Pregnancy, Low Back Pain and Chiropractic

 

A report on the scientific literature 


 

By: Mark Studin DC, FASBE(C), DAAPM, DAAMLP

 

It has been this authors personal experience that pregnant woman experiencing low back pain secondary to her pregnancy has been told to “wait and see” over time, with the hope that the back pain would go away. This is predominantly because the “drug option” is off the table with complications to the fetus and most doctors are not willing to take the chance to relieve mechanical (no tumors, fractures or infection) low back pain.  My patients reported to me that their obstetricians told them their pain was a result of altered biomechanics and hormonal changes affecting the muscles and ligament of their spine. Current research has now verified through scientific evidence what practicing chiropractors and their patients have been claiming for decades, that chiropractic work to help relieve pain for pregnant woman with a safe, conservative treatment for both mother and the fetus. As a result of the effectiveness and safety, it now demands that chiropractic be the first referral option for pregnant woman experiencing low back pain.

 

 

According to Petersen, Muhlemann and Humphreys (2014) “Low back and pelvic pain in pregnant women is such a common phenomenon that it is often considered a normal part of the pregnancy [1-3]. However, the high prevalence of this problem (50-80% of women) and the impact that this may have on their quality of life, as well as the fact that back pain during pregnancy is commonly linked to low back pain persisting after pregnancy, mandates that it be taken seriously by health care practitioners. Many of these patients rate their back pain as moderate to severe with a small percentage claiming to be significantly disabled by the pain [6-8]. Pregnancy-related low back pain is most often divided into 3 categories based on location. These are: lumbar spine pain, posterior pelvic pain, or a combination of these two, with posterior pelvic pain reported to be the most common presentation and the location most specific for pregnant patients. Although the etiology of low back pain associated with pregnancy is not definitively known, the predominate theories include biomechanical changes due to the enlarging uterus resulting in an increasing lumbar lordosis and the influence of the hormone relaxin on stabilizing ligaments leading to hypermobility of joints.” [pg. 2]

 

Petersen went on to report “The results of this current study which showed that a high proportion of pregnant patients with LBP undergoing chiropractic treatment reported clinically relevant improvementsupport those published in a recent cohort study as well as the recent randomized clinical trial (RCT) looking at chiropractic treatment for pregnant patients with low back or pelvic pain.” [pg. 5] Meaning, that chiropractic works for low back pain in pregnant woman and it has been proven in many scientific studies. The result showed that at various times during the pregnancy, upwards of 90% of pregnant woman reported positive results. The specific results reported:

 

52% improved at 1 week

70% improved at 1 month

85% improved at 3 months

90% improved at 6 months

 

All of these were with chiropractic care only and no drugs or any other type of intervention beyond patient education by the chiropractor.

 

 

Mullen ET. Al reported that when interviewing midwives, that 88.8% had an experience with chiropractors and 97% was positive. In addition, 94.5% of those had chiropractors treated their children and had a positive experience.  The most revealing statistic is one of safety. 100% of midwives question answered that chiropractic was safe for their pregnant patients.

 

 

We also know that chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration.  Whedon, Mackenzie, Phillips, and Lurie (2015) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury into normal healthy tissues has been identified (Whedon et al., 2015, p. 5) 

 

References:

  1. Petersen C., Muhlemann D., Humphreys B. (2014) 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 22:15, 1-7
  2. Mullin, L., Alcantara J., Barton D., Dever L. (2011) Attitudes and Views on Chiropractic: A Survey of United States Midwives, Complementary Therapies in Clinical Practice 17 (2011) 135-140
  3. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

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Published in Low Back Problems

Pregnancy and Chiropractic: Care and Safety

“A Report on Midwives & Chiropractic”

 

A report on the scientific literature 


By: Mark Studin DC, FASBE(C), DAAPM, DAAMLP

 

 

Being a chiropractor for 34 years, I have treated hundreds of pregnant patients in my career for a host of “pregnancy related spinal conditions.” The impetus for conservative chiropractic care was in part because the pregnant patient could not utilize drugs as a result of contraindications with pregnancy and also in part because of the positive experiences both patients, midwives and obstetricians have observed through the years. It has been my persona observation that chiropractic is a safe alternative for pregnant patients and should always be the first option for anyone (pregnant or not) before the utilization of drugs, making them needless if a non-drug approach delivers positive outcomes. 

 

According to Mullen, Alcantara, Barton and Dever (2011) “Chiropractors and midwives, with their conservative approach to patient care grounded in a holistic and vitalistic philosophy, share many common ideals in the care of patients. In the age of evidence based practice with an emphasis on an integrative approach to patient care, chiropractors and midwives have a unique opportunity to develop partnerships in this regard.” They found “that 57% of their nurse-midwife responders recommended chiropractic to their pregnant patients to address pregnancy-related neuromusculoskeletal (NMS) complaints, sciatica and fetal malposition. In a survey of both lay-midwives and nurse-midwives on their use of CAM (complementary and alternative medicine)  therapies, found chiropractic was the most popular CAM therapy to address musculoskeletal back pain. There are also indicators that chiropractors advocate for a strong working relationship with midwivesparticularly in addressing fetal malposition during pregnancy.” Pg. 135

 

Mullen Et. Al went on to report that 98.9% of midwives were aware that chiropractors worked with “birthing professionals” and 92.5% were knowledgeable about chiropractic’s role in prenatal care. 88.8% had an experience with chiropractors and 97% was positive. In addition, 94.5% of those had chiropractors treated their children and had a positive experience.  The most revealing statistic is one of safety as 100% of midwives questioned answered that chiropractic was safe for their pregnant patients. 

 

We are now starting to get answers from disparate sects of healthcare that verify what was once considered “miracles” with maladies such as fetal repositioning during pregnancy. These research findings verify that the chiropractic adjustment does not deliver miracles, it only helps the body work better and we now know why. 

 

We also know that chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration.  Whedon, Mackenzie, Phillips, and Lurie (2015) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury into normal healthy tissues has been identified (Whedon et al., 2015, p. 5) 

 

References:

 

 

  1. Mullin, L., Alcantara J., Barton D., Dever L. (2011) Attitudes and Views on Chiropractic: A Survey of United States Midwives, Complementary Therapies in Clinical Practice 17 (2011) 135-140
  2. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

 

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Published in Low Back Problems

Chiropractic: Safer Pregnancy and Birthing

A recent article in the Jamaica Observer in the May 25 issue titled “Safer pregnancy, birthing through chiropractic care,” highlighted a increase in the number of pregnant women who are looking for a safer, more natural and easier birthing process.  The article goes on to describe what happens to the woman’s body structurally and hormonally throughout the pregnancy.

These changes include increases in weight, which shift her center of gravity outward and forward.  When this is added to the laxity of ligaments, due to the release of relaxin and elastin, needed for the birthing process it tends to destabilize posture and realign the carriage of weight and forces throughout the joints of the body.  This can lead to misalignment in the spine and pelvis or subluxations causing low back pain. 

The author goes on to explain how a condition called intrauterine constraint can be effected by spinal and pelvic misalignment.  The mother’s pelvic anatomy and the relationship between its biomechanics and the baby's positioning can be affected adversely.  If the pelvis is supported symmetrically it allows the baby optimal room for movement and the opportunity to develop free of constraint. 

On the other hand if the pelvis is out of alignment it can create an uneven pulling effect on the uterine ligaments limiting the space available for the baby to develop.  This can lead to development problems in the baby's musculoskeletal system.  Fetal positioning is important for delivery without outside intervention.  The optimal positioning is rear-facing, head down.  When the baby presents breech or posterior, it often is the result of an imbalance in the mother's pelvis. 

If the mother's biomechanics are not working properly then obstetric interventions are more likely to be recommended and implemented.  The problem is that each and every intervention has significant side effects for both mother and baby.  Fortunately, today more and more parents are becoming aware of the detrimental effects of these interventions and are choosing safer alternatives including chiropractic to address both the needs of the mother and the newborn.

For more news articles or chiropractic research please click on the research link on the Uschirodirectory.com website.

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Pregnancy, Back Pain & Chiropractic

A report on the scientific literature 



By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP

 
"Back pain during pregnancy can be significant in terms of intensity and resulting disability" (Stuber & Smith, 2008, p. 447). It often exacerbates (magnifies) an underlying problem with the change in body mechanics as the pregnancy progresses and the fetus grows. One study found that 35.5% of woman had at least moderately severe back pain during 1 or more of their pregnancies. The pain scales of the pregnant woman (on the Owestry rating scale of 0-10, where 0 is no pain and 10 is the worst pain imaginable) ranged from 5.86 to 9.21.1
 
One of the problems with patients not seeking care during pregnancy is this can become a long- term chronic condition and inherently more difficult to resolve as muscles and connective tissue compensate to accommodate the increasing forward center of gravity. Over time, the tissue becomes "patterned" to the 9 month temporary state and abruptly changed, upon delivery. These multiple, sudden changes can cause a weakening of the supportive tissue, creating an abnormal chronic problem if not stabilized during pregnancy.
 
One study, in a retrospective review of 179 pregnant woman in 5 clinics regarding back pain during pregnancy and labor, found that 85% reported relief of their low back pain as a direct result of chiropractic care. In an unrelated study, 25% had complete remission of their back pain, 50% reported feeling very well and 15% were feeling better. Only 10% reported no changes
.1
 
In one study, the average pain scale prior to chiropractic care was 7.58 out of 10 and while they were under chiropractic care was 4.25. A second study revealed the average pain scale before chiropractic care was 5.9 and post chiropractic care 1.5 out of 10 on the Owestry scale.
 
This author, having practiced chiropractic for 30 years and cared for 100’s of pregnant patients during that time, has had similar results in the clinical setting. The primary reason these pregnant patients have sought chiropractic care has been that it is a drugless approach and it works. Beyond that, pregnant patients shouldn't spend 9 months in pain. They should be able to enjoy an active pregnancy and get the exercise needed to have a healthy, full-term labor and delivery.
 
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for pregnant patients with back pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.uschirodirectory.comand search your state.



References:


1.  Stuber, K. J., & Smith, D. L. (2008). Chiropractic treatment of pregnancy-related low back pain: A systematic review of the evidence. Journal of Manipulative and Physiological Therapeutics, 31(6), 447-454.

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