Chiropractic Treatment of the Musculoskeletal System During Pregnancy

Bilgrai-Cohen KJournal Of The American Chiropractic AssociationMay 1997: 33-34, 90

Abstract: The childbearing year is a period of dynamic change and adaptation. Alterations occur in every system, including the musculoskeletal system. This article will discuss the major structural changes inherent in pregnancy, the goals of therapy and protocol for the major presenting complaints, including sacroiliac, lumbar and thoracic involvement Pregnancy is a time of profound change and adaptation. As early as 10-12 weeks after fertilization, increased estrogen and relaxin begin to affect the musculoskeletal system by causing the softening of ligaments and increased joint laxity. Compensation for the enlarging uterus, anteriorly, produces the need for the pregnant woman to lean back, thus increasing the lumbar lordosis shifting the center of gravity over the lower extremity. I point out the three joints in the ring (two SI joints and one pubic symphysis) and explain that hormonally, one or both of the SI joints has become softened and is less supportive than normal. The tender muscles and joint pain is the body’s response to this instability in the joints. A portion of my treatment of sacroiliac dysfunction occurs with the patient in the prone position. I accomplish this by using SOT-type blocks and pillows. Sacroiliac Involvement In the non-gravid state, the sacroiliac (SI) joint is very stable relative to the lumbosacral joint. However, during pregnancy, the ligamentous support to the SI joint is significantly relaxed. This is the most common presenting musculoskeletal complaint comprising 75-85 percent of women seen during pregnancy. A portion of my treatment of sacroiliac dysfunction occurs with the patient in the prone position. I accomplish this by using SOT-type blocks and pillows. Lumbopelvic treatment considerations focus on the pelvic block placement with the patient in a the prone position, sacral pumping into dural flexion on inhalation, adjust for bilateral AS ilium, and neurolymphatic drainage particularly over the sacrum. Thoracic techniques are also stressed in many ways during pregnancy due to enlargement and increased weight in the breasts, widening of the sub-costal angle and pressure on the lower four to five ribs, viscero-somatic reflex from stressed organs such as the stomach, liver and pancreas and response to increasing lordosis of the lumbar region.

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