Osteopathy may help relieve the stresses and strains on your body during pregnancy and after birth. It can also help with any discomfort that may arise from looking after the newborn.
A woman’s body undergoes changes during pregnancy. These changes include the softening of ligaments, weight increase and changes to posture. This can lead to additional pressure on joints in various parts of the body, including the spine or pelvis.
As a uterus grows, its increasing size and weight can put pressure on the pubis, tilting the pelvis forward and increasing the natural curve of the lumbar spine. This can cause postural compensations higher up in the spine and surrounding areas which can cause pain.
Hormones, especially relaxin, contribute to changes in the pelvis by allowing sacroiliac joints and the pubic symphysis to widen. Because of these alterations, muscles frequently work harder to add structural support which can contribute to the feeling of pain and stiffness and may also affect tissue circulation and lymphatic flow, leading to tissue congestion and swelling.
Common symptoms of pregnancy
Evidence from practice has informed osteopaths that common symptoms experienced by patients during pregnancy can vary to include;
Lower back pain and pelvic girdle pain
mid thoracic pain
pubic symphysis pain
indigestion and gastrointestinal reflux
hypertension
sacroiliac pain
carpal tunnel syndrome.
Is osteopathic treatment safe in pregnancy?
An osteopath is trained to screen for medical conditions and will take a careful case history with patients to allow for correct differential diagnosis of symptoms.
It is by no means uncommon for patients to experience complications of pregnancy which manifest as musculoskeletal symptoms, such as diabetes or thyroid problems, as well as being alert to symptoms of pre-eclampsia.
In these instances, the patient would be referred to their GP for further investigation, or to A&E; if deemed an emergency.
Are there any reasons osteopathy may not be suitable during pregnancy?
Although there are many benefits for pregnant women receiving osteopathic treatment during pregnancy, there are a number of contraindications that an osteopath would be aware of and screen for during the case history and again, any concerns would result in referral to the GP or to A&E.
Some of these include, but are not limited to;
placental abruption
ectopic pregnancy
distress of the fetus
preterm labour
undiagnosed vaginal bleeding
unstable vital signs of the pregnant mother
elevated maternal blood pressure
untreated venous thromboembolism or deep vein thrombosis
Pregnancy and back pain
One of the most frequently reported symptoms during pregnancy is low back pain, which has been described as occurring in in up to 70% of patients.
One study by Wang et al in 2004, reported that of 950 pregnant women with low back pain, 57% complained that their daily activities were adversely affected, 47% avoided certain activities, 31% avoided exercise and 11% had missed work. Challenges persist in the identification of safe, effective treatment options for pregnant women, not least because most pain medications are not recommended during pregnancy, which leaves few options for pain control.
Some females struggle with LBP in early pregnancy, when they have elevated levels of relaxin. Others report LBP later in pregnancy when the additional weight that they carry causes various stresses on muscles and ligaments in the body. LBP can be further complicated by injury to nerves around the lower back and pelvic areas which may result in burning or numbness in various areas of the body.
Treatment
Osteopathic treatment is a body-based treatment that offers a conservative, noninvasive option for relieving pregnancy-related LBP while increasing back-related function.
The alteration of normal biomechanics, accompanied by ligamentous strain, increased muscle tension, decreased range of motion and pain can be treated with a variety of osteopathic techniques, thereby increasing range of motion, improving tissue texture, and decreasing pain.
Evidence base
The evidence base relating to the use of manual therapies, including osteopathic techniques, for conditions specific to pregnant women, children and babies is in its infancy, but it is growing.
The conviction is that pregnancy-related lower back pain is a temporary and self-eliminating problem resulting in the fact that few women receive appropriate help. Still 25% of them suffer from post-birth and it may negatively affect their quality of life for months or even years. The complexity of this, as well as socio-economic consequences of chronic pain require adequate treatment introduced as early as possible.
Although studies of Osteopathic treatment for LBP in non-pregnant populations have provided sufficient evidence of safety and efficacy for the establishment of practice guidelines for the recommendation of Osteopathic treatment for general LBP, it was not known if osteopathic treatment would produce the same positive outcomes in pregnant women with LBP.
However a pilot study by Hensel, et al., in 2015 did find a slower progression of back pain amongst pregnant women when using osteopathic treatment
In 2016, the Promote (The Pregnancy Research on Osteopathic Manipulation Optimising Treatment Effects) study, based on that pilot study, investigated whether an osteopathic protocol would improve low back pain and functional status in the third trimester and whether this would reduce the incidence of certain complications of pregnancy, labor and delivery.
It was the largest RCT using OMT on pregnant women as a unique population. Treatments began during the participants’ 30th gestational week and a combination of gentle techniques were used, however the manipulations or ‘clicks’ were and are generally excluded from treatments to pregnant women due to the increasing ligamentous laxity that occurs in later pregnancy.
The results showed a slower rate of deterioration of pain and back-specific dysfunction during the third trimester with no higher incidences of common labor and/or delivery related complications.
It was concluded that in light of the limited safe options for controlling pain during pregnancy, osteopathic treatment appears to be safe and effective way to manage back pain and function during pregnancy and its implementation during prenatal care could have positive effects on both maternal and fetal well-being.
In addition to the positive, growing evidence base for osteopathic treatment of lower back pain in pregnancy, a recent study in 2017, by Sheraton et al, focused on pregnant women’s experience of receiving osteopathic care. In addition to relief from low back and pelvic pain associated with pregnancy, the women reported that osteopathic care provided both physical and mental health benefits during pregnancy, labour, and in the post-birth recovery period.
They chose osteopathic care because it was perceived as a gentle manual therapy and supportive of a natural approach to pregnancy and childbirth, that is, a pregnancy with minimal medical intervention.
In conclusion!
Lower back pain is a common complaint that is present throughout pregnancy. Osteopathic treatments offer an approach to assess the sources of pain and discomfort from physiological and anatomical changes by using the body’s ability to heal itself. Osteopathic medicine offers an option for women throughout pregnancy in aiding the alleviation of pain and discomfort throughout pregnancy. Osteopathic treatment does have contraindications for a number of conditions. For this reason, it is important to visit a licensed, skilled osteopath for evaluation and treatment. Osteopathy can be combined with other treatment options to help the pregnant patient experience a more comfortable pregnancy.
Hannah Marsh
Registered osteopath
M.Ost
GOsC 10422
References:
Aveyard, H., 2014. Doing a literature review in Health and Social Care: a practical guide, 3rd ed. Glasgow: Bell and Bain Ltd.
Field, T., Figueiredo, B., Hernandez, M., Miguel, R., Deeds, O. and Ascencio, A. 2008. Massage therapy reduces pain in pregnant women, alleviates prenatal depression in both parents and improves their relationships. Journal of Bodywork and Movement Therapy, 12(2), pp.146-150.
Hensel, K., Buchanan, S., Brown, S., Rodriguez, M. and Cruser, A. 2014. Pregnancy research on osteopathic manipulation optimizing treatment effects: the promote study. American Journal of Obstetrics and Gynecology, 1(9), pp. 212-215.
Hensel, K., Carnes, M. and Stoll, S. 2016. Pregnancy research on osteopathic manipulation optimizing treatment effects: the promote study protocol. The Journal of the American Osteopathic Association, 116(11), pp.716-724.
Licciardone, J., Buchanan, S., Hensel, K., King, H., Fulda, K. and Stoll, S. 2010. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomised control trial. American Journal of Obstetrics and Gynecology, 202(43), pp.1-8.
McNabb, M., Kimber, L., Haines, A. and McCourt, C. 2006. Does regular massage from late pregnancy to birth decrease maternal pain perception during labour and birth? – a feasibility study to investigate a programme of massage, controlled breathing, visualisation, from 36 weeks of pregnancy until birth. Complimentary Therapies in Clinical Practice, 12(3), pp.222-231.
Roland, M. and Morris, R. 1983. A study of the natural history of back pain: part 1, development of a reliable and sensitive measure of disability in low back pain. Spine, 8, pp.141-144.
Stratford, PW., Binkley, J., Solomon, P., Gill, C. and Finch, E. 1994. Assessing change over time in patients with low back pain. Physical Therapy, 74, pp. 528-533.
Starzec, M. and Truszczynska, A. 2017. Pregnancy-related lumbopelvic pain – treatment modalities. Postepy Rehabilitacji, 2, pp.69-78.
Stuber, K., Wynd, S. and Weis, C. 2012. Adverse events from spinal manipulation in the pregnant and postpartum periods – a critical review of the literature. Chiropractic and Manual Therapies, 20(8), DOI: 10.1186/2045-709X-20-8.
Comments