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Many women experience back pain and instability during their pregnancies as their bodies change to accommodate the growing fetus. Chiropractic treatment is one of several manual therapies that may be used to address these issues and offer some relief without the use of medication, but there is little research to support its efficacy.
While the medical community generally regards chiropractic treatment during pregnancy as safe because adverse outcomes are rare, it’s hard to quantify the benefits because there isn’t a lot of compelling research [*].
However, there are some encouraging studies that suggest that chiropractic treatment may help relieve musculoskeletal pain, mitigate the need for a c-section, help control nausea, or relax stressed muscles that may be causing less space for the fetus – a condition known as intrauterine constraint [*][*].
Your care team may tell you that it’s okay to see a chiropractor while pregnant, but should you? It depends.
Pregnancy puts a major strain on a woman’s body. Lower back and pelvic girdle pain is more common than not in pregnancy, occurring in 50-85% of women [*]. While the exact cause is unknown, it is thought to be the result of changes to posture, musculoskeletal structures, hormones, metabolic factors, and stress on ligaments.
If you’re pregnant, you may already have begun to experience some unpleasant and unfamiliar side effects of the increased blood volume, added weight you’re carrying, and the hormones that help your body expand to accommodate the fetus.
If you are suffering from musculoskeletal pain or muscle tension, chiropractic treatment with a chiropractor experienced in treating pregnant women may help. And you don’t need to wait until you’re bursting at the seams in your third trimester to take advantage of chiropractic treatment.
Chiropractic treatment involves spinal manipulative therapy, soft tissue massage, mobilizations, and exercises to help correct imbalances in the musculoskeletal structures of your body. It may also include specific protocols such as the Webster technique, if your DC is certified in it, which is designed to help ease intrauterine restriction.
You’ll be fully clothed in loose clothing and lying on a table that is made to accommodate pregnant women. Your chiropractor will help you perform certain movements, like bending your feet up toward your buttocks, to evaluate your pelvic alignment and discuss any symptoms you have with you.
Dr. George M. Nicolopoulos, a Chicago chiropractor, works frequently with pregnant women and is certified in the Webster technique. While each client is different, he commonly sees ailments such as these in pregnant clients at each stage of pregnancy [*]:
“Early in the first trimester, we'll see a lot of patients who have headaches and muscle tension just simply due to the increase in blood volume,” he says. Making blood for two can make muscles more swollen and tight around the base of the skull, leading to headaches, he explains.
At the same time, DCs trained to treat pregnant women should be aware that not all headaches in pregnancy arise from muscle tension. “Patients will often say, ‘My OB says I'm fine,’ and then they come in with blistering headaches and migraines and things that they think are normal in pregnancy that could be signs of more severe issues.”
In the second trimester, the increase in breast tissue can lead to upper back pain, tightness, and tension. “Second trimester and third trimester is about putting on mass on the fetus, which tends to mean that there's a lot of weight gain, a lot of tension, a lot of pain with that. So we do a lot of mobility work during that time,” Dr. Nicolopoulos says.
Patients presenting with pain in the second trimester may benefit from working with a massage therapist to help with lymph drainage and fluid buildup and keep muscles as hydrated and unconstricted as possible.
“From my perspective, chiropractic care during pregnancy is less about manipulation of the spine and more about getting the muscles moving in a way that is less painful for the pregnant woman.”
The third trimester can be a particularly stressful time for the mother’s body, as the hormone Relaxin is released to relax muscle and ligament tissue to allow the baby to pass through the pelvis. This can lead to pain and muscle fatigue as muscle tissue tightens to compensate for loosened and unstable joints which have the added burden of the weight gain needed to sustain the baby.
Sometimes the muscles tighten in a way that makes it impossible for the baby to move into the head-first position of a normal vaginal delivery. In these situations of intrauterine constraint, chiropractors trained in the Webster technique work to relax the abdominal tissue to allow room for the baby to flip itself into a cephalic position.
The Webster technique was developed in the 1980s and a certification program was launched in 2000. It may be a less risky alternative in breech presentations to ECV (external cephalic version), a procedure in which a healthcare professional such as a trained midwife or OBGYN places hands on your belly and tries to flip the baby manually. ECV works roughly 50% of the time. In rare instances, the baby may flip itself back into breech position [*].
While one study cited an 82% success rate for the Webster technique, the sample size was only 112 women – encouraging, but too small a population from which to draw firm conclusions [*].
Of the 42 pregnant clients Dr. Nicolopoulos has seen over the last decade, only three had to have a c-section delivery. That’s well below the average for c-sections in the U.S. today, which has climbed over recent years to nearly 1 in 3 women [*].
There isn’t a lot of quality research on the benefits of chiropractic care during pregnancy, but what there is suggests that it may [*][*]:
Another benefit derives from the fact that most pregnant clients see their chiropractor more than their OBGYN in the course of pregnancy. It may surprise you to learn that in 33 states, including Illinois, chiropractors are considered primary care physicians [*]. Many DCs may recognize red flag symptoms of a more serious complication that the client's care team has missed or hasn’t yet seen and encourage them to seek a diagnosis and treatment.
A study comparing standard obstetrics care to multimodal care including manual therapy, chiropractic treatment, and patient education found multimodal care to provide better outcomes in relieving low back and pelvic pain overall [*].
Adverse outcomes following spinal manipulation therapy during pregnancy range from a transient increase in pain to severe and life-threatening complications but these outcomes are exceedingly rare [*][*][*].
It’s important to talk to your care team before seeking chiropractic care, especially if you have a high-risk pregnancy or a complication like placenta previa that might be exacerbated by physical manipulation.
If you experience symptoms such as vaginal bleeding, sharp abdominal pain or cramping, unusual swelling, numbness, vision changes, or blood pressure fluctuations, consult with your care team immediately — whether you have had chiropractic treatment or not.
This depends on your symptoms and if you are also doing beneficial exercises like yoga or swimming, physical therapy, or massage. Talk to your care team and your chiropractor to discuss what’s best for you.
For patients presenting symptoms in the first and second trimesters, a chiropractor may recommend once-a-week treatment. Late in the third trimester, if intrauterine constraint is presented, you may be treated as much as three times a week.
The research on postpartum benefits of chiropractic care is scarce and of low quality [*]. But if you found chiropractic care to be of benefit during your pregnancy, there’s no reason to think it wouldn’t help afterward.
However, depending on a chiropractor to correct your posture may not be the best solution in the long term. Ideally, as you adjust to your postpartum body, having to constantly lift your baby and breastfeed, you will want to relearn how to carry yourself in a manner that doesn’t cause you pain. To help prevent what is causing your pain and recapture your body’s proper alignment, you may want to look into a method like the Alexander Technique [*].
Chiropractic treatment may offer some relief from low back pain and pelvic pain while providing other key benefits during your pregnancy and labor.
Given that adverse outcomes are exceedingly rare, you may find it worth exploring if you’re in pain and your care team approves.
Be sure to work with a chiropractor who is Webster certified and experienced in the care of pregnant women, and look into physical therapy, massage therapy, and gentle exercise as well to mitigate the need for intervention.
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