Given the recent news regarding increased concern for opioid addiction, it seems important to revisit this subject, especially as informed patients are doing research into alternative methods for managing back pain in pregnancy. Specifically, some questions have come up regarding chiropractors and massage therapists during pregnancy. After looking into ACOG (American Congress of Obstetricians and Gynecologists) resources, I found very little information on the subject. Even looking into academic literature shows that there have been very few studies on the subject, but the following is a brief summary of what I found.
What causes back pain in pregnancy? Spinal dysfunction, displaced load on the spine, stretching of the peritoneum, adnexa and uterus, lordosis and joint laxity are among the main causes. Huh? Essentially, unless you typically walk around with your abdomen pushed out in front of you with an extra 25-35 pounds pulling it forward, then your spine won’t be in its usual alignment during pregnancy. This can compress the usual space between your vertebrae causing pain. There’s also a constant pulling sensation on all of the structures that usually hold your uterus in place, and even the tiniest added tension can sometimes cause muscle spasms. The closest thing I can describe would be taking a very non-flexible guy like myself, trying to touch my toes (hello shins!), then having someone come up behind me and push me until my hands are now flat on the floor. Lastly, progesterone causes the joints to relax (it’s meant to target the pubic bone to allow more room for a baby), and this can lead to easier sprains of any of your joints.
So, that’s really helpful. Now I know why I feel like crap, but what can I do about it? Honestly, to some degree back pain is going to be hard to avoid entirely due to the changes above, but there are certainly options to help you feel better. First of all, stay active. Women who exercise during pregnancy tend to have stronger core muscles to help offset some of the changes listed above, and they also tend to gain significantly less weight during the course of pregnancy. Less weight gain generally leads to reduction of back pain symptoms. Warm and cold compresses are also options, although it’s best to stay away from hot tubs while you’re pregnant. Topical treatments such as Icy Hot have been given a category B rating, meaning no harm in animal studies but no human studies are available. Some women find relief with “belly band” or other more supportive undergarments whereas others feel that stretching is more beneficial. Side-sleeping with a pillow between your legs can often be a more restorative way to rest during pregnancy as this can help keep your spine in better alignment. Lastly, Tylenol could be used when all else fails.
Can I phone a friend? Absolutely! At this time, there are no in depth studies evaluating the safety of chiropractor adjustments or massage during pregnancy. The limited data available would seem to suggest that this type of intervention can often be helpful in as little as two sessions, and a non-drug treatment option for pain is always a good option to consider. For women who are able to find relief of their back pain with these sessions, pregnancy can often be much more enjoyable. Constant contraction of the piriformis and iliopsoas muscles occurs during the new position of the spine during pregnancy, and adjustments that focus on relaxation of these areas have been shown to improve pain in some cases. If you do book a treatment, be sure your chiropractor avoids unnecessary pressure to your abdomen.
Fortunately, the joint laxity we talked about above can actually make adjustments easier than usual, so if you decide to go for it, your chiropractor may be more likely to achieve the desired effects. That being said, be sure to discuss your specific pregnancy conditions and concerns with your doctor before scheduling an adjustment (these sessions may not be safe in some scenarios), and if you think you are in labor, that your water has broken, or that you’re having vaginal bleeding, the definitely seek out your ob/gyn first.
Hopefully, you’ll be one of the lucky moms who avoids any significant back pain in pregnancy, but if not, then you could certainly consider the options listed above. Good luck, and remember that even if back pain makes your pregnancy seem like it takes forever, once your little one here, it will totally be worth it. In fact, after seeing how cute your little guy or girl is, you may even want to do it again :)
Dr. Nick
What causes back pain in pregnancy? Spinal dysfunction, displaced load on the spine, stretching of the peritoneum, adnexa and uterus, lordosis and joint laxity are among the main causes. Huh? Essentially, unless you typically walk around with your abdomen pushed out in front of you with an extra 25-35 pounds pulling it forward, then your spine won’t be in its usual alignment during pregnancy. This can compress the usual space between your vertebrae causing pain. There’s also a constant pulling sensation on all of the structures that usually hold your uterus in place, and even the tiniest added tension can sometimes cause muscle spasms. The closest thing I can describe would be taking a very non-flexible guy like myself, trying to touch my toes (hello shins!), then having someone come up behind me and push me until my hands are now flat on the floor. Lastly, progesterone causes the joints to relax (it’s meant to target the pubic bone to allow more room for a baby), and this can lead to easier sprains of any of your joints.
So, that’s really helpful. Now I know why I feel like crap, but what can I do about it? Honestly, to some degree back pain is going to be hard to avoid entirely due to the changes above, but there are certainly options to help you feel better. First of all, stay active. Women who exercise during pregnancy tend to have stronger core muscles to help offset some of the changes listed above, and they also tend to gain significantly less weight during the course of pregnancy. Less weight gain generally leads to reduction of back pain symptoms. Warm and cold compresses are also options, although it’s best to stay away from hot tubs while you’re pregnant. Topical treatments such as Icy Hot have been given a category B rating, meaning no harm in animal studies but no human studies are available. Some women find relief with “belly band” or other more supportive undergarments whereas others feel that stretching is more beneficial. Side-sleeping with a pillow between your legs can often be a more restorative way to rest during pregnancy as this can help keep your spine in better alignment. Lastly, Tylenol could be used when all else fails.
Can I phone a friend? Absolutely! At this time, there are no in depth studies evaluating the safety of chiropractor adjustments or massage during pregnancy. The limited data available would seem to suggest that this type of intervention can often be helpful in as little as two sessions, and a non-drug treatment option for pain is always a good option to consider. For women who are able to find relief of their back pain with these sessions, pregnancy can often be much more enjoyable. Constant contraction of the piriformis and iliopsoas muscles occurs during the new position of the spine during pregnancy, and adjustments that focus on relaxation of these areas have been shown to improve pain in some cases. If you do book a treatment, be sure your chiropractor avoids unnecessary pressure to your abdomen.
Fortunately, the joint laxity we talked about above can actually make adjustments easier than usual, so if you decide to go for it, your chiropractor may be more likely to achieve the desired effects. That being said, be sure to discuss your specific pregnancy conditions and concerns with your doctor before scheduling an adjustment (these sessions may not be safe in some scenarios), and if you think you are in labor, that your water has broken, or that you’re having vaginal bleeding, the definitely seek out your ob/gyn first.
Hopefully, you’ll be one of the lucky moms who avoids any significant back pain in pregnancy, but if not, then you could certainly consider the options listed above. Good luck, and remember that even if back pain makes your pregnancy seem like it takes forever, once your little one here, it will totally be worth it. In fact, after seeing how cute your little guy or girl is, you may even want to do it again :)
Dr. Nick
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