Manipulative skills for the pregnant patient
Cascioli, V. and Webster, M. (2005) Manipulative skills for the pregnant patient. In: Byfield, D., (ed.) Chiropractic manipulative skills. Churchill Livingstone, United Kingdom, pp. 421-440.
Back and pelvic pain are common complaints suffered by women during pregnancy, with the reported incidence rate varying between 4% and 85%. The true rate is difficult to assess because of the lack of an exact clinical definition of pregnancy-related low back pain and the large variety of study designs (Albert, 2001). Weeks 20 to 28 of pregnancy however are the most frequently reported dates for the onset of back and pelvic pains (Fast et aI., 1987). The incidence of sacroiliac pain in 'women in week 30 of gestation is approximately 19%, and in week 33 of gestation 20.1% of women suffered from daily pain
arising from their pelvic joints. Studies looking at back and pelvic pain during pregnancy found that the majority (62.5%) of women suffering from pain experienced disappearance within 1 month after delivery, but in 8.6% of women the pain persisted at least 2 years after childbirth (Berg et al., 1988; Fast et al., 1987; Nygaard, 1996). Back pain intensity during pregnancy has been reported to average 4.3 on a 0-10 visual analogue scale, with a large variation in pain severity. The most intense pain being experienced around week 30 of pregnancy (Ostgaard, 1999).
It is important to keep in mind that the aetiology of low back pain during pregnancy is thought not to be primarily biomechanical, but rather the result of multiple complex factors. Altered biomechanics, however, are believed to play a significant role (Ostgaard et al., 1993).
Physically strenuous, work and previous back pain have been identified as risk factors for the development of back pain during pregnancy (Berg et al., 1988; Ostgaard and Andersson,1991). Back pain lasts longer, and the point prevalence of back pain in weeks 12, 24, 30 and 36 is three times higher, in the pregnant women who had back pain prior to pregnancy compared to pregnant women with no previous history of back pain (Ostgaard and Andersson, 1991). Women with a previous history of pregnancy tend to have an increased risk of back pain during subsequent pregnancies. Women below the age of 29 years of age also have a significantly increased risk of suffering from pregnancy-related back pain (Ostgaard and Andersson, 1991). The relative risk of experiencing back pain during labour is almost three times greater in ,vomen who suffered from back pain during the pregnancy (Diakow et aI., 1991). With respect to therapeutic intervention, pregnant women receiving manual manipulation experienced significantly less pain during labour than the group that did not and 84% receiving manipulative treatment reported relief of back pain during pregnancy (Diakow et aI., 1991). Mobilization techniques for low lumbar and sacral structures are also successful in significantly diminishing low back pain in pregnant women in their second or third trimester (MCIntyre and Broadhurst, 1996).
Therefore the relief of pain and discomfort as well as the maintenance of activities of daily living should be the primary goals in the manual treatment of the pregnant patient. Treatment should be individualized to the patient's particular presentation and needs to facilitate the patient's adaptation to the increasing and changing demands placed on the body and muscloskeletal system during pregnancy. Understanding the changes that take place during pregnancy is of paramount importance in allowing the chiropractor to determine how to treat a pregnant patient, what technique modifications may need to be made and which cases need referral to another healthcare provider.
|Publication Type:||Book Chapter|
|Copyright:||2005 Elsevier Ltd|
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