise (ASLR) and P4 tests are positive at a clinical examination in mid-pregnancy, a course of persistent bothersome pelvic pain for more than 5 days per week throughout pregnancy may be predicted. The number of days per week with bothersome pelvic pain increases for every added pregnancy, but individual control over work situation and regular exercise may work as a PGP prophylactic since it invigorates a positive impact on optimal force closure of the pelvis, reduces risk of instability in the pelvic joints and enhances overall well-being.
	Effect of Spinal Manipulation on Pelvic Floor Functional Changes in Pregnant and Nonpregnant Women: A Preliminary Study J Manipulative Physiol Ther. 2016 (Jun); 39 (5): 339–347 ~ FULL TEXT Spinal manipulation of pregnant women in their second trimester increased the levator hiatal area at rest and thus appears to relax the pelvic floor muscles. This did not occur in the nonpregnant control participants, suggesting that it may be pregnancy related.
	Outcomes Of Pregnant Patients With Low Back Pain Undergoing Chiropractic Treatment: A Prospective Cohort Study With Short Term, Medium Term and 1 Year Follow-up Chiropractic & Manual Therapies 2014 (Apr 1); 22 (1): 15 ~ FULL TEXT Pregnant patients with low back or pelvic pain, no contraindications to manipulative therapy and no manual therapy in the prior 3 months were recruited. Baseline numerical rating scale (NRS) and Oswestry questionnaire data were collected. Duration of complaint, number of previous LBP episodes, LBP during a previous pregnancy, and category of pain location were recorded. 52% of 115 recruited patients 'improved' at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year. There were significant reductions in NRS and Oswestry scores (p < 0.0005).
	A Randomized Controlled Trial Comparing A Multimodal Intervention and Standard Obstetrics Care For Low Back and Pelvic Pain In Pregnancy Am J Obstet Gynecol. 2013 (Apr); 208 (4): 295. e1–7 ~ FULL TEXT A prospective, randomized trial of 169 women was conducted. Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants. The group that received standard obstetric care demonstrated no significant improvements. The chiroprtactic group demonstrated significant mean reductions in Numerical Pain Rating Scale scores.
	The Treatment Experience of Patients With Low Back Pain During Pregnancy and Their Chiropractors: A Qualitative Study Chiropractic & Manual Therapies 2012 (Oct 9) ~ FULL TEXT Chiropractors approach pregnant patients with low back pain from a patient-centered standpoint, and the pregnant patients interviewed in this study who sought chiropractic care appeared to find this approach helpful for managing their back pain symptoms.
	Outcome of Pregnancy-Related Lumbopelvic Pain Treated According to a Diagnosis-Based Decision Rule: A Prospective Observational Cohort Study J Manipulative Physiol Ther 2009 (Oct); 32 (8): 616–624 Fifty-seven patients (73%) reported their improvement as either "excellent" or "good." The mean patient-rated improvement was 61.5%. The mean improvement in BDQ was 17.8 points. The mean percentage of improvement in BDQ was 39% and the median was 48%. Mean improvement in pain was 2.9 points. Fifty-one percent of the patients had experienced clinically significant improvement in disability and 67% patients had experienced clinically significant improvement in pain. Patients were seen an average 6.8 visits. Follow-up data for an average of 11 months after the end of treatment were collected on 61 patients. Upon follow-up, 85.5% of patients rated their improvement as either "excellent" or "good." The mean patient-rated improvement was 83.2%. The mean improvement in BDQ was 28.1 points. The mean percentage of improvement in BDQ was 68% and the median was 87.5%. Mean improvement in pain was 3.5 points. Seventy-three percent of the patients had experienced clinically significant improvement in disability and 82% patients had experienced clinically significant improvement in pain.
	Manipulative Therapy for Pregnancy and Related Conditions: A Systematic Review Obstet Gynecol Surv 2009 (Jun); 64 (6): 416–427 ~ FULL TEXT In summary, the use of manipulative therapies (SMT or OMT) during pregnancy to reduce back pain and other related symptoms are supported by limited evidence; the evidence for the effects of manipulative therapies on labor and delivery is even more limited. Overall, this body of evidence is best described as emergent. Definitive evidence supporting its effectiveness has not yet been developed; however, definitive evidence supporting a lack of effectiveness is also lacking. Therefore, high quality clinical trials on safety and effectiveness should be a priority. However, until they are available, because safe and effective treatments for pregnancy-related back pain are limited, clinicians may want to consider SMT as a treatment option for patients who have a preference for this approach if no contraindications are present.
	Manipulative Therapy for Pregnancy and Related Conditions: A Systematic Review Obstet Gynecol Surv 2009 (Jun); 64 (6): 416–427 ~ FULL TEXT Overall, this body of evidence is best described as emergent. However, since effective treatments for pregnancy-related back pain are limited, clinicians may want to consider SMT as a treatment option, if no contraindications are present.
	Chiropractic Treatment of Pregnancy-related Low Back Pain: A Systematic Review of the Evidence J Manipulative Physiol Ther 2008 (Jul); 31 (6): 447–454 ~ FULL TEXT Results from the 6 included studies showed that chiropractic care is associated with improved outcomes in pregnancy-related LBP. However, the low-to-moderate quality of evidence of the included studies preclude any definitive statement as to the efficacy of such care because all studies lacked both randomization and control groups. Given the relatively common use of chiropractic care during pregnancy, there is need for higher quality observational studies and controlled trials to determine efficacy.
	Chiropractic Spinal Manipulation for Low Back Pain of Pregnancy: A Retrospective Case Series J Midwifery Womens Health 2006 (Jan); 51 (1): e7–10 Sixteen of 17 (94.1%) cases 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). No adverse effects were reported in any of the 17 cases. The results suggest that chiropractic treatment was safe in these cases and support the hypothesis that it may be effective for reducing pain intensity.
	Chiropractic Care in Pregnancy for Safer, Easier Births Jeanne Ohm, D.C. Another important reason for chiropractic care throughout pregnancy is to help establish balance in the mother’s pelvis. Because of a lifetime of stress and trauma to her spine and pelvis, her pelvic opening may be compromised, resulting in a less than optimum passage for the baby. Williams Obstetrics Text tells us that, "Any contraction of the pelvic diameters that diminish the capacity of the pelvis can create dystocia (difficulty) during labor." You can find more articles like this in our Pediatric Section.
	Post Partum and Beyond: Managing Back Pain in Women Dr. Diane Benizzi DiMarco ~ FULL TEXT The post partum patient retains a higher risk for potential injury as compared to the patient who has not endured pregnancy or has not been pregnant for an extended period of time. Fertilization propels the release of estrogen, progesterone and relaxin, hormones essential to the growth and development of the embryo and fetus. These hormones that are essential to the pregnancy cause global relaxation to the ligaments and muscles in the female pregnant patient. A conglomerate of anatomical changes created by the global laxity in muscles and ligaments compromises the stability of the spine.

Results for Pregnancy-related Headaches

Intractable Migraine Headaches During Pregnancy Under Chiropractic Care Complementary Therapies in Clinical Practice 2009 (Nov); 15 (4): 192–7 The absence of hormone fluctuations and/or the analgesic effects of increased beta-endorphins are thought to confer improvements in headache symptoms during pregnancy. However, for a number of pregnant patients, they continue to suffer or have worsening headache symptoms. The use of pharmacotherapy for palliative care is a concern for both the mother and the developing fetus and alternative/complementary care options are sought. We present a 24-year-old gravid female with chronic migraine headaches since age 12years. Previous unsuccessful care included osteopathy, physical therapy, massage and medication. Non-steroidal anti-inflammatory medication with codeine provided minor and temporary relief. Chiropractic care involving spinal manipulative therapy (SMT) and adjunctive therapies resulted in symptom improvement and independence from medication. This document provides supporting evidence on the safety and possible effectiveness of chiropractic care for patients with headaches during pregnancy.

Other Management Approaches

	Safety of Ginger Use in Pregnancy: Results From a Large Population-based Cohort Study Eur J Clin Pharmacol. 2013 (Feb); 69 (2): 269–277 Although previous studies have shown the effectiveness of Ginger use on the nausea of pregnancy, this study explored the safety of ginger use during pregnancy. This Norwegian study reports on the outcomes of 68,522 pregnancies. More than one thousand women used ginger to halt morning sickness, but were NO increases in premature births, stillbirths, low birth weights, or low Apgar scores at birth. This study clearly signals that ginger use appears to be perfectly safe for use during pregnancy.
	Maternal Vitamin D Status Determines Bone Variables in the Newborn J Clin Endocrinol Metab. 2010 (Apr); 95 (4): 1749–1757 ~ FULL TEXT In this study, it was found that although the intake of vitamin D among the mothers met current recommendations, 71 percent of these same women, and 15 percent of their newborns were deficient during pregnancy. These results suggest that efforts should be made to revise current nutrition recommendations for pregnant women since this could have a permanent effect on the well-being of their children.
	Polycystic Ovary Syndrome: Clinical Considerations Alternative Medicine Review 2001 (Jun); 6 (3): 272–292 Polycystic ovary syndrome (PCOS) is one of the most frequently encountered endocrine disorders occurring in women of reproductive age. Clinically, a patient usually presents with menstrual irregularities, infertility, and hirsutism. If not treated properly, a patient is at risk for type 2 diabetes, cardiovascular disease, and hyperestrogen-related cancers.
	A Smart Start for Pregnancy and Lactation Nutrition Science News (March 1999) Many health–conscious women who are pregnant or breast–feeding adhere to dietary guidelines set by the American College of Obstetrics and Gynecology that recommend limiting fat intake for the health of their babies. However, scientists now recognize that specific long–chain polyunsaturated fatty acids (LCPs) are required for the development of a baby's brain, nerves, heart and eyes. Furthermore, research has revealed that pregnant American women do not get enough LCPs in their diet, even when they are not necessarily trying to limit fat intake. [1]
	Prenatal Nutrition Nutrition Science News (Februaey 2000) Often when a woman becomes pregnant, or is trying to get pregnant, she develops a new perspective on her health. For most this means a new or renewed interest in nutrition and healthy food choices. Some women are afraid their diet is insufficient and worry it might affect their baby. Others simply want to do everything in their power to have an easy pregnancy and a normal infant. All are valid concerns. They are also opportunities for you to discuss the reasons to supplement, even for those already eating healthfully.

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Updated 6-24-2022