As many new mothers can attest, the muscle strains of pregnancy are very real and can be more than just a nuisance. The average weight gain of 25 to 35 pounds, combined with the increased stress placed on the body by the baby, may result in severe discomfort. Studies have found that about half of all expectant mothers will develop low-back pain at some point during their pregnancies.1-3 This is especially true during late pregnancy, when the baby's head presses down on a woman's back, legs, and buttocks, irritating her sciatic nerve. And for those who already suffer from low-back pain, the problem can become even worse.

During pregnancy, a woman's center of gravity almost immediately begins to shift forward to the front of her pelvis. Although a woman's sacrum-or posterior section of the pelvis-has enough depth to enable her to carry a baby, the displaced weight still increases the stress on her joints. As the baby grows in size, the woman's weight is projected even farther forward, and the curvature of her lower back is increased, placing extra stress on the spinal disks. In compensation, the normal curvature of the upper spine increases, as well.

While these changes sound dramatic, pregnancy hormones help loosen the ligaments attached to the pelvic bones. But even these natural changes designed to accommodate the growing baby can result in postural imbalances, making pregnant women prone to having awkward trips and falls.

What Can You Do?
The ACA recommend the following tips for pregnant women:

Exercise

• Safe exercise during pregnancy can help strengthen your muscles and prevent discomfort. Try exercising at least three times a week, gently stretching before and after exercise. If you weren't active before your pregnancy, check with your doctor before starting or continuing any exercise.
• Walking, swimming, and stationary cycling are relatively safe cardiovascular exercises for pregnant women because they do not require jerking or bouncing movements. Jogging can be safe for women who were avid runners before becoming pregnant-if done carefully and under a doctor's supervision.
• Be sure to exercise in an area with secure footing to minimize the likelihood of falls. Your heart rate should not exceed 140 beats per minute during exercise. Strenuous activity should last no more than 15 minutes at a time.
• Stop your exercise routine immediately if you notice any unusual symptoms, such as vaginal bleeding, dizziness, nausea, weakness, blurred vision, increased swelling, or heart palpitations.

Health and Safety

• Wear flat, sensible shoes. High or chunky heels can exacerbate postural imbalances and make you less steady on your feet, especially as your pregnancy progresses.
• When picking up children, bend from the knees, not the waist. And never turn your head when you lift. Avoid picking up heavy objects, if possible.
• Get plenty of rest. Pamper yourself and ask for help if you need it. Take a nap if you're tired, or lie down and elevate your feet for a few moments when you need a break.

Pregnancy Ergonomics: Your Bed and Desk

• Sleep on your side with a pillow between your knees to take pressure off your lower back. Full-length "body pillows" or "pregnancy wedges" may be helpful. Lying on your left side allows unobstructed blood flow and helps your kidneys flush waste from your body.
• If you have to sit at a computer for long hours, make your workstation ergonomically correct. Position the computer monitor so the top of the screen is at or below your eye level, and place your feet on a small footrest to take pressure off your legs and feet. Take periodic breaks every 30 minutes with a quick walk around the office.

Nutrition

• Eat small meals or snacks every four to five hours-rather than the usual three large meals-to help keep nausea or extreme hunger at bay. Snack on crackers or yogurt-bland foods high in carbohydrates and protein. Keep saltines in your desk drawer or purse to help stave off waves of "morning sickness."
• Supplementing with at least 400 micrograms of folic acid a day before and during pregnancy has been shown to decrease the risk of neural tube birth defects, such as spina bifida. Check with your doctor before taking any vitamin or herbal supplement to make sure it's safety for you and the baby.

How Can Your Doctor of Chiropractic Help?
Before you become pregnant, your doctor of chiropractic can detect any imbalances in the pelvis or elsewhere in your body that could contribute to pregnancy discomfort or possible neuromusculoskeletal problems after childbirth.

Many pregnant women have found that chiropractic adjustments provide relief from the increased low-back pain brought on by pregnancy. Chiropractic manipulation is safe for the pregnant woman and her baby and can be especially attractive to those who are trying to avoid medications in treating their back pain. Doctors of chiropractic can also offer nutrition, ergonomic, and exercise advice to help a woman enjoy a healthy pregnancy.

Chiropractic care can also help after childbirth. In the eight weeks following labor and delivery, the ligaments that loosened during pregnancy begin to tighten up again. Ideally, joint problems brought on during pregnancy from improper lifting or reaching should be treated before the ligaments return to their pre-pregnancy state-to prevent muscle tension, headaches, rib discomfort, and shoulder problems.

For More Information
To find more information on prevention and wellness, or to find a doctor of chiropractic near you, go to Patient Information section on the ACA's Web site at www.acatoday.com or call 800-986-4636.

Felicity Feather, MPA, ACA Communications Vice President, Writer
Jerome McAndrews, DC, Consultant
Carol Kline, MA, and Nataliya Schetchikova, PhD, Editors
David Cundiff, MA, Art Director

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The For Your Health patient page is a public service of the Journal of the American Chiropractic Association. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for a diagnosis by a specialist. For specific information concerning your health condition, consult your doctor of chiropractic. This page may be reproduced noncommercially by doctors of chiropractic and other healthcare professionals to educate patients. Any other reproduction is subject to ACA approval.

References

1. Östgaard HC, et al. Prevalence of Back Pain in Pregnancy. Spine 1991;16:549-52.
2. Berg G, et al. Low back pain during pregnancy. Obstet Gynecol 1988;71:71-5.
3. Mantle MJ, et al. Backache in pregnancy. Rheumatology Rehabilitation 1977;16:95-101.

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