Osteopathy during pregnancy
Muscle and joint pain during pregnancy
Causes and contributing factors to joint and muscle pain in pregnant women
Charbel Jean Kortbawi, specialized osteopath in Paris 16
Former osteopath at the American Hospital of Paris (Maternity Unit)
Mechanical and postural changes during pregnancy
Pregnancy is a period of profound physiological changes that have a significant impact on the body mechanics and posture of the pregnant woman. Understanding these changes enables us to take better care of you, so as to prevent and effectively treat the associated pain and discomfort.
During pregnancy, the progressive increase in the weight and volume of the uterus leads to an anterior shift in the center of gravity. This postural change manifests itself in an accentuated lumbar lordosis (arching of the lower back), an anterior tilt of the pelvis and a stretching of the abdominal muscles. These changes can lead to increased stress on the lumbar and pelvic regions, frequently resulting in lumbar pain, symphysis pubis pain or sacroiliac pain. The lower limbs are also subject to increased stress, due to increased body weight and the postural adaptations required to maintain balance. This can lead to pain in the hips, knees and feet.
Hormonal changes impacting the musculoskeletal system
During pregnancy, major hormonal changes occur which have a significant impact on the musculoskeletal system. Among these hormones, relaxin plays a predominant role, accompanied indirectly by progesterone and estrogen.
Relaxin, produced initially by the ovarian corpus luteum and then mainly by the placenta, peaks during the first trimester. It causes marked ligament laxity, particularly in the pelvis, facilitating the passage of the fetus during delivery. This increased laxity can also extend to other joints, increasing their mobility and potentially exposing them to the risk of joint instability and musculoskeletal pain such as low back pain or pelvic pain.
Progesterone, although primarily involved in uterine smooth muscle relaxation, can indirectly amplify general muscle relaxation and slightly influence ligament laxity, without however constituting the major hormonal effect.
Estrogens, on the other hand, induce fluid retention and increased soft-tissue vascularization, which can lead to increased joint sensitivity and exacerbate muscle or ligament discomfort, without however directly causing significant ligament laxity.
Indications of osteopathy during pregnancy
Low back pain and pelvic girdle pain
Lower back and pelvic pain is one of the most common complaints during pregnancy, affecting up to 50% of pregnant women. A systematic review by Franke et al (2017) in the Journal of Bodywork and Movement Therapies indicates that osteopathy significantly reduces this pain and improves functional pelvic mobility. These findings are corroborated by another randomized controlled trial conducted by Licciardone et al. (2010) published in the American Journal of Obstetrics & Gynecology, which reports a substantial improvement in symptoms in women who received osteopathic treatment compared with a control group. The PROMOTE study by Hensel et al (2015), published in the American Journal of Obstetrics & Gynecology, found significant improvement in low back pain and functional improvement in pregnant women receiving osteopathic treatment.
Preparing for labour
Osteopathy offers a complementary, non-invasive approach to helping pregnant women prepare for childbirth.
Osteopathic treatment aims to relieve mechanical stress by working gently on joints, muscles and ligaments. These gentle, non-invasive techniques facilitate pelvic mobility, optimize posture, improve blood and lymph circulation, and reduce musculoskeletal tension. In this way, osteopathy also helps prepare the body for a more harmonious childbirth.
Several scientific studies underline the value of osteopathic consultations in the prenatal period to improve the general well-being and quality of life of the mother-to-be, promoting better adaptation of the body to the changes of pregnancy (Sheraton et al, 2018; Correia et al, 2023, Correia, M. L. A. et al, 2024.).
Pregnancy rib pain
Rib pain during pregnancy is common and mainly related to the expansion of the uterus pushing against the rib cage, the position of the baby and the action of relaxin relaxing the ligaments. The diaphragm may also be compressed, causing breathing difficulties or additional tension. Osteopathy can help relieve these pains by reducing muscular and diaphragmatic tension, thus improving thoracic mobility and respiratory comfort. These pains usually disappear after childbirth.