Chiropractic Management of Pregnancy-Related Lumbopelvic Pain: A Case Study
SOURCE: J Chiropractic Medicine 2016 (Jun); 15 (2): 129–133
Maria Bernard, BSc, GradDipChiro, GradCertChiroPaediatrics,
Peter Tuchin, BSc, GredDipChiro, OHS, PhD
Private Practice,
Sydney, Australia.
Associate Professor,
Department of Chiropractic Faculty Science,
Macquarie University,
Sydney, NSW, Australia.
OBJECTIVE: The purpose of this case report is to describe chiropractic management of a patient with pregnancy-related lumbopelvic pain.
CLINICAL FEATURES: A pregnant 35-year-old woman experienced insidious moderate to severe pregnancy-related lumbopelvic pain and leg pain at 32 weeks’ gestation. Pain limited her endurance capacity for walking and sitting. Clinical testing revealed a left sacroiliac joint functional disturbance and myofascial trigger points reproducing back and leg pain.
INTERVENTION AND OUTCOME: A diagnosis of pregnancy-related low back pain and pregnancy-related pelvic girdle pain was made. The patient was treated with chiropractic spinal manipulation, soft tissue therapy, exercises, and ergonomic advice in 13 visits over 6 weeks. She consulted her obstetrician for her weekly obstetric visits. At the end of treatment, her low back pain reduced from 7 to 2 on a 0-10 numeric pain scale rating. Functional activities reported such as walking, sitting, and traveling comfortably in a car had improved.
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CONCLUSION: This patient with pregnancy-related lumbopelvic pain improved in pain and function after chiropractic treatment and usual obstetric management.
KEYWORDS: Chiropractic; Low back pain; Manipulation; Pregnancy; Spinal
From the Full-Text Article:
Introduction
There are discrepancies to defining lumbopelvic pain in the pregnant population. [1, 2] Current terminology, pain topography, functional disabilities, and positive correlation of clinical testing have demarcated the classification of pregnancy-related lumbopelvic pain (PR LPP) into 2 subgroups:
pregnancy-related low back pain (PR LBP) and
pregnancy-related pelvic girdle pain (PR PGP). [2-4]
Careful observation of the clinical features of PR LPP can help distinguish the seriousness of the potential symptoms and prognosis. Pain has shown to influence pregnant women’s daily lives and the challenges they encounter concerning their physical, psychological, occupational, and social function. [1-8] Defining PR LPP is imperative for the early diagnosis and effective management of PR LPP to improve quality of life. [5] A recent prospective cross-sectional descriptive study [9] by midwives demonstrated that the majority of pregnant women agreed that “LPP was expected because of the pregnancy.” Only 25% recounted receiving any form of back treatment. In early pregnancy, women classified with combined low back pain and pelvic girdle pain exhibit the highest risk for persistent pain postpartum, functional disability, and recurrence of PR LPP in subsequent pregnancies. [5, 6, 10]
There is no “gold standard” for diagnosing PR LPP, [4, 10] and this diagnosis is dependent on assessing clinical features, including etiology and risk factors, symptoms and pain topography, functional disabilities, and positive results to provocation tests.
Etiology continues to be considered as unknown, [6] but some reported that trigger factors include hormones, [11] biomechanics, trauma, metabolic factors, inadequate motor control, and stress of the ligament structures. [2, 12, 13] Symptoms of PR LPP can begin as early as the first trimester or at any stage during the pregnancy. Risk factors for developing PR LPP are strongly related to a history of previous low back pain, previous trauma to the pelvis, multiparity, and a high work load. [5]
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