Chiropractic Care for Pregnancy-Related Back and Pelvic Pain | Podcast Ep. 243

Foreign. Welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with more research and it is a good one. We are talking management of low back and pelvic pain during pregnancy. And what type of effect can your care have for these women? Very impactful, very clinically relevant study that you're gonna wanna tune in for as we break it down and make it actionable for your practice. Before we get started, I'm gonna ask you as a listener, please leave us a rating or review on itunes if you have not done so yet. If you're listening on your iPhone, you can just scroll on down, tap how many stars you think this show earned and I would greatly appreciate it. That helps us reach more and more docs. We average about 10,000 downloads each and every week of this podcast, which is incredible. So thank you for tuning in and listening, but we always want to grow that audience, have more people understand the science of what we do as chiropractors. And one way that you can help me do that, very simply, very easily and for free, is to give us a rating or review on itunes. So I'd greatly appreciate it. But as we said at the top, we are talking research today and this is a study from the Journal of Advanced Nursing and this came out in January 2014. You could check out the episode notes, scroll on down there and head over if you want to check it out on PubMed. The title of the study is A Systematic review Investigating the effectiveness of complementary and alternative medicine for the management of low back and or pelvic pain in pregnancy. So a long title, bottom line is Systematic review Checking out the effectiveness of CAM treatment, Complementary and alternative medicine treatment for, for low back and or pelvic pain during pregnancy. So we now know that new research suggests that up to 1/3 of women use medications during pregnancy to manage low back and pelvic pain. Which is incredible because majority of the time, very, very rare exceptions, these are completely contraindicated during any of the three trimesters. And truth be told, there's also research showcasing that before, I guess, conception in a few months prior to that. It's also not a great idea to be taking heavy doses of NSAIDs or more aggressive pain type medication. So this startling statistic illustrates the need for more education and cooperative care between complementary providers and a woman's birth team. And my private practice actually had a significant portion of my private practice that was related to pregnancy care. Built a lot of fantastic relationships with midwives, doulas, obgyns, and this is just an area of opportunity within the evidence based chiropractor. Obviously we're all about building those B2B relationships, right? Bridging the gap and building relationships with medical doctors, quote unquote in your community. But as I always say, it's just easy to say medical doctors, we really extend that to paraprofessionals. Complementary. Who has your patients in their practice? Midwives, OB GYNs, doulas certainly do because these women don't have any other opportunity. Over 80% or more are going to have pregnancy related low back pain or pelvic pain and they really don't have any options. Imaging out the window, medications out the window, surgery out the window, injections out the window, and you as a chiropractor are bar none in terms of the research. In terms of what I've seen personally their best option a overwhelming majority of the time. And this is really gets down to quality of life we've seen and I'll to cite a paper that's gonna have an upcoming episode which really directs the fact of there's potential for impact on the birth process. I don't wanna overstate it, but just in the sheer management of pain. If a woman could get up and moving around during labor, that has a correlation to decreased labor time. It has a correlation to decreased interventions. If somebody's in pain, they're stressed out, they're not able to get up and move around, they're. That's a challenging situation. So don't take it for granted just like, oh, just like getting rid of low back pain during pregnancy. Yeah, it is a huge, huge deal. It can have a significant impact on the baby and the mother, their experience and ultimately the intervention rate. So don't take it for granted. This systematic review analyzed the data around complementary and alternative medicine strategies for women dealing with low back pain during pregnancy. They found that chiropractic care provides patients with clinically significant improvements in function and pain. A woman's ability to remain functional throughout pregnancy is super important as we know and has a potential to reduce future complications. So let's break out a couple facts from this study. We'll break out the facts, we'll break down what they mean and how you can utilize this information in your practice. These researchers found, quote, in light of the apparent frequent high use of medications in pregnancy for managing low back pain, many of which are not recommended during pregnancy, there is an urgent need to investigate the effectiveness of non pharmacological methods like CAM for managing this problem. Researchers also found, quote, it did report a clinically important improvement in function for 80% of the spinal manipulative therapy participants and 67% of the SMT participants for pain. So huge benefit for a majority of women in function, Huge benefit for a majority of women in pain reduction. Finally, they found, quote, the chiropractic study showed clinically important results following chiropractic treatment. Always really important to understand. Okay, there's data and then there's results, but is it statistically significant? And more importantly, is it clinically important? Is it clinically significant? Because that's really what it's all about, right? I mean, data is data, but we're talking about human beings living their life, dynamic bodies, challenges, stresses, you name it. So being able to have a clinically important result is very, very important. No pun intended. So let's break down this study, why it's so important, how you can utilize it to bridge the gap and build the relationships, and then we'll kind of take it from there. So we know statistically overwhelming majority of women are going to have low back or pelvic pain during pregnancy. Why is this the case? Multifactorial. There is a hormonal component to this, but it's biomechanical as a result of the hormonal component or biomechanical first, depending upon the timing. So as the baby and the fetus grow, we end up having a shifting of the center of gravity, the instantaneous axis of rotation. Anteriorly, of course, that creates a hyperloridosis. So it pulls forward, pulls anterior on that lumbar spine, creating a hyperlordosis. And then we see compensation up in the thoracic spine as well, as well as the cervical spine. So as the baby grows, as the pelvis is opening up, as relaxant's taking hold, and everything throughout the body is becoming, becoming more mobile. That's ultimately what creates the cascade of challenges for many women. When you get into a really a hyperlordotic spine, you can have a variety of things go on. Ultimately you can have, you know, facade issues. You could have disc irritation, you could have some potential slight reduction in the size of the IVFs. There's really a lot of different things that can go on. And then you add to it the fact that that hypolidosis is occurring due to stress, like, literally stress, weight pulling forward, baby growing and pulling things forward, and the pelvis tilting anteriorly. All of these biomechanical changes create, at the bare minimum, changes in dynamic load to the lumbar spine, and in a majority of women, increase Stress and load on the lumbar spine. And I always think about it like man depending upon when a woman gets pregnant, whether they're 20, whether they're 30, whether they're 35, they've lived all of these years not with those biomechanics. And for like one year of their life, nine months of their life, the biomechanics of a woman changes dramatically. The baby's born and then things go back to as close to normal as possible. That's a lot of dynamic change in a very, very short period of time. So when that's the case, we see a lot of these cascading effects of low back pain. And many women, while the birth process can be fun and it's exciting, it's also stressful, right? So there's a mental component of stress, there's a body biomechanical component of load and load change, and all of that affects how a woman moves. And this is really, really important because it gets down to what I consider to be a core tenet of chiropractic, which is movement, segmental movement, regional movement, whole body movement. Facilitating proper movement or as biomechanically sound movement as possible throughout pregnancy is a really important job of a chiropractor. How can you keep somebody functional and as pain free as possible throughout the time of dynamic change? That's a complicated tightrope to walk, right? Their body is gonna continue to change until that baby's born. And then actually once the baby's born, the body's gonna continue to change, getting back to the pre labor type of state or pre pregnancy state. So there's a lot of change happening in about a 12 month window. And that change is dynamic and ongoing. So understanding that working with these mothers and, and helping them remain functional and pain free, incredibly important part of the birth process. And you are incredibly important part of the birth team. But for a lot of docs, you know, I think we're underserving the pregnant market because in my opinion, when we look at 80% plus of women experiencing pain that really don't have any other great options except for live with it, that's not a great option. So getting out there, talking about studies like this, bridging the gap with other healthcare providers, again, midwives, doulas, you name it, OB GYNs, I've worked with all types of birth providers and many of them incidentally have been very, very open to working with chiropractors in a way that maybe some other specialists are not. And that's a really important point. As well. If you're new to bridging the gap and building relationships, it's a great starting place because sometimes, you know, there can be a competitive aspect. I don't think there should be, but. But in real life there is. If you're going into a pain management doctor's office, you're going into a surgeon's office. Less so on the primary care side. But when we're talking about becoming a part of a woman's birth team, there tends to be very, very little friction. Now, of course, the OB gyn, if they've never worked with a chiropractor before, they're going to be very interested in safety and what you're doing. Those are going to be parts of what you go through during your conversation. But showcasing research like this really puts your best foot forward. It showcases through the literature exactly what's going on with the results that people have got with chiropractic care. The safety, the efficacy, you name it. There's a lot of opportunity to showcase who you are and what you do through the research. And in light of that, we recently put together a specialty series of research briefs for all of our members of the Evans based chiropractor that do focus on birth. So we put together a specialty series of 10 research briefs specifically devoted to to pregnancy care. So, 10 research briefs. 1, 2, 3, 4, 5, 6, 9, 10. They cover a variety of different years and a variety of different angles on the results and efficacy of chiropractic care during pregnancy. I think it's extremely powerful, these 10 research briefs. There's no question that when you get these research briefs out in a cadence one time a month, one time a month, and you're dripping this information on the midwives, doulas and obgyns in your area, there is just no question that it has the potential to make a big impact, generate a ton of referrals for your practice and also help out a tremendous amount of women in your community, which is really what it's all about going through the birth process. As we talked about, super exciting time. It's a pivotal time for many women's lives. None, very few, let's put it this way, should be bedridden the last few months with low back pain, with pelvic pain, and with inability to function. There are options out there. That option is you 99 of the time, I'm gonna say. So get out there, talk about this research, showcase it to your patients, showcase it to the other healthcare providers, showcase it to your audience and health tribe on Facebook. Let people know who you are, what you're about and how you can help them and your practice will grow. Make it a great week in practice and I'll talk to you soon.

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