Dr Sam Fitzgibbons, Principal Chiropractor; Moorooka Chiropractic Centre
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At Moorooka Chiropractic Centre on Brisbane’s southside, we see many pregnant women with back and pelvic aches. If you're dealing with them, you're far from alone, and you may be wondering whether chiropractic care during pregnancy is an option. In this article, Dr Sam Fitzgibbons explains what tends to cause these aches, what an appointment involves, what the research does and doesn't show, and when to check with your GP or midwife first.
Common back and pelvic aches in pregnancy
A large Cochrane review found that more than two-thirds of pregnant women experience low back pain and almost one in five experience pelvic pain. The pain often increases as pregnancy progresses and can interfere with work, daily activities and sleep [1].
Typical patterns include:
- Low back pain: an ache across the lower back, often worse after long periods of standing, sitting or walking.
- Pelvic girdle pain: pain deep in the buttocks, at the back of the pelvis or at the pubic bone at the front. It is often noticed when rolling over in bed, climbing stairs or standing on one leg.
- Mid-back pain: an ache between the shoulder blades or around the ribs.
Researchers don't fully understand why these aches happen. Changes in posture and body shape, hormonal changes that affect ligaments, and a past history of back pain may all play a part [2].
What to expect at your chiropractic appointment during your pregnancy
1. Assessment.
We start by talking with you: how far along you are, how your pregnancy is going, who is looking after you (GP, midwife or obstetrician), your medical history, and what your pain is like and what makes it better or worse.
The physical examination is adapted to pregnancy. We use seated, standing or side-lying positions, avoid long periods lying flat on your back or tummy, and use pillows or pregnancy cushions for comfort. We also check whether your symptoms look like they are coming from your muscles and joints or whether they need to be looked at by your GP or midwife instead.
2. Care.
What we recommend depends on you. It may include gentle hands-on techniques for the muscles and joints of your back and pelvis, advice on posture, sleeping positions, lifting and daily activities, and exercises.
We may also talk about supports such as a pelvic belt, finding the right pillows or cushions, and seat wedges.
Techniques are modified for your stage of pregnancy and comfort, and you can ask us to stop or change anything at any time. If we are considering a technique such as spinal manipulation (chiropractic adjustment), we will explain it first and only go ahead with your consent.
What the evidence says about chiropractic care in pregnancy
Research on treatments for pregnancy-related back and pelvic pain is still developing, and no treatment can guarantee results. What the research does show is encouraging enough that a conservative, hands-on approach is worth considering for many women.
A Cochrane review of trials in pregnant women found that physiotherapy, osteopathic manipulation, acupuncture, exercise and multi-part programs appeared to relieve back or pelvic pain somewhat more than usual antenatal care alone. The effects were modest and the evidence was mostly of low to moderate quality, but the overall direction favoured active, drug-free options [3].
Research on chiropractic care in pregnancy is smaller. A systematic review found the evidence for spinal manipulative therapy to be limited [2], with few well-designed randomised trials and much of the evidence coming from case studies [4]. That’s why we usually take a multi-modal approach, combining chiropractic adjustments with exercise and ergonomic advice. Multi-part programs were among those that appeared helpful in the wider research [3].
On safety, reviews of published reports have found only a small number of adverse events following spinal manipulation in pregnant and postpartum women: one serious case involving the neck and a handful of minor, short-lived low back reactions. The authors concluded that evidence of harm is limited and that serious injuries may be rare, while calling for better reporting [4, 5]. This is reassuring, but it isn’t a guarantee, and some people feel temporarily sore after treatment.
Spinal manipulation is also well supported for low back pain in the general population. On that basis, the authors of one systematic review suggested it is reasonable to consider a trial of manipulative therapy for back pain in an uncomplicated pregnancy, even though pregnancy-specific research is small. They also noted that the forces involved appear to sit within the body’s normal physiological ranges, so these techniques are unlikely to be a concern in uncomplicated pregnancies [2]. Every pregnancy is different, so we’ll always check that this is suitable for you, and your GP or midwife can advise if you have any concerns.
When to check with your GP or midwife first before booking a chiropractic appointment
Please speak with your GP, midwife or obstetrician before booking if:
- you have been told your pregnancy needs extra monitoring or that you should limit your activity;
- you have had bleeding, placenta problems, high blood pressure or threatened early labour in this pregnancy;
- your back or pelvic pain is new, severe or getting worse quickly.
Seek urgent medical advice (contact your midwife, maternity unit or GP straight away, or call 000 in an emergency) if you have:
- vaginal bleeding or a leak of fluid;
- regular tightening or cramping that comes and goes, especially before 37 weeks;
- reduced baby movements;
- a severe headache with vision changes, or sudden swelling of your face or hands;
- fever, burning when passing urine, or pain in the sides of your back;
- a painful, swollen or red calf, chest pain or shortness of breath;
- numbness around the groin or inner thighs, new bladder or bowel difficulties, or new leg weakness;
- severe, constant pain that doesn't ease with rest or a change of position.
These can be signs of problems that are not musculoskeletal and need medical assessment rather than chiropractic care.
Back or pelvic aches in pregnancy? Book an appointment at Moorooka Chiropractic Centre, 168 Beaudesert Road, or call 07 3848 8526. Let us know how far along you are when you book.
Frequently asked questions
| Is chiropractic care safe during pregnancy? | The available evidence suggests serious problems are rare, but the research is limited. That's why we screen carefully, adapt our assessment and techniques to pregnancy, and encourage you to check with your GP or midwife first if you have any pregnancy complications. |
| Which trimester can I start in? | Back and pelvic pain can occur at any stage of pregnancy. There is no single trimester you must wait for, and what's appropriate depends on your health and how your pregnancy is progressing. If you're unsure, ask your midwife or GP, and let us know how far along you are when you book. We often treat pregnant women from the first trimester all the way through the third, after birth, and beyond as their body continues to change after pregnancy. |
| How many visits will I need? | There is no set number. It depends on your symptoms and how you respond. We usually review after the first few visits to see whether things are changing. If they aren't, we'll talk with you about changing the approach or referring you on. We aim to provide only the care you need, and we'll tell you when more visits aren't helping. |
| Should I tell my midwife or GP? | Yes. We encourage you to let your midwife or GP know you're seeing us so that everyone involved in your care is on the same page. |
This article is general information only and isn't a substitute for personal medical advice. If you have questions about your own situation, please speak with a health professional.
References
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Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database of Systematic Reviews. 2015;(9):CD001139.
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Khorsan R, et al. Manipulative therapy for pregnancy and related conditions: a systematic review. Obstetrical & Gynecological Survey. 2009.
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Pennick V, Liddle SD. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database of Systematic Reviews. 2013;(8):CD001139.
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Weis CA, Stuber K, Murnaghan K, Wynd S. Adverse events from spinal manipulations in the pregnant and postpartum periods: a systematic review and update. Journal of the Canadian Chiropractic Association. 2021;65(1):32-49.
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Stuber K, Wynd S, Weis CA. Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature. Chiropractic & Manual Therapies. 2012;20:8.