Sciatica: A Real Pain In The Backside!

Sciatica is another constant companion of many a pregnant woman. Like indigestion, edema, and constant urination, sciatica tends to show up in the 2nd trimester. And like its companions it tends to stick around until the baby is born. The good news is that sciatica can be sent on its way rather quickly and leave you alone to deal with the indigestion, edema, and constant urination.

What is sciatica?

Sciatica is an often misused term. Many people say they have sciatica if they have any lower back pain. However, sciatica occurs when the sciatic nerve (the largest nerve in the body and the one that innervates the majority of the lower body) becomes pinched or irritated.

Sciatic pain follows a particular path from the lower back or hips and runs down the leg generally ending near the knee. Sciatic pain is often described as a burning pain or a pins and needles sensation. Numbness and tingling can occur as well. Sciatic pain makes it incredibly painful for a person to sit, stand, bend, or really do anything other than lay on their back.


Why is sciatica so often associated with pregnancy?

Sciatica in pregnancy is common for 2 reasons.

Hormones: Our good friend relaxin is just doing his job and is allowing the pelvis to become hyper-mobile. (Read previous post on relaxin.) Unfortunately the sciatic nerve is attached in the pelvis and becomes irritated with all the unaccustomed movement.

Structure: As the baby grows, the uterus grows and puts pressure on the sciatic nerves and its surroundings. This weight is pulled forward, which increases the arch of the back and can lead to pressure on the sciatic nerve.

What can be done to ease the pain?

Sciatica can cause even the toughest to break into tears. It can be debilitating and miserable, but it doesn't have to last. Although it is tempting to stay in bed, not moving a muscle and praying to feel better, recent studies have shown that this is ineffective and can actually prolong the agony.
Getting up and moving while painful, will ultimately help the sciatic nerve.

Home remedies:

• An ice pack applied for 10 minutes to the low back can help and is safe for pregnancy.
• Sleep or lie down on your side with a pillow between your legs and one in the small of your back.
• Try to stand as straight as possible and sit up straight.
• Avoid standing or sitting for extended periods of time.
• No heavy lifting.
  

Outside help:

• Chiropractic is one of the best and safest treatments for sciatica. Using a gentle, low-force adjustment a chiropractor can free the sciatic nerve and allow normal impulses to return. A majority of women feel relief after the first treatment, and all but the rarest case are feeling fine by the 2nd or 3rd visit.

• Some women find that acupuncture can really relieve the pain. It is believed to be safe for the baby and effective. Although it is great for pain relief, it does not correct the underlying structural problems causing sciatica, and it will return.

So, all you sciatica sufferers, get moving. Help your amazing body do its job without hurting you!

Can you turn breech babies?

Recently I have been getting the same question over and over . . . .
"Dr. Richards can you turn a breech baby?" Because this question comes up with alarming frequency I thought I would address it here. (Although this is not strictly a back pain related topic.)

First of all chiropractors do not and should not "turn babies". Turning a baby is a terribly painful and brutal practice. While some OBs may try to turn a baby, it is generally not successful and carries inherent risks, such as rupture of the placenta, injury to the baby, and early labor.
Once again, chiropractors do not turn babies.

Some of the confusion may lie in the fact that chiropractors often use a technique called the Webster Technique which was once known as the "Webster's Breech Turning Technique" due to the high frequency of babies turning following the technique.

What is the Webster Technique and how does it work?

The Webster Technique corrects intrauterine constraint, which occurs when the proper shape of the uterus in constricted due to tight ligaments, rotated sacrum, or other external forces. When intrauterine constraint is present it can keep the fetus from attaining the proper head-down birthing position, which leads most often to a cesarean section. In fact 13% of all cesarean sections in the US are due to breech positioning.

Performance of the Webster Technique begins by analysis of the relationship of the bones of the pelvis. Upon finding a restriction, a light force chiropractic adjustment of the sacrum corrects the restriction. The chiropractor will then analyze abdominal muscle tension or spasm and work to relax this tightening.

Does the Webster Technique work?

The Journal of Manipulative and Physiological Therapeutics reported in the July/August 2002 issue an 82% success rate of babies turning head down when doctors of chiropractic used the Webster Technique. Further, the results from the study suggest that it may be beneficial to perform the Webster Technique as early as the 8th month of pregnancy when a woman has a breech presentation.

To summarize, if you have a breech baby and are concerned about the possibility of a cesarean, the Webster Technique is a safe and effective treatment. To find a chiropractor near you who is certified in the Webster Technique follow this link.

Round Ligament Pain Relief

Today we are going to talk about one of the major irritants and complaints of pregnancy . . . . round ligament pain. Round ligament pain can range from uncomfortable to down-right painful. Generally, the pain is referred to as a brief, sharp, stabbing pain or a long lasting dull pain centered in the abdomen. Usually, this condition starts in the second trimester of your pregnancy

Many pregnant women experience round ligament pain initially when suddenly getting up from the bed, from the chair, when rolling over in your bed, whenever you cough, or when you get out of the bath tub. Most times you will experience a short, stabbing feeling (most commonly on the right side) that will quickly resolve, however some woman experience chronic pain.

Why do women get round ligament pain?

The round ligaments attach the front section of the uterus to the groin, and like muscles they can contract and release. However, unlike muscles they function slowly. During pregnancy these ligaments stretch well beyond their "norm". They then become apt to seize up or contract.

If you make any movements like changing the position quickly, coughing or laughing, then the ligaments become stretched, making them to contract very quickly. This can cause you to experience the pain, but the pain only exists for a few seconds. Some women have chronically tight ligaments and will have continual aching and dull pain in the abdomen.

Reducing round ligament pain

Anything that stretches these ligaments slowly and gradually will help alleviate pain. Therefore:

• Daily stretching exercises help a great deal. The most often prescribed exercise is performed by keeping your hands and knees on the floor, lowering the head to the floor and by placing the bottom in the air.

• Apply heat to the area to relieve from the pain. A warm bath will also give you some relief.

• If you know that you are going to sneeze, cough or laugh, slowly bend and flex your hips. This can greatly reduce the pull on these ligaments.

• Lie on the opposite side to alleviate the pain. Lie on your left side with a pillow under your belly for proper support and place another one in between the legs.

• If you are suffering from chronic round ligament pain or are having a them often, visit a chiropractor who can use a variety of ligament release techniques to get you out of pain.

The good news is that as your pregnancy progresses into the 3rd trimester, the pain usually decreases.

*Please note that if the pain exists more than few minutes, or is accompanied by any bleeding, chills, or nausea please t contact your doctor immediately.

What is relaxin?

If you are pregnant you are well aware of the surge of hormones that has taken over your body. As soon as a woman is pregnant hormones flood through her body, often leading an expectant mother to wonder what happened to her former self. Many pregnant women tell me about feeling happy one minute and weeping the next. Others are plagued with acne, reflux, and low energy levels. This hormone flood may produce side effects that a mom could do without, but they all play a very important role in the development of your baby.

However, one, often maligned, hormone is very specifically important to the health of the pregnant woman. It is relaxin. Relaxin is a hormone produced during pregnancy that allows the birth process by increasing collagen breakdown which in turn causes a softening and lengthening of the cervix and the pubic symphysis . It allows the baby to pass through the birth canal. This is a good thing for a pregnant woman.

Relaxin is a hormone that is always present in the female body, however during pregnancy, the hormone relaxin is present in 10 times its normal concentration. Unfortunately, relaxin also causes abnormal motion in many other joints of the body, causing inflammation and pain. Some people are more affected by relaxin than others for reasons we don't entirely understand. Those who experience significant pain due to loosening joints can get relief with the practices listed here.

Upon delivery the raging hormones gradually go back into hibernation and loosey-goosey joints tighten up again. Relaxin has allowed the human body to do something that seems impossible. (Birthing a baby.) So let's hear it for relaxin. It gets a bad rap, but is your best friend come delivery day!

Why hasn't my OB recommended chiropractic care?

There are a number of reasons that your obstetrician may not refer you to a chiropractor.

• Although countless studies have shown the safety and efficacy of chiropractic, many MD's don't understand chiropractic. Historically chiropractic has been viewed as "alternative health care" and doctors were skeptical about sending patients to chiropractors. Many fallacies still abound about chiropractic, but the medical community at large is beginning to see the value in cooperative care.
  
  
• Many MDs do not understand that the training involved in becoming a chiropractor is comparable to their own. They may not understand that a Doctor of Chiropractic is as skilled and as trained as any medical professional.
  

Subject		Chiropractic Schools			Medical Schools
		Hours	% of Total		Hours	% of Total
Anatomy		570	40		368	31
Biochemistry		150	11		120	10
Microbiology		120	8		120	10
Public Health		70	5		289	24
Pathology		205	14		162	14
Total Hours		1,420	100		1,200	100

• Finally, many MDs don't know a chiropractor to refer their patients to! (To find a chiropractor specializing in pregnancy click here.)
  

You don’t need anyone’s approval to seek a chiropractic opinion about health issues affecting you and your child. Consulting another health care expert is always helpful in the decision-making process. Most chiropractors work closely with other practitioners who keep up with the latest research and understand the value of this natural, drug-free approach to better health.

Decreased Labor Time with Chiropractic Care

Good news for those of you who have or fear long labors. Not only can chiropractic care ease symptoms during pregnancy, there is research that show it can ease delivery time and pain as well.
Research found that women who receive chiropractic care during pregnancy have approximately 6 fewer hours of labor than women who did not receive care.
According to a study by Irvin Hendryson, MD "visiting a chiropractor while being pregnant can help the expectent mother deliver the baby with more comfort." That's great news for mom and baby alike!


American Medical Association records released in 1987 during trial in U.S. District Court Northern Illinois Eastern Division, No. 76 C 3777

84% of Pregnant Women Get Back Pain Relief From Chiropractic

Here is a little gem of a study for those of you contemplating chiropractic treatment for your back pain or sciatica.

In a recent study 84% of patients receiving chiropractic manipulation reported relief of back pain during pregnancy. There was significantly less likelihood of back labor when spinal manipulative therapy was administered during pregnancy. ("Back pain during pregnancy and labor". Diakow PR, et al. Journal of Manipulative and Physiologic Therapeutics, 1991: 14(2): 116-118.)

Not only does chiropractic treatment bring relief of symptoms it also reduces the chance of "back labor" which as many of you know can be rather painful. Chiropractic is safe and effective and can help you feel better now and keep you from pain later.

Understanding Pelvic Pain in Pregnancy

One problem that many pregnant women complain about is pubic pain. Yet doctors and midwives often dismiss this pain as either 'inconsequential', 'unfixable', or 'just one of those pregnancy discomforts that have to be endured'. Occasionally, some uninformed doctors have even erroneously told women that such pubic pain means that they would need an elective cesarean section in order not to permanently damage that area during birth, or as a result of prior damage to the area.

Yet none of this is true. Pubic pain in pregnancy is certainly not 'inconsequential'; Although many doctors and midwives do not know what causes it or how to fix it, many women are able to get improvement or relief with chiropractic treatment or osteopathic manipulation. It is not something that you 'just have to live with'. And although extra care should be taken during labor and birth in order to prevent trauma, it absolutely does NOT mean that you 'have' to have a cesarean!

Although not every provider has a name for this condition, it is most commonly called Symphysis Pubis Dysfunction (or SPD), especially in Britain. Other names for it include: pubic shear (osteopathic term), symphyseal separation, pubic symphysis separation, separated symphysis, pelvic girdle relaxation of pregnancy, pelvic joint syndrome.

The symptoms of SPD vary from person to person, but almost all women who have it experience substantial pubic pain. Tenderness and pain down low in the front is common, but often this pain feels as if it's inside. The pubic area is generally very tender to the touch; many moms find it painful when the doctor or midwife pushes down on the pubic bone while measuring the uterus (fundal height).

Any activity that involves lifting one leg at a time or parting the legs tends to be particularly painful. Lifting the leg to put on clothes, getting out of a car, bending over, sitting down or getting up, walking up stairs, standing on one leg, lifting heavy objects, and walking in general tend to be difficult at times. Many women report that moving or turning over in bed is especially excruciating.

Many movements become difficult when the pubic symphysis area is affected. Although the greatest pain is associated with movements of lifting one leg or parting the legs, some women experience a 'freezing', where they get up out of bed and find it hard to get their bodies moving right away--the hip bone seems stuck in place and won't move at first. Or they describe having to wait for it to 'pop into place' before being able to walk. The range of hip movement is usually affected, and abduction of the hips especially painful. Many women also report sciatica when pubic pain is present. SPD can also also be associated with bladder dysfunction, especially when going from lying down (or squatting) to a standing position. Some women also feel a 'clicking' when they walk or shift just 'so', or lots of pressure down low near the pubic area.

Many women with SPED also report very strong round ligament pain (pulling or tearing feelings in the abdomen when rolling over, moving suddenly, sneezing, coughing, getting up, etc.). Some chiropractors feel that round ligament pain can be an early symptom of SPED problems, and indicate the need for adjustments. Other providers consider round ligament pain normal, part of the body adjusting to the growing uterus. If experienced with pubic and/or low back pain, it probably is associated with the SPED.

Indeed, although pubic pain often does go away after pregnancy, many women find that it sticks around afterward, usually diminished but still present. If treatment to resolve any underlying causes is not done, long-term pain usually sticks around. Anecdotally, this often seems to be associated with long-term low back pain or reduced flexibility in the hips. Even worse, if the mother is mishandled during the birth, the pubic symphysis can separate even more or be permanently damaged. This is called Diastasis Symphysis Pubis.

Although the best idea may be to resolve chronic SPD pain through realigning the pelvis girdle and soft tissues, most women have some residual pubic and low back discomfort sticking around during pregnancy and the early postpartum weeks because of hormones. Therefore, tips for coping with pubic pain tend to be a focus of many SPD websites.

Many of the suggestions include:

Use a pillow between your legs when sleeping; body pillows are a great investment!

Use a pillow under your 'bump' (pregnancy tummy) when sleeping

Keep your legs and hips as parallel/symmetrical as possible when moving or turning in bed

Some women also find it helpful to have their partners stabilize their hips and hold them 'together' when rolling over in bed or otherwise adjusting position

Some women report a waterbed mattress to be helpful

Swimming may help relieve pressure on the joint

Keep your legs close together and move symmetrically

When standing, stand symmetrically, with your weight evenly distributed through both legs

Sit down to get dressed, especially when putting on underwear or pants

Avoid 'straddle' movements

Swing your legs together as a unit when getting in and out of cars; use plastics or something smooth and slippery (like a garbage bag) on the car seat to help you enter car backwards and then turn your legs as a unit

An ice pack may feel soothing and help reduce inflammation in the pubic area

Move slowly and without sudden movements

Visit a chiropractor who has experience treating pregnant women.

taken from Symphysis Pubis Dysfunction
by Pamela Vireday
ICPA Newsletter Jan-Feb 2003

Pelvic Pain in Pregnancy

Pelvic pain during pregnancy is something that is often misunderstood by the medical community at large. The degree of pain is something that is often not addressed at all.
I became aware of the severity of pelvic pain when my wife was pregnant with our second child.

During the 2nd month of my wife’s pregnancy she began to complain about pain in her hips and pelvis when she rolled over in bed at night. She said it felt as if her bones were grinding together. I was a young, inexperienced student at that time and I told her I didn’t know how to help her.

She went to her OB multiple times over the next 3 months as the pain became debilitating. She walked as if she were an old woman, and used a wheelchair for situations that required a lot of movement. Her OB could only recommend Tylenol and told her she might want to try massage. Other than those suggestions she would just have to wait it out.

Now, my wife is not one to sit around and wait for anything, so she began her own research. She found a small blurb about something called Pubic Symphysis Disorder or PSD in a medical journal online; she then was able to find a support group for PSD in Great Britain. She emailed them and found out that this disorder is something that is just recently gaining attention in Great Britain and they sent her some literature. She was relieved when one of the first treatments mentioned was chiropractic care. (Did I mention I was a student and was somewhat MIA?)

My wife began chiropractic care and within a week was making great progress. Her pain levels went from a 10 to a 3 and she was able to tolerate the remainder of her pregnancy without too much discomfort. She moved like a different woman in a matter of weeks.

So now, thanks to my wife, I look like the hero when I tell pregnant women I know what is wrong with them and how to help them. She is the real hero.

Check back next week for details about PSD and its treatment, or email me directly at drrichards@abetterbrain.com.

New Office Space for Pregnant Moms

CT - June, 1 2008 - Dr. Jason B Richards of Keystone Chiropractic is making a move to better serve his patients. He recently expanded his office space to be able to accommodate mothers with small children and pregnant women.

Dr. Richards expanded Keystone Chiropractic office space in response to what he saw as a chronic problem. "Mothers are caught in a difficult dilemma. Medical offices are open during the hours when mothers are the sole caregiver. Mothers have to decide if they will get a sitter, chase their kids around an office, or not get care.To ease this problem Dr. Richards’ new office includes a treatment room just for mothers with small children. The room has a window cutout into a playroom for children. Mothers can talk to and see their children and the children can play with toys or watch movies. This allows mothers to relax without worry. "My patients love it" says Dr. Richards.

Dr. Richards hopes that his additions to his practice will help mothers make some healthier choices in their lives. He hopes that making chiropractic care easier will allow moms to be able to take care of themselves as well as their households. "Moms do some heavy lifting, I'm just trying to lighten their load."

Keystone Chiropractic has been serving the Hamden/North Haven community for the past 4 years. Dr. Jason B Richards graduated Summa Cum Laud from University of Bridgeport Chiropractic College in 2003. He has advanced training in neurology and pregnancy.

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