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Should Pain be Expected when Expecting?

Pregnancy is a span of time in which a woman’s body undergoes many changes, some changes being more comfortable than others.

Although we often picture pregnancy as a wonderful expectation in the growth of new life, the physical changes a woman’s body goes through can feel anything but miraculous. Over 50% of pregnant women report their biggest complaint during pregnancy is low back pain, sometimes lasting over 3 months!  Additionally, up to three-fourths of women will experience low back pain at some point during their pregnancy.1,2

Add to this pelvic girdle pain, which is experienced by up to 20% of women at some point during pregnancy,3, and it’s no wonder that pregnancy can be physically exhausting!

Although pain is usually experienced sometime between the fifth and seventh month of being pregnant, it can begin as soon as eight to twelve weeks after becoming pregnant.2

And as the fetus grows, a woman’s center of gravity changes to accommodate, shifting forward to accommodate for the growth of the baby.  The abdomen stretches, and the woman’s belly moves forward and out accordingly to increase in the baby’s weight and development; so, too, does the shift in gravity of a woman’s weight3 on her low back, pelvis, knees, ankles, and feet.

In fact, the thoracic (mid-back) and lumbar (low back) spine curvature can change during pregnancy, causing an increase in pain in the low back and pelvic regions.  This can also cause alterations to balance and gait patterns.3  Think of the pregnant “waddle” that some women do while walking, and you have an idea as to the changes that take place in the abdomen, low back, pelvis, and sacrum!

This can, and often does, place additional stress and strain on the joints in the low back and posterior pelvis, known as the lumbar and sacroiliac areas.  These postural changes lead to increased pain, muscle tightness, tenderness, and discomfort.2  Pregnancy can even lead to changes in the curvature of the woman’s spine.

Low back and pelvic pain can also be major deterrents in a woman who could, and would, be otherwise motivated to continue working and taking care of both herself and her home.  Pain has shown to influence pregnant women’s daily lives in the challenges they encounter concerning their physiological, psychological, occupational, and social functions.4

And it doesn’t always stop there.  Sometimes women can experience low back and pelvic region pain the year after birth, and even up to three years after labor and delivery.1,5  Pregnancy-related low back and pelvic pain, as well as post-partum mechanical spinal disorders, are not only common, but they can impede recovery, nursing, and caregiving – three very important components in taking care of the newborn after labor and delivery.5

How will a pregnant woman know if her pain is being caused by her pregnancy?  What is pregnancy pain like?  Some women describe it as a deep discomfort.   Others describe it as stabbing, continuous, recurrent, and intense.6  The discomfort can also vary in intensity; some days can be more difficult than others, and there may be times when the pregnant woman feels like even basic tasks are difficult to do.

Where might pregnancy-related pain be felt on the body?  For some, the pain occurs anteriorly, or in the front, by the pubic bone.  Others may feel discomfort directly at the low back above the gluteal area – sort of around the beltline.  And for others still, the pain also occurs between the hip bones and the gluteal fold. 

Sometimes this discomfort even travels down the back of the thigh to the knee and the calf6, or even down to their feet.2,7   Most women say that their pelvic and low back pain is more intense during pregnancy than after labor and delivery, and it is still physically limiting as it may cause a pregnant woman to withdraw from activities that she would normally gravitate toward, such as social interactions or work.6

Since pregnancy can drastically change a woman’s body in such a relatively small period of time with lasting effects, how can chiropractic care help with physical changes encountered during pregnancy, especially ones that contribute to pain?

While a chiropractor cannot help with changes in hormones that naturally occur with fetal growth, the resulting biomechanical changes that occur in a woman’s body during pregnancy can be lessened or alleviated by the help of a knowledgeable chiropractor.

A chiropractor who is well-versed in addressing pregnancy-related issues will be able to accurately assess, diagnose, and treat low back pain and pelvic girdle pain.

Some options for treatment include chiropractic spinal manipulation, soft tissue therapy, exercises, and ergonomic advice, as well as encouraging regular visits to her obstetrician.  Treatment could improve functional activities such as sitting, traveling comfortably in a car, walking, and more.3  And, addressing this discomfort sooner rather than later is preferred, especially if employment or maternity leave is a concern.  Low back pain is the most common cause of sick leave after delivery!7

Maintaining optimal function and reducing pain levels to more manageable levels are goals that should be discussed with a doctor of chiropractic as well as an OBGYN when it comes to pregnancy-related pain.2  A detailed history and clinical examination are essential for determining what biomechanical source is causing a pregnant woman’s low back or pelvic pain.6 

A knowledgeable chiropractor will be able to accurately assess changes in pelvic positioning, curvature changes in the upper and lower back, stress on the lower back including muscle tension and tightness in the lumbosacral area, and any radiating (shooting) pain that can travel from the low back into the legs or lower extremities.

A chiropractor can also help identify any areas of stiffness7 that may accumulate in weak areas of the body8, contributing to an increase in back pain during pregnancy.  This may be the case if poor posture, excessive standing, and bending over trigger or escalate any back and pelvic pain.

Low back pain and pelvic pain do not have to be an inevitable part of pregnancy.  If you are one of the 50%+ of pregnant women experiencing pain during your pregnancy, there are options for treatment available to help make your pregnancy more comfortable and productive!

Even as your body changes, a well-trained chiropractor will be able to give you conservative management options for your low back and pelvic pain.  Your doctor will work with your OB/GYN to make sure that your options for treatment are safe and effective.

References

  1. Yoo, H., Shin, D., and Song, M. (2015). Changes in the spinal curvature, degree of pain, balance ability, and gait ability according to pregnancy period in pregnant and nonpregnant women. J Phys Ther Sci. 2015 Jan; 27(1): 279–284.
  2. Montgomery, S.P. “Management of back pain during pregnancy.” (2009). Retrieved March 2020 from: https://www.spine-health.com/conditions/pregnancy-and-back-pain/management-back-pain-pregnancy
  3. Verstraete, V.H., Vanderstraeten, G., and Parewijck, W. (2013). Pelvic Girdle Pain during or after pregnancy: a review of recent evidence and a clinical care path proposal. Facts Views Vis Obgyn. 2013; 5(1): 33–43.
  4. Bernard, M., and Tuchin, P. (2016). Chiropractic management of pregnancy-related lumbopelvic pain: a case study. J Chiropr Med. 2016 Jun; 15(2): 129–133.
  5. Maiers, M., et al. (2018). Chiropractic in Global Health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic. Chiropr Man Therap. 2018; 26: 26.
  6. Katonis, P., et al. (2011). Pregnancy-related low back pain. Hippokratia. Jul-Sep; 15(3): 205–210.
  7. Sabino, J., and Grauer, J.N. (2008). Pregnancy and low back pain. Curr Rev Musculoskelet Med. 2008 Jun; 1(2): 137–141.
  8. “Back pain during pregnancy: causes, treatment and prevention.” American Pregnancy Association. Retrieved March 2020 from: https://americanpregnancy.org/pregnancy-health/back-pain-during-pregnancy

What Pillow should I get?

Are you Sleeping on the Right Pillow?

Determining the right pillow is a personal choice that a person will make every so often. When it comes to thinking about sleep equipment, most people solely focus on the mattress. The mattress is one of the most important sleep equipment you will buy, but when it comes to sleep quality pillows are just as important. How you lay your head when sleeping plays a huge role in determining the type of support you need. Pillows not only impact the quality of sleep but can prevent any neck discomfort.

Why Does Your Pillow Matter?

A proper pillow will facilitate a good night’s sleep without you waking up at night or waking up with pain or a stiff neck. Having the wrong pillow over time can exacerbate unnecessary neck pain. There are a few factors that go into making a guide for yourself to determine the proper pillow for you.

Back Sleeper:

Sleeping on your back might appear to be comfy, but will highlight the underlying issue of snoring if you have a pillow that allows your head to sink. As you lay your head back, gravity will push the tongue back and block your throat. A better alternative will be a pillow that offers height, neck support and keeps the throat at a comfortable level.

Side Sleeper:

One of the most common positions to sleep in is on the side. You will need more support to keep the neck at a neutral angle.

Stomach Sleeper:

Sleeping on your stomach might be comfortable for a few nights, but after a while can become taxing on your back and neck. However, having the right pillow can negate some of these issues. A firm/plump pillow will force your neck into an odd angle that might lead to some discomfort. A better alternative would be a softer option.

When Is It Time To Replace Your Pillow?

On average, a pillow should be replaced every 18 months. The old age rule “ you pay for what you get” applies to this transaction. A higher quality pillow will last longer than an inexpensive option. Something you can do to your pillow to see if you need a new one is, take it out of the pillowcase to see if there are any stains or fold it in half and see if the pillow stays folded. If either of these are a yes then it is time to replace your pillow.

More research showing chiropractic is safe

A systematic review of 47 randomized trials found that cervical manipulation is safe and effective:

  • An effect in favor of thrust manipulation plus exercise compared to an exercise regimen alone for a reduction in pain and disability.
  • Of the 25 studies (that evaluated adverse events), either no or minor events occurred.
  • According to the published trials reviewed, manipulation and mobilization appear safe.  

Coulter ID et al. Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel. Pain Physician. 2019 Mar;22(2):E55-E70.

Impaired Core Stability as a Risk Factor for the Development of Lower Extremity Overuse Injuries: A Prospective Cohort Study

A weak core can increase your chances for lower extremity injury during exercise!

The core is important for your lower back and neck health for sure. It’s also very important for extremity health. If you have been dealing with an arm or leg injury (extremity) that has not been getting better with treatment, it might be good to add in some core exercise to improve outcomes.

Take Home Message from the study: A college freshman with dynamic postural control limb imbalances, decreased hip extension strength, or decreased core muscle endurance during bridging exercises is more likely to develop a lower extremity overuse injury.

Muscle as viewed through an electron microscope!

This is a pretty cool picture. Can you believe the detail? The red in the picture is the muscle and the white stuff is the connective tissue is called fascia. A painful area in a muscle can be caused by damage to one or both of theses structures!

What type of running shoe I get part 2

Part 2:

Ok, we’ve worked on any muscle imbalances, fixed any joints that needed fixing and now we’re working on running form. What’s next is everyone’s favorite: running shoes

Let’s talk about running shoes!

When I’m looking for a running shoe these are the things I look for:

  1. Heel to toe drop:

This a zero drop shoe.  That means the heel and toe are at the same level.

IMG_0939

Here’s a large heel drop.

IMG_0949

Now which one to choose?

You can not use a zero drop shoe if you were using a running shoe (with a large heel drop) like the one above your whole life. Doing that you would destroy your Achilles tendon and calves. 

I would suggest using the lowest heel to toe drop you can tolerate. better to error on a bigger drop then lesser drop.  You can always go lower the next shoe.  This will lower your chance of soreness.  Remember change can take time, don’t rush things

2.  Where the shoe bends:

I like the shoe to bend where my big toe bends which is the “knuckle” part of the big toe.  It only makes sense that the shoe bends where the body bends.

IMG_0944

3.  The toe box:

The toe box is the space around the toes.  Take your foot out of the shoe or sneaker and take a  look.  I bet it does not look like your shoe.  Most people don’t have elf shaped feet.

A big toe box gives more room for your foot and toes. The second picture is an insert( black one) from a shoe with a big toe box.  My foot does not spill over the insert(green one) like the first picture.  

IMG_0945IMG_0946

If you have any question please call the office! Or you could bring your shoe in and we can go over it in person.

How much protein do you need per day?

How much protein do you need per day?

As with most things in nutrition, there’s no simple answer. Your individual needs will depend on your health, body composition, the main goal you have, and level of physical activity (type, intensity, and duration). Even when taking all of this into account, you’ll end up with a starting number, which you’ll need to adjust through self-experimentation.

Daily requirements are expressed in grams of protein, either per kilogram of body weight (g/kg) or per pound of body weight (g/lb).

  • If you’re of a healthy weight and sedentary, aim for 1.2–1.8 g/kg (0.54–0.82 g/lb).
  • If you’re of healthy weight, active, and wish to keep your weight, aim for 1.4–2.2 g/kg (0.64–1.00 g/lb). Try for the higher end of this range, as tolerated, especially if you’re an athlete.
  • If you’re of healthy weight, active, and wish to build muscle, aim for 1.4–3.3 g/kg (0.64–1.50 g/lb). Eating more than 2.6 g/kg (1.18 g/lb) is probably not going to lead to greater muscle gains, but it can minimize fat gains when “bulking” — i.e. when eating above maintenance in order to gain (muscle) weight.
  • If you’re of healthy weight, active, and wish to lose fat, aim for 2.3–3.1 g/kg (1.04–1.41 g/lb), skewing toward the higher end of this range as you become leaner or if you increase your caloric deficit (hypocaloric diet).
  • If you’re overweight or obese, aim for 1.2–1.5 g/kg (0.54–0.68 g/lb). You do not need to try to figure out your ideal body weight or your lean mass (aka fat-free mass). Most studies on people with obesity report their findings based on total body weight.
  • If you’re pregnant, aim for 1.66–1.77 g/kg (0.75–0.80 g/lb)
  • If you’re lactating, aim for more than 1.5 g/kg (0.68 g/lb)
  • If you’re vegan or obtain most of your protein from plants, then protein requirements may be higher due to the inferior protein quality (both the EAA profile and bioavailability) of plant-based proteins relative to animal-based proteins.

https://examine.com/nutrition/how-much-protein-do-you-need/#summary1

Congratulations, Bob!

bobmiller

We want to say a huge congratulations to one of our amazing patients! Bob recently completed the “Strolling Jim” UltraMarathon. This race included 4,000 feet of elevation, 4,000 feet of decline and a total of 41.5 miles! What an accomplishment, Bob! We are so proud of you!
We also received the message below from Bob after his race. We are so glad we could be a part of your journey. 🙂
“Thank you to Dr Steve and Nickie for, without whom, I could not have achieved my goal of finishing my latest UltraMarthon of over 40 miles and 4000 ft elevation AND 4000 of decline. Thank you Dr and Nickie!!!!!”

If you’re training for a race Dr. Steve can help! Call the office and get race ready!

Strengthening the Glutes Can Help Back Pain!

Here’s a great exercise to help strengthen the Gluteus medius.

Myofascial pain syndrome (primarily involving the gluteus medius) is present in the majority of patients with LBP (73%) , sciatica (50%), and LBP with sciatica (85%).”

Kameda M, Tanimae H. Effectiveness of active soft tissue release and trigger point block for the diagnosis and treatment of low back and leg pain of predominantly gluteus medius origin: a report of 115 cases. J Phys Ther Sci. 2019;31(2):141-148.

It hurts when I do my rehab exercises!

What to expect when starting rehab or exercise program?

It’s normal for the pain to increase when starting any rehab or exercise program if you have chronic or persistent pain.  This is normal and over time this will improve.  Exercise/rehab will decrease the pain over time.  It will take time.  So stick with it and you’ll get better!

Here’s a nice paper that goes into the mechanism of how exercise works.

Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena

https://physoc.onlinelibrary.wiley.com/doi/full/10.1113/JP273355?fbclid=IwAR00pU_w5lH5XFbzyQl97uiP8nlntGXiqQppQPLKlPqZ3bSeo0-1M907vKs&