One of the most commonly reported symptoms during pregnancy is lumbar pain, affecting 50% to 82% of pregnant women. Back pain and pain described as sciatica are the most common symptoms reported to osteopaths. Symptoms that may also occur in women during pregnancy include indigestion and gastrointestinal reflux, hypertension, sacroiliac pain, and carpal tunnel syndrome. An accurate history is essential for a proper differential diagnosis of symptoms. It is not uncommon for patients to have musculoskeletal symptoms. Symptoms that may herald the condition of pre-epilepsy should not be underestimated:
- Severe headache.
- Visual disturbances such as blurred vision or flashes in front of your eyes.
- Vomiting.
- Sudden swelling in your face, hands or feet.
- Severe pain just below the ribs.
The occurrence of gastrointestinal disorders is not uncommon during pregnancy. These may include nausea and vomiting, symptomatic gastroesophageal reflux disease, and the occurrence of constipation or exacerbation of chronic constipation. Carpal tunnel syndrome is a well-documented symptom in pregnancy. A careful differential diagnosis is essential, as carpal tunnel syndrome can also be associated with many other conditions, including diabetes and thyroid disease. Chest pain exacerbated by changes in connective tissue and increased breast weight are also commonly reported in osteopathic practice. The course of pregnancy and the hormonal changes associated with it can also have negative effects. Relaxin is one of the hormones that affect the musculoskeletal system – it makes the tissues more elastic. In pregnant women, the arches of the feet may lower, their stiffness may decrease and the foot may lengthen, which negatively affects its mechanics. Foot problems may persist until the end of breastfeeding (1-3).
Pregnancy brings dramatic changes to the musculoskeletal system that alter normal biomechanics, with ligament tension, increased muscle tone, and decreased range of motion causing pain. Manipulative osteopathic treatment (OMT) addresses somatic dysfunction using a variety of techniques to increase range of motion, improve tissue structure and reduce pain. Osteopathic treatment typically includes soft tissue therapy, myofascial release, muscle energy techniques and mobilization. High velocity, low amplitude manipulations tend to be excluded in pregnant women due to the possible theoretical risk of increased ligament laxity. The use of cranial techniques may also be excluded due to the theoretical risk of labor induction (4).
Grzegorz Jędrzejewski
References:
- Lavelle JM. Osteopathic manipulative treatment in pregnant women. J Am Osteopath Assoc. czerwiec 2012;112(6):343–6.
- D’Alessandro G, Cerritelli F, Cortelli P. Sensitization and Interoception as Key Neurological Concepts in Osteopathy and Other Manual Medicines. Front Neurosci. 2016;10:100.
- Franke H, Franke JD, Belz S, Fryer G. Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: A systematic review and meta-analysis. J Bodyw Mov Ther. październik 2017;21(4):752–62.
- HENSEL KL, BUCHANAN S, BROWN SK, RODRIGUEZ M, CRUSER des A. Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects: The PROMOTE Study A Randomized Controlled Trial. Am J Obstet Gynecol. styczeń 2015;212(1):108.e1-108.e9.
