We are very grateful to the wonderful David Diehm, a highly experienced and knowledgeable, local chiropractor, for supplying this article:
“Pregnancy is an exciting journey in a women’s life, it also marks a time of change as the body prepares to grow, nourish and support the growth of your baby. A women’s body will show changes emotionally, hormonally, mentally and biomechanically. It’s a time when many women look for natural, safe and effective options to support their pregnancy. Women receiving chiropractic care through their pregnancy constantly report a high level of satisfaction with treatment outcomes 1.
The number of women who experience low back pain during pregnancy is quite high. Eighty percent of women will experience Low back pain and /or pelvic pain during pregnancy 2. Musculoskeletal complaints like low back pain should be taken seriously, persistent pain can affect quality of life and sleep 3. Back pain during pregnancy is commonly linked to low back pain persisting after pregnancy 4-7. Approximately 20% of women will experience isolated lower pelvic girdle pain around the sacrum 8,9.
Chiropractic in its approach to pregnancy care pays particular attention to the function of the spine, pelvis and nervous system. Its important to understand the anatomy and physiology of what your body and pelvis is designed to do.
A women’s body weight during pregnancy will increase by 15-25%, this significantly increases the burden on the joints ligaments and tendons 10. As pregnancy moves along, the uterus enlarges, as does breast volume, further shifting the body’s center of gravity forwards. The pelvis is tilted simultaneously and the low back curve increases 11. The most significant spine curve change is observed between the second and third trimester 11.
As your center of gravity shifts many changes occur at the pelvis, sacrum and surrounding ligaments in order for your body to adapt. The hormones relaxin and estrogen are responsible for loosening of the ligaments which further increases the likelihood of soft tissue injury 12,13.
Your pelvic structure has 4 joints that play an important role in pregnancy and during birthing. These joints are connected by surrounding ligaments and tendons. The joints include:
1) Sacroiliac joints (there are 2 of these, either side of the sacrum at the back)
2) Symphysis pubis ( located at the front)
3) Coccyx ( tailbone)
The scaro-illiac joints are located where you can often see and feel dimples above your bottom. Symmetry of these joints and surrounding ligaments is a key focus of chiropractic analysis and care. Instability and movement at the symphysis pubis bone can be excruciatingly painful, often the support of a rigid pelvic belt will be recommended 14.
A females pelvis has several key ligaments that surround and help support the uterus during pregnancy 15. One of these ligaments is the round ligament, it holds the uterus in suspension within the abdomen. It can become thin and tight like a rubber band and is often the cause of sharp sudden jabs of pain in the lower belly. Movement at the sacrum can be multi directional 16, if your pelvis is aligned and balanced during pregnancy, the uterus and the surrounding ligaments will be supported symmetrically.
The hormone relaxin is an important hormone that will relax and loosen the ligaments, especially in the pelvic area. This accommodates the expansion of the growing baby. Ligament laxity can make the pelvic bones very unstable and allow for easy misalignment which can be quite painful.
Sacral misalignments and/or restrictions can result in a torsion or increased tension within specific pelvic ligaments or muscles which can then influence the uterus 17.
To restore any imbalances during pregnancy we use gentle adjustments to the spine and pelvis utilising specialised tables and techniques. Most pregnant patients undergoing chiropractic treatment report a clinically relevant improvement 18. As it becomes uncomfortable for you to lay on your stomach, parts of our table move away to provide room for the growing bub and specialized pillows are used to add comfort and support. At all times the health of you and your growing bub is our priority.
The Webster technique is our preferred method of assessing any pelvis misalignment such as a sacral imbalance. A chiropractic adjustment called the Webster technique is a specific sacral adjustment to help facilitate the mother’s pelvic alignment and nerve system function 19. This aim of this approach is to provide balance to the pelvic muscles and ligaments which in theory would reduce the torsion on the uterus.
During your pregnancy I would encourage you to partake in an active lifestyle to support healthy movement 20. The activities you feel comfortable with will likely change as your body changes. Walking, pilates, yoga, stretching, aqua aerobics or jogging are all effective ways of supporting a healthy spine and pelvis through pregnancy 21,22,23.
Pregnancy is an exciting period of any woman’s life. In our experience a pregnancy supported by a well-functioning spine and pelvis will be more comfortable and enjoyable. If you’re seeking a non-invasive, drug free approach to help support your pregnancy consider a chiropractor as a valuable support person on your team”.
Article written by David Diehm, Family Life Chiropractic.
P (02) 4965 4391
A 59A Stewart Ave, Hamilton South NSW 2303
1. J Altern Complement Med. 2018 Jan 1; 24(1): 90–98.
2. Back pain is a major problem for many pregnant women. Martins RF, Silva JL Rev Assoc Med Bras (1992). 2005 May-Jun; 51(3):144-7.
3. Sloan E. Sleep disruption during pregnancy. Sleep Medicine Clinics. 2008;3(1):73–80.
4. Perkins J, Hammer RL, Loubert PV. Identification and management of pregnancy-related low back pain. J Nurse Midwifery. 1998;43:331–340.
5. Pennick V, Young G. Interventions for preventing and treating pelvic and back pain in pregnancy (Review) Cochrane Database Syst Rev. 2007;18:CD001139
6. Skaggs CD, Prather H, Gross G, George JW, Thompson PA, Nelson DM. Back pain and pelvic pain in an underserved United States pregnant population: a preliminary descriptive survey. J Manipulative Physiol Ther. 2007;30:130–134.
7. Khorsan R, Hawk C, Lisi AJ, Kizhakkeveettil A. Manipulative therapy for pregnancy and related conditions: a systematic review. Obstet Gynecol Surv. 2009;64:416–427.
8. Maria C. Low back and pelvic girdle pain of pregnancy: Recommendations for diagnosis and clinical management. J Clinical Chiropractic Pediatrics. 2010;11(2):774–779.
9. Vleeming A, Albert H, Ostgaard H, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine J. 2008;17(6):794–819
10. Korsten-Reck U, Marquardt K, Wurster KG: Schwangerschaft und Sport. DZSM, 2009, 60: 117–121
11. J Phys Ther Sci. 2016 Apr; 28(4): 1199–1207. Impact of pregnancy on back pain and body posture in women.
12. Physical exercise during pregnancy–physiological considerations and recommendations. Hartmann S, Bung P J Perinat Med. 1999; 27(3):204-15.
13. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Artal R, O’Toole M Br J Sports Med. 2003 Feb; 37(1):6-12; discussion 12.
14. Jill Depledge et al. Management of Symphysis Pubis Dysfunction During Pregnancy Using Exercise and Pelvic Support Belts. Physical Therapy, Volume 85, Issue 12, 1 December 2005.
15. Clayson, SJ, Newman, IM, and Debevec, D. Evaluation of mobility of hip and lumbar vertebrae of normal young women. Arch Phys Med Rehabil. 1962; 43: 1–8
16. Schafer, RC. Clinical biomechanics: Musculoskeletal actions and reactions. 2nd ed. : Williams and Wilkins, Baltimore; 1987.
17. P Walters, PJ, Pelvis. In: Textbook of clinical chiropractic. A specific biomechanical approach. Plaugher G, Editor: Williams and Wilkins, Baltimore; 1993
18. 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. Peterson CK, Mühlemann D, Humphreys BK Chiropr Man Therap. 2014 Apr 1; 22(1):15.
19. Ohm J, Alcantara J. The Webster Technique: Definition, application and implications. J Pediatr Matern Fam Health Chiropr2012;2012:49–53.
20. Physical Activity Patterns and Factors Related to Exercise during Pregnancy: A Cross Sectional Study. Nascimento SL, Surita FG, Godoy AC, Kasawara KT, Morais SS PLoS One. 2015; 0(6):e0128953.
21. Melzer, K., Schutz, Y., Boulvain, M., & Kaiser, B. (2010, June 1). Physical activity and pregnancy: cardiovascular adaptations, recommendations and pregnancy outcomes. Sports Medicine 406, 493-507.
22. Acta Obstet Gynecol Scand. 2015 Oct;94(10):1039-47.
23. Physical exercise during pregnancy–physiological considerations and recommendations. Hartmann S, Bung P J Perinat Med. 1999; 27(3):204-15.