Is Spinal Manipulation Safe During Pregnancy? A Hamilton Osteopaths View

Summary

1. Yes but not for everybody

2. There are some neat benefits beyond pain management too

3. It is best to seek out somebody who specializes in the field of pregnancy so that they can identify anything of concern.

Pregnancy Osteopath Jess

Is back cracking safe during pregnancy?

Short answer, Yes. Long answer, also yes - but with a few caveats. What are the caveats? Well the existing research that explores exactly this question is limited. What are the limitations? Put simply, there aren't enough studies in general, and the studies we do have are inconsistent in describing when something goes wrong, including exactly what happened and why. But that doesn't mean it is unsafe and issues are not been reported, in fact its probably quite the opposite. A recent review suggested that the reason we have such little data about these adverse events, is because adverse events are very un common - which makes it hard to collect data on them! In addition to that, most countries have a system for reporting adverse events, including nz! and these systems are used. Here is a link to this study -> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128327/ Another point to consider is that spinal manipulation during pregnancy is VERY common. We often manipulate pregnant ladies spines as osteopaths in Hamilton. As such, if adverse events were common, then I think we would be hearing about them. Especially in this time of social media. Nonetheless, you should do your due diligence and make sure your practitioner is familiar in working with pregnant bodies. A practitioner who 'knows what they are doing' is also more likely to pick up on other signs that your back or neck pain may be something more sinister, or if indeed you are they type of person who has a back that should not be cracked. This is also the type of practitioner that will be able to offer you more advice about your pregnancy in general.

If however, you are susceptible to miss carriages, have other health more serious health concerns, are in extreme pain, or just very apprehensive about having your back manipulated then it would be best to speak to your mid wife or GP first. Given there is a (low) risk, you may ask yourself if there are benefits to having spinal manipulation when pregnant, and if you don't want spinal manipulation what else can we do?

Benefits of spinal manipulation in pregnancy

The 2 main benefits would be pain relief and also relaxation of the pelvic floor. Plenty of people have written about how spinal manipulation helps ease pain, so I won't go into detail on that here. But if pain relief is what you are after then spinal manipulation is worth a go!. The effect of spinal manipulation on the pelvic floor is less often discussed but is super interesting. Spinal manipulation of pregnant women, particularly in their second trimester, appears to relax the pelvic floor muscles (PFMS) at rest. This relaxation of the PFMS muscles seen with spinal manipulation may mean that spinal manipulation could be of benefit to pregnant women’s vaginal delivery by aiding the relaxation of their PFMs if this does not occur naturally for them. No PFMS changes seem to occur post-manipulation in the nonpregnant woman; thus, the changes seen in the pregnant group may be due to the hormonal changes of pregnancy. This is based on an NZ study linked here https://pubmed.ncbi.nlm.nih.gov/27157677/

That is to say - Manipulating the sacroiliac joint (low low back joints) can improve the activation of the transversus abdominus muscle and of the abdominal oblique muscles (core muscles). Furthermore spinal manipulation relaxes their pelvic floor muscles, which could aid vaginal delivery.

Alternatives to spinal manipulation during pregnancy

If you don't want to try spinal manipulation then we do have alternatives. Our Hamilton osteopaths at TLC are considered 'pregnancy osteopaths'. As such, we have all taken extra time to develop the skills and knowledge that help pregnant woman. This includes myofascial release, acupuncture, Pilates exercises, various advanced massage techniques and even cupping (the list goes on). Of note, our osteopath Jess seldom feels the need to perform manipulation on pregnant ladies. But the pregnant ladies she treats still feel better from treatment and go on to birth their beautiful babies.

Pregnancy osteopath Tessa working on Jess (who was pregnant at the time of this photo but no body knew!)

A word from us

I'm not sure where in the world you are reading this, but the most important technique a practitioner has to offer is time. If that time is coupled with expertise then you are onto a winner! But, if that practitioner does not have the time, techniques and expertise that suit you, then its best to try somewhere else. We are osteopaths in Hamilton Nz. There is no official title for osteopaths that work with pregnant people, but 'pregnancy osteopaths' is something that we are informally referred to as. If you think we can help you, then please reach out, book online, or add a question below. We have several other blogs on pregnancy complaints like sciatica and we have also written about treating babies.

Written by Darryl Jenkins Hamilton Osteopath

Darryl Jenkins is a friendly Hamilton osteopath and co-owner of TLC Osteopaths. His formal qualifications include a undergraduate certificate in Exercise science from Wintec, a degree in Human Biology from Unitec, and a master's degree in osteopathy from Unitec, where he also completed his thesis on human movement assessment. He also holds a postgraduate certificate in acupuncture from AUT and would like to be pursuing the postgraduate certificate in Pain Science at Otago Uni (awaiting spouse approval).