Kan man behandla den gravida kvinnan med kiropraktik?
Under graviditeten har kvinnan en ökad risk att drabbas av mekaniska problem som kan vara smärtsamma och hindrar henne från normala aktiviteter. Behandling hos en kiropraktor (legitimerad och med godkänd utbildning) som har kompetens att behandla den gravida kvinnan är helt ofarlig. Man använder mjukare tekniker och tar hänsyn till båda fostret och mamman. Eftersom kroppen ändrar sig så dramatiskt under denna tid, mår kvinnorna normalt väldigt bra av behandling och kan fortsätta längre in i graviditeten med sitt arbete och vardagliga aktiviteter.
Spinal Manipulative Therapy deemed safe and effective for lumbar and pelvic pain on pregnancy in British Medical Journal
Low back pain is a common musculoskeletal symptom in pregnancy that can present as lumbar pain or pelvic girdle pain, with significant physical and psychosocial implications. Pelvic girdle pain is more prevalent and results in greater disability than lumbar pain. It is possible to distinguish between these two conditions from a detailed history based on the site of the pain, its intensity, disability and pain provocation tests. Management of low back and pelvic pain in pregnancy is conservative: for lumbar pain physical exercise is individualized while simultaneously minimizing activities that exacerbate pain, gentle manipulative techniques designed for the pregnant patient have good effect and are considered safe; for pelvic girdle pain, analgesics and bed rest pain are sometimes required. It is important to avoid abduction beyond the pain-free zone. There is evidence that gentle spinal manipulative therapy and pelvic belts can improve function in Daily Life. Stabilising exercises in patients with pelvic girdle pain postpartum have a beneficial effect. Other treatment modalities that have been shown to be safe and effective include pelvic belts, transcutaneous electrical nerve stimulation, spinal manipulative therapy, acupuncture and complementary therapy with yoga. Other orthopaedic complications in pregnancy such as carpal tunnel syndrome, pubic symphysis rupture, transient osteoporosis and osteonecrosis are usually self-limiting with a satisfactory outcome. However, a lack of awareness and failure to recognise these complications can result in long-term morbidity. Swedish studies have demonstrated that persistent pregnancy related lowback pain and pelvic girdle pain is a major individual and public health issue among women 14 months postpartum, negatively affecting their self-reported Health. Read article here>. Further Swedish studies indicate that pregnant women with lowback pain and/or pelvic girlde pain should be addressed early in pregnancy to reduce both individual suffering and the risk of transition into chronicity.Read article here>. The Swiss have studied specifically chiropractic treatment of the pregnant patient with lowback pain and found that most pregnant patients undergoing chiropractic treatment reported clinically relevant improvement at all time points.Read article here>.
The perinatal period increases the risk for complications with the cardiovascular system, therefore treatment during this time should only be performed by those with specialty education in pregnancy. Care for the cervical spine is modified by using more gentle techniques particular to avoid forceful rotary manuevers. Dr. Weber has published an article about this. See the reference below.
Bergström C, Persson M and Mogren I. 2016. Sick leave and healthcare utilisation in women reporting pregnancy related low back pain and/or pelvic girdle pain at 14 months postpartum. Chiropractic & Manual Therapies;24:7 DOI 10.1186/s12998-016-0088-9
Bergström C, Persson M, Mogren I. 2014 Pregnancy-related low back pain and pelvic girdle pain approximately 14 months after pregnancy – pain status, self-rated health and family situation. BMC Pregnancy and Childbirth;14:48 http://www.biomedcentral.com/1471-2393/14/48.
Bhardwaj A, Nagandla K. Postgrad Med J. 2014 Aug;90(1066):450-60. doi: 10.1136/postgradmedj-2013-132377. Spinal Manipulative Therapy deemed safe and effective for lumbar and pelvic pain on pregnancy in British Medical Journal.