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Donald Davis

August 16, 2017

Background / Clinical Scenario


A 28-year-old pregnant female in her third trimester presented with gradual onset of low back
pain. She reports that this is her first pregnancy and she has no prior history of LBP. Her past
medical history is unremarkable except for a fractured right tibia from an automobile accident
when she was 19. The fracture is completely healed and does not cause her any problems. The
patient states that she saw a chiropractor while she was in high school for intermittent
migraines which resolved when she was in her early 20s. She reports that she is following the
healthy diet recommendations of her obstetrician. She reports that she exercised regularly
until recently when her LBP flared up again. She has abstained from prescription medications,
over the counter medications or herbal supplements. She reports that she did try topical Arnica
once on the advice of a friend but was concerned about side effects so discontinued it.
She reports the pain is dull ache, non-descript refractory pain that progresses in severity
throughout the day ranging between a 3 to 5 on a 10-point scale. She reports trouble sleeping
and sitting, She states that she is not overly concerned about the pain and feels that it will pass
after she delivers her baby. She does report that she is concerned that she is gaining more
weight than she thought she would. She is 5’6” and weighs 162 lbs., with normal pulse and
blood pressure. On physical examination, she has a positive Straight leg raise test, positive
Posterior pelvic pain provocation test, and mild pain with the Long dorsal ligament test. She has
normal upper and lower extremity deep tendon reflexes and no radicular symptoms.

Clinical Question

Does chiropractic care decrease LBP in pregnant women safely and effectively?

Search Strategy

 Search engine: PubMed


 Search terms used: low back pain, pregnant, safe, effective, treatment
Christopher Review Manual Therapy Results showed Listed adverse
Oswald, including spinal manual therapies effects as very
DC, Ceara C.
Higgins, DC, manipulation and were safe and minor
and Demetry massage effective for tx of LBP
Assimakopoulos,
DC
Lisi AJ1 Case Series, 17 Chiropractic Results showed No adverse
cases involved manipulation improvement in pain effects reported
scores with spinal
manipulation
Donald R. Cohort Study 115 patients Improvement of LBP No adverse
Murphy, DC, Eric questionnaire after effects reported
L. Hurwitz, DC, treatment by
PhD, Ericka E. Chiropractor/physical
McGovern, DC therapy team

Discussion

The number of studies that I reviewed with my current search terms were not high. They all reported
that spinal manipulation and manual therapies were effective and safe for pregnant women at any time
of pregnancy. The covered studies all had no adverse effects or the effects were very minor. Improved
search terms would possibly broaden the scope of studies that could be included to answer the clinical
question.

Clinical Bottom Line

The bottom line is that chiropractic management of low back pain during pregnancy is not only safe but
very effective.

References

1: Oswald C, Higgins CC, Assimakopoulos D. Optimizing pain relief during


pregnancy using manual therapy. Can Fam Physician. 2013 Aug;59(8):841-2. PubMed
PMID: 23946024; PubMed Central PMCID: PMC3743693.

2: Lisi AJ. Chiropractic spinal manipulation for low back pain of pregnancy: a
retrospective case series. J Midwifery Womens Health. 2006 Jan-Feb;51(1):e7-10.
PubMed PMID: 16399602.

3: Murphy DR, Hurwitz EL, McGovern EE. Outcome of pregnancy-related lumbopelvic


pain treated according to a diagnosis-based decision rule: a prospective
observational cohort study. J Manipulative Physiol Ther. 2009 Oct;32(8):616-24.
doi: 10.1016/j.jmpt.2009.09.002. PubMed PMID: 19836597.

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