With pregnancy come significant changes to a woman’s physiology and biomechanics that can pose a challenge for soon-to-be mums. There is often a focus on the potentially injurious outcomes of pregnancy, however the same hormonal changes that are responsible for back and pelvic pain also provide a unique potential for healing longstanding or chronic musculoskeletal injuries.
PHYSIOLOGICAL CHANGES IN PREGNANCY
The hormones in question are Relaxin, Progesterone and Oestrogen.
Relaxin is a hormone which is thought to be primarily responsible for ligamentous changes during pregnancy. It is released by the corpus luteum from about week 12 of pregnancy. The effect of relaxin in pregnant women is fairly contentious. Much of the research has been done with oestreous rats, which has proven to cause ligamentous softening around the pelvis. Whilst relaxin does appear to be involved in collagen breakdown and ligament laxity, there is a significant lack of correlation between relaxin levels and pelvic pain severity. (Daniela Aldabe, 2012)
Progesterone and oestrogen are hormones known to cause salt and water retention. Although the effect of relaxin is disputed, progesterone and oestrogen influence the biomechanical structures of the pregnant posture by changing the structure of connective tissue and increase mobility of joint capsules and spinal segments.
THE EFFECT ON OTHER PARTS OF THE BODY
A study by Segal et al showed that a drop in foot arch height, which occurs secondary to hormone-induced laxity and increased weight, actually remains postpartum. (Ned A. Heitz, 1999)
A UNIQUE OPPORTUNITY
This opens up a new window of opportunity for treating long-lasting musculoskeletal dysfunction during pregnancy through means which are not available outside of it. If we extrapolate these findings to elsewhere in the body, we can see that many chronic pain disorders have the potential to be addressed during pregnancy. Maybe it’s your chronic neck pain that is secondary to thoracic stiffness? Or maybe that shoulder which has always given you trouble during your golf swing can finally be mobilised? Or perhaps you’ve suffered a chronic knee injury secondary to a lack of foot mobility?
Regardless of the story, the opportunity for healing is vast. As Osteopaths, we believe in placing the body in a position where it can be allowed to heal optimally. These hormonal changes perfectly illustrate a chance for us to coax the body into such a position, which up until now, we may have been unsuccessful in healing. Whether via manipulation, mobilisation or exercise rehabilitation, the effect of manual therapy on each joint is optimised by the aforementioned hormones.
So if you’re expecting, keep in mind this window of potential granted to you for newfound health and mobility. But before you go out and try to mobilise every joint in your body, remember that these therapies need to be applied in the context of the complex physiological and biomechanical changes occurring to pregnant women, and always by a trained practitioner.
Dr David Sokoloff is a firm believer that the body requires movement to heal optimally and he incorporates functional movement into his treatments, in conjunction with traditional osteopathic techniques.
Daniela Aldabe, D. C. (2012). Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review . European Spine Journal , 1769–1776.
Ned A. Heitz, P. A. (1999). Hormonal Changes Throughout the Menstrual Cycle and Increased Anterior Cruciate Ligament Laxity in Females. Journal of Athletic Training , 144-149.
Neil A. Segal, M. M.-Y. (2013). Pregnancy Leads to Lasting Changes in Foot Structure . American Journal of Physical Medicine and Rehabilitation , 232-240.