Pregnancy & Osteo.

Pregnancy can bring about various musculoskeletal complaints due to the physical changes and hormonal fluctuations that occur in a woman's body. Here are some common musculoskeletal complaints during pregnancy:

Back pain: This is one of the most prevalent complaints during pregnancy. The weight gain and shift in the center of gravity can strain the lower back, upper back or neck, leading to discomfort or pain.

Pelvic girdle pain (PGP): PGP encompasses pain in the pelvic region, including the sacroiliac joints and symphysis pubis. It can cause pain during walking, climbing stairs, or even changing positions.

Round ligament pain: The round ligaments support the uterus, and as it expands during pregnancy, these ligaments can stretch and cause sharp, shooting pains in the lower abdomen or groin area.

Carpal tunnel syndrome (CTS): Some pregnant women may experience CTS, characterized by numbness, tingling, or pain in the hands and fingers. It occurs due to fluid retention and swelling, which can compress the median nerve in the wrist (Padua et al, 2010).

Leg cramps: Pregnant women may experience painful cramps, often in the calves or feet, which can be caused by changes in circulation, mineral imbalances, or compression of nerves.

Sciatica: Pressure on the sciatic nerve can lead to sciatica during pregnancy, resulting in sharp or shooting pain that radiates from the lower back down the leg.

Postural changes: As the baby grows, a woman's posture can alter, leading to changes in gait and centre of mass (Ogamba et al, 2017).

There are many ways to assist with the Management of Musculoskeletal Complaints during Pregnancy, these might be:

• Regular exercise, especially those that strengthen the core and pelvic floor muscles.

• Applying heat or cold packs to alleviate pain short-term

• Lifestyle modifications but not limited to regular movement, supportive footwear, use of pillows as support when sleeping and braces/ supports.

• Seeking professional help, such as an Osteopath

  It's important to consult with a healthcare provider to determine the cause of musculoskeletal complaints and to receive personalized advice and treatment options based on your specific situation.

What Does The Evidence Say?

• ‘Results showed an effectiveness of osteopathic care in gynaecology and obstetrics, but the studies were too heterogeneous to perform quantitative analysis and make clinical recommendations. Nevertheless, limited evidence suggests that osteopathic care is safe when complementary to traditional gynaecological care.’ (Ruffini Et al 2020)

• ‘Motor control exercises, when combined with other musculoskeletal therapies (such as manipulation, manual joint mobilisation, massage, exercise), may decrease short term pain and disability, especially in peripartum females’ (Mapinduzi et al 2021)

• ‘This review suggests Osteopathic Manipulative Treatment produces clinically relevant benefits for pregnant or postpartum women with LBP. Further research may change estimates of effect, and larger, high-quality randomized controlled trials with robust comparison groups are recommended (Franke et al 2017)

• ‘The application of Osteopathic Manual Manipationl is generally underused and overlooked in the management of CTS. Although there are multiple causes of CTS, using OMM (ie, osteopathic structural examination and OMT) in the diagnosis and management of CTS may ultimately prevent or delay surgical intervention in patients with this condition ( Sis et al, 2017)

• ‘Compared with not exercising, prenatal exercise decreased the severity of LBP, PGP or LBPP during and following pregnancy but did not decrease the odds of any of these conditions at any time point’ (Davenport et al, 2019)

References:

Davenport, M. H., Marchand, A. A., Mottola, M. F., Poitras, V. J., Gray, C. E., Jaramillo Garcia, A., Barrowman, N., Sobierajski, F., James, M., Meah, V. L., Skow, R. J., Riske, L., Nuspl, M., Nagpal, T. S., Courbalay, A., Slater, L. G., Adamo, K. B., Davies, G. A., Barakat, R., & Ruchat, S. M. (2019). Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. British journal of sports medicine, 53(2), 90–98. https://doi.org/10.1136/bjsports-2018-099400

Franke H et al. 2017. Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: A systematic review and meta-analysis. Journal of Bodywork and Movement Therapies Vol 21 Issue 4, pp752-762

Mapinduzi J et al. 2021. Effectiveness of motor control exercises versus other musculoskeletal therapies in patients with pelvic girdle pain of sacroiliac joint origin: A systematic review with meta-analysis of randomized controlled trials. J Back MSK Rehabilitation Dec 14. doi: 10.3233/BMR-210108

Ruffini, N., D'Alessandro, G., Pimpinella, A., Galli, M., Galeotti, T., Cerritelli, F., & Tramontano, M. (2022). The Role of Osteopathic Care in Gynaecology and Obstetrics: An Updated Systematic Review. Healthcare (Basel, Switzerland), 10(8), 1566. https://doi.org/10.3390/healthcare10081566

Padua, L., Pasquale, A. D., Pazzaglia, C., Liotta, G. A., Librante, A., & Mondelli, M. (2010). Systematic review of pregnancy-related carpal tunnel syndrome. Muscle & Nerve, 42(5), 697–702. doi:10.1002/mus.21910 

Ogamba, M. I., Loverro, K. L., Laudicina, N. M., Gill, S. V., & Lewis, C. L. (2016). Changes in Gait with Anteriorly Added Mass: A Pregnancy Simulation Study. Journal of applied biomechanics, 32(4), 379–387. https://doi.org/10.1123/jab.2015-0178

Siu, G., Jaffe, J., Rafique, M. & Weinik, M. (2012). Osteopathic Manipulative Medicine for Carpal Tunnel Syndrome. Journal of Osteopathic Medicine, 112(3), 127-139. https://doi.org/10.7556/jaoa.2012.112.3.127.

Wallace S et al. 2019. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin. Obstet Gynecol. Dec; 31(6): 485-493