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regnancy should be a time sal ofthe cervical lordosis, a shift ofthe plumb it will pull the pelvis toward it (Anony-
of joy for the expectant line posteriorly and a change in the sacro- mous 2003).
mother. However, it's also coccygeal angle (Benizzi DiMarco 2003).
a virtually unparalleled period of rapid These changes in posture cause an increased Beyond Low Back Painthe Role of
change in one's morphology. The stresses load on the posterior aspects ofthe vertebral the Chiropractor in the Evaluation
placed on a human's anatomy and physi- column including the zygapophyseal joints; and Management of the
ology result in compensatory altered bio- intervertebral discs; supraspinous, intraspi- Pregnant Patient
mechanics and gait to perform even the nous and intertransverse ligaments along Besides low back pain, other conditions
'k^M^M\ n^ost basic activities of daily living. These with the ligamentum flavum and muscles that occur during pregnancy are within
| | _ 0 _ ^ changes to an individual often result in including the deep spinal muscles; the erec- a chiropractic scope of practice for man-
the onset of a myriad of musculoskeletal tors; the psoas and the muscles ofthe pelvis. agement or evaluation. These include peri-
issues that can develop during pregnancy. (Editor's Note: For a better understanding of pheral nerve entrapments, headaches, tran-
This article details the current expla- the psoas in relation to pregnancy, see "Birth- sient osteoporosis or osteonecrosis and pubic
nations of these changes as well as the ing Fear: The Iliopsoas Muscle," Midwifery Today,pain. Common nerve entrapments at the
potential role of chiropractic therapy for Issue 74.) In addition, anterior structures are carpal tunnel (median nerve) and the inguinal
the pregnant woman. not spared; stretching of the anterior longi- region (lateral femoral cutaneous nerve) lead
tudinal ligament also occurs, yielding spinal to carpal tunnel symptoms or meralgia pares-
Low Back Pain and Physiologic instability (Ibid). thetica (numbness in the outer thigh) respec-
Changes in the Pregnant Patient Although lumbar disc herniations are tively (Borg-Stein, Dugan and Gruber 2005).
Low back pain is a common complaint uncommon in pregnant women, they do Nerve entrapments during pregnancy can be
of the pregnant woman (Ritchie 2003). appear in approximately one of 10,000 attributed to hormonal changes causing pos-
Research has demonstrated that between cases of lumbosacral pain during preg- sible edema around a nerve, compression or
50% and 80% ofpregnant patients report low nancy (LaBan et al. 1995). Weight gain, traction to the nerve itself Edema around the
back pain (Skaggs et al. 2004), the majority coupled with the previously mentioned extensor pollicus brevis and abductor pollicus
when the mother is between 20 and 40 weeks hormonal and postural changes, alters bio- longus can cause DeQuervain's syndrome
pregnant (Kristiansson, Svrdsudd and von mechanics, which may contribute to disc (stenosing tenosynovitis) (Ibid).
Schoultz 1996). herniations. Weight gain further increases The pregnant patient also may present
An estimated 25% of women with low loads on the joints ofthe lumbar spine. A with headache. Melhado, Macial and Guer-
back pain during pregnancy have a severity weight gain of 20%, which is adequate, reiro (2007) found that the majority ofwomen
of pain categorized as temporarily disabling increases the load on the zygapophyseal with headaches during pregnancy presented
(Borg-Stein, Dugan and Gruber 2005). A joints by as much as 100% (Ritchie 2003). with migraine headaches, which the women
portion of this back pain can be attributed The morphology and biomechanical strain had prior to conception. Most disappeared
to the release ofthe hormones progesterone, on a pregnant woman are not unlike that by the second or third trimester (Melhado,
estrogen and relaxin during the beginning of the man with a pendulous protuber- Macial and Guerreiro 2007).
stages ofpregnancy (Borg-Stein, Dugan and ant abdomen or "beer belly." Differences Although rare, transient osteoporosis
Gruber 2005). These hormones primarily between the two would be, most notably, of the femoroacetabular joint can develop
cause decreased muscle tone, changes in con- the slow onset of weight in males and the during pregnancy. This condition presents
nective tissue integrity, retention of water lack of hormonally-induced ligamentous with weight-bearing hip pain, usually in
and laxity of ligaments. Ligamentous laxity laxity. An empirical comparison of these the third trimester (Borg-Stein, Dugan and
(looseness ofthe ligaments) in the pelvis can populations in terms of lordosis, stability Gruber 2005). The etiology for this condition
cause hypermobility ofthe pubic symphysis and response to intervention needs fur- is unknown (Ritchie 2003). A possibility of
or the sacroiliac joints, thus affecting lumbar ther study. osteonecrosis ofthe femoral head also exists.
spine stability (Bogduk 1997). This laxity, Another contribution to low back pain Causes for the condition are unknown, but
along with changes in posture, may be the in pregnant women is anterior pelvic rota- some theorize that the higher cortisol levels
main components of low back pain in the tion and subsequent muscle hypertonicity, combined with increased stress of the joint
pregnant population. Postural changes in the because pelvic rotation leads to increased from weight gain may be responsible (Cheng,
pregnant patient include: increased lumbar lumbar lordosis (Borg-Stein, Dugan and Burssens and Mulier 1982). Another hypoth-
lordosis (leading to shortened lumbar muscu- Gruber 2005). Asymmetrically taut ham- esis is that the higher levels of estrogen and
lature), increased sacral base angle, increased strings may also affect pelvic rotation. If progesterone along with increased intraos-
extremity pronation, possible transient rever- one side is more hypertonic than the other seous pressure may contribute to the devel-