What if You're Pregnant?
Chiropractic and
Pregnancy
By Sanford Skolnik, D.C.
There are several changes that take place to the woman's musculoskeletal system
in pregnancy.
The more observable of these involves posture.
There are primarily four (4) postural changes that occur in pregnancy. First,
there is an increasing lumbar lordosis (the normal, gentle curve to the low
back) and shifting of the center of gravity towards the back over the lower
legs. Secondly, the sacrum (the bone between the hips) angle of attachment
becomes increased. There is an increased mobility of the sacroiliac,
sacrococcygeal, and pubic joints that therefore lead to an alteration of gait.
There is an alteration in the feet, including turning outward, flattening of
the arches, and a shift of weight bearing toward the heel
leading to muscle imbalance, weakness, and compromised coordination.
In a pregnant patient, the Sacro-Iliac joint becomes very unstable. Some of the
findings associated with this instability are: pain and tenderness to palpation
along the sacroiliac joint; most often unilateral, but may be bilateral. This
may be accompanied by palpable swelling and fluid distention of the joint
between the hips. There is a decreased lumbar range of motion. There is
tenderness at the lateral aspect of the posterior superior iliac spine (PSIS)
at the attachment of the piriformis muscle. This is the same muscle that
becomes sore and tender with excessive exercise like a stair master.
Pain and tenderness along the iliac crest at the attachment of the gluteus
maximus muscle is common. Tenderness is also common at the greater trochanter
at the insertion of the gluteal muscles, and in the belly of the piriformis
muscle (this is along the buttocks and to the back of the thigh).
There is spasm of the erector spinae of the side of the posterior ilium. Spasm,
or decreased tone, or involvement of the posas muscle on the side of the
gluteal irritation. Commonly, there are symptoms such as pain when rising from
seated position, pain and spasm while turning over in bed, inability to place
weight on the lower extremity on the side of sacroiliac involvement, etc.
Additionally, there is irritation, sensitization or frank inflammation of the
sciatic nerve as it passes under or through the piriformis.
What happens to the lumbar spine during pregnancy and how does it present?
As the pregnancy progresses, there is increasing weight added to the anterior
of the pelvis. In order to maintain more stable and evenly distributed weight
bearing structure, the lumbar spine becomes ever increasingly more
lordotic. This, however, places an ever increasing load of weight bearing
on the posterior elements (facets) of the spine. This imbalance combined with
the stretching of the abdominal muscles sets the stage for lumbar strain and a
bilaterally, anteriorly, rotated pelvis.
What happens to the thoracic spine during pregnancy and how does it present?
The weight of the breasts, widening of the angle that the ribs attach and
pressure on the lower four to five ribs, viscero-somatic reflex from stressed
organs such as the stomach, liver and pancreas, and thereby responsively
increasing the lumbar lordosis.
The psychological changes that occur with pregnancy are either due to normal or
biomechanical changes. The changes that occur due to progesterone or a decrease
in smooth muscle and vascular tone, increase in fat storage, temperature, and
development of the breasts for nursing. Changes in estrogen levels cause
significant alterations in the connective tissue, control and function of the
uterus, growth and regulation of the fetus.
There are primarily three neurological conditions that are associated with
pregnancy.
1. Meralgia parasthetica: Compression of the lateral,
femoral, cutaneous nerve as it passes
beneath the inguinal ligament. Pain
and most often paresthesia are seen in the lateral aspect
of the upper thigh.
2. Sciatic neuralgia: Compression of the lumbar plexus
resulting in pain in the pelvic region
and/or pain radiating down the leg.
3. Traumatic neuritis: Motor and sensory deficits of L5, S1
and S2 nerve roots after labor.
It may be a result of one or more of
the following:
disc
protrusion at IVD
traction of
lumbosacral trunk (forceps)
compression
of lumbosacral trunk by fetal head
compression
of popliteal nerve due to positioning
What types of techniques would work well on a pregnant patient?
I think that the more gentle, low force techniques (i.e. S.O.T., Activator,
Biophysics and Diversified) would be of greatest value to these patients
because of the ligamentous laxity induced by all of the hormonal and
biomechanical changes that the patient is experiencing. Lack of proper
equipment for the comfort of the pregnant patient are my primary concerns.
Last modified April 13, 2014 |