POST-DISPATCH HEALTH & FITNESS EDITOR
07/02/2007
When Tykita Bethley was pregnant the first
time, she had what she called the usual aches and pains
of pregnancy.
"My back hurt, and then once I had my
daughter, it hurt even more, especially on the right side,"
says Bethley, 22, of St. Louis.
That was four years ago. When she got pregnant
a second time, the pain got worse.
"My back hurt like crazy then, too, but
I had accepted my back pain for the longest time."
As the pain became worse during this pregnancy, she mentioned
it to a nurse.
The nurse suggested she try the Musculoskeletal
Pain and Pregnancy Clinic at Barnes-Jewish Hospital. The
clinic, set up to help study the effect of chiropractic
care and exercise on pregnant women, was free to Bethley,
as it is to many women who qualify.
She came weekly from about Week 27 on, getting
help with exercises and gentle adjustments.
Bethley says that discussing her pain with
health professionals who take it seriously has helped her.
"That makes me feel much, much better,
that I know I hurt for a reason," she says.
The treatment she gets and the stretches and
exercises she does at home have led her to declare herself
nearly pain-free.
"I can't tell you," she says. "I
feel so much better."
So much so, she says, that with just a few
weeks to go before her due date, her doctor has said she
could come in as needed now.
Don't accept pain
Bethley's story is typical. Many pregnant
women accept pain as a normal part of pregnancy.
But it's not just the moms who ignore it.
Health care professionals often do, too.
"It's a pretty interesting phenomenon,"
says Dr. Clayton Skaggs, an associate professor of research
at Logan University's College of Chiropractic, an adjunct
instructor at Washington University and the medical director
of The Central Institute for Human Performance in Kirkwood.
"There a perception that it's normal,"
he says, "and that's not true."
Skaggs began to work with pregnant women about
eight years ago when one of his patients, Dr. D. Michael
Nelson, suggested it.
What resulted was the Musculoskeletal Pain
and Pregnancy Clinic at Barnes-Jewish Hospital.
It's grown so much that now there are additional
clinics at Missouri Baptist Medical Center and the Center
for Advanced Medicine.
The clinics focus on an interdisciplinary
approach to managing acute and chronic back pain in pregnancy.
The care includes exercise, chiropractic care (gentle manual
manipulation) and education about everyday movements, such
as lifting and getting out of a chair.
"I guess we'd always figured," Nelson
says, "that if you had swallowed a 30-pound watermelon
and carried it around in front of you that you would have
these symptoms of pain and there was not a lot you could
do about it. "
But with these clinics, they decided to try
to do something about it.
And as Tykita Bethley's story suggests, they
made a difference.
The Moms study
After four or five years of anecdotal evidence,
Washington University and Logan University combined to do
a study on pregnancy and musculoskeletal pain. The study
was called MOMs, for Musculoskeletal and Obstetric Management
Study.
What researchers found was that 70 percent
of the nearly 600 women in the study suffered from low back
pain in pregnancy. The team also discovered that of those
women who suffered from low back pain, 80 percent were offered
no treatment.
Findings of the research team show that reducing
low back and pelvic pain in pregnancy may:
— Reduce needless suffering and impairment.
— Lessen costs of medical care and sick
leave during and after pregnancy.
— Eliminate chances of disability and
injury affecting women and their children postpartum.
The study also found that:
— Low back pain in pregnancy is perceived
as normal.
— Pain doesn't always go away upon giving
birth.
— Low back pain is associated with sleep
problems.
— Forty percent of those with pain were
taking pain medication. "That's alarming," Skaggs
says, because there is a certain risk to pregnancy, including
miscarriage, when taking certain medications.
The study was purely descriptive, but Skaggs,
Nelson and their teams have moved on.
In February, Logan and Washington University
launched the official clinical trial that will compare MOMs
to standard obstetric care alone for patients with low back
pain and pelvic pain during and after pregnancy. The randomized
trial of at least 300 qualified pregnant participants will
conclude in August 2009.
"If women were educated early enough
and there was proper intervention, I think we could decrease
chronic low back pain, and we are in the process of trying
to prove it," Skaggs says.
Why pain?
There's more than one reason women get pain
during pregnancy, says Dr. Traci Lepper, a chiropractic
physician whose office is in Crestwood. The most common
reason is the dysfunction of the sacroiliac joint, she says.
The sacroiliac joint is the main joint in
the pelvis, which allows normal alternating movement for
walking. As a pregnancy progresses, the hormone relaxin
becomes present at 10 times its normal concentration to
allow these sacroiliac joints to stretch, allowing room
for the baby to pass through the birth canal. Relaxin causes
abnormal motion in the sacroiliac joint and others. This
can cause inflammation and pain.
Another reason for low back pain in pregnancy
is the weakening and stretching of the abdominal muscles,
which usually support the lumbar spine, pelvis and hips.
It's the old watermelon theory, Nelson says.
Lepper has used chiropractic care for her
patients for years. Chiropractic care "is very successful
at relieving many women's low back pain by restoring normal
biomechanics of the body," she says. Lepper, who received
chiropractic care throughout two pregnancies, also recommends
massage therapy and exercises to strengthen the core.
"I was able to work literally to the
day of delivery despite the physical nature of taking care
of my patients," she says. "Also, because my pelvis
and spine were aligned prior to delivery, I had an easy
recovery and was back at work within four weeks both times.
My pregnant patients and I truly wonder how women get through
the pregnancy without chiropractic."
abertrand@post-dispatch.com
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