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| Hi all,
I just got back from my very first visit to a chirpractor. I'm 5 & 1/2 m. pregnant and am having some pretty bad pain from sciadic nerver & sacro-illiac (sp?) joint issues, so I thought I'd give it a try. My experience was less than positive but not awful. I asked a lot of questions about what happens to the spine during pregnancy and the doctor was either not sure of herself or just had a personality that communicated insecurity or they're not used to anyone asking questions, which I find hard to believe. During the adjustments, she had my lie on my side ,upper leg crossed over, upper shoulder facing the ceiling and she pushed on my upper shoulder, upper knee for lots of popping noises. It didn't hurt, but I was surprised by this because I've been told the #1 thing in yoga modifications during pregnancy is to never, ever do this kind of spinal twist. So I asked her in a non-confrontational way to explain to me what she was doing and why it wouldn't be safe in my yoga practice but okay on her table. She immediately answered with "if you're not comfortable with this, we can do adjustments with you sitting down." I tried to ask her again, explaining I wasn't necessarily questioning her medical wisdom, I just liked to understand things, and she said "well, I've been adjusted this way during all four of my pregnancies and I can assure you it's safe." Sigh. So I came home, went online to do some quick "research" and am not finding anything. I'm posting this to see if there are any chiropractic experts out there (also familiar with yoga & pregnancy). I'm also going to call my doctor and see if she can enlighten me. It just makes me very nervous and I want to understand what it is they are doing to me and if it's safe or not for the baby.
Thanks for your input,
Joanna
p.s. I do understand the reason for chiropractic care (especially during pregnancy) and what's going on physically and neurologically. What I'm not clear on is specifically this twisting of the spine & what adjustments are done and why in prenatal chirpractic care (b/c I wasn't comfortable there, I probably won't go back, but would like to be informed enough to seek out the kind of chirpractic professional I need to be seeing). |
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| Hi Joanna,
Bummer you had that less than positive experience. I know there are chiros out there that specialize in treating pregnant women - my boss is one of them. He has special tables just for them.
I wonder if there is an association of chiros that specialize in treating pregnant women that you can contact for some referrals? Or perhaps your OB can recommend one.
Wish I could help out more ~ |
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| i do not know why it would be ok in chiropractic, but in yoga it's taught that it pulls too much on the abdomen and causes compression of the abdomen which can have negative affect on the baby.
but, there is a 'lower spinal' twist that is allowed for pregnant women that i teach in prenatal classes (or classes with pregnant women) that helps with the SI and sciatic pain. essentially, reclining on an ascending pile of blankets (lowest at hips; highest at head) so that the mother isn't reclining directly on her back, the right foot moves to the right edge of the mat, the left foot moves to the left edge of the mat. feet are flat on the floor, knees bent. then, both knees are dropped toward one side, held for a bit, and then moved to the other side. keeping the feet apart moves the spinal twist down to the lowest part of the back, removing abdominal compression that comes during regular spinal twists. |
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| This is good to know - I've never been shown this. I just tried it and there wasn't that pinching pain I usually get. Thanks. |
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Expert Yogi
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| joanna - I would not be terribly comfortable with that adjustment during pregnancy but I don't know enough to say if it is safe or not. I have been to 3 chiros in the past 5 years or so and they all seem to be backing off this sort of adjustment in general and going with less "crunchy" sorts of adjustments. The fancy table idea seems to be making a bigger impact now and all sorts of adjusting tools. I hope you can get some good advice from those here who know more about it. And oh, how I wish I had known about chiropractic during my pregnancies! It would have been so helpful, especially with the second.
How does your back feel? |
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| I always makes me nervous when somebody says "because I said so". Generally it means they don't know the reason. In this case it might be good, it might be bad. There's a lot of rote learning and rule of thumb in most disciplines. |
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| Tourist - my back feels okay today, but it comes and goes anyway, so I have no idea if it's due to the adjustments or not. It's all very strange, because my first pregnancy I was in horrible shape (and was in grad school, finishing up my Master's, hunched over books ALL the time) - no back pain. This pregnancy I went into it in quite good shape (running + yoga six days a week, at my ideal weight) and have had constant back problems. It's very frustrating to be trying to go to yoga and stay healthy when every time I left my leg for something as simple as stepping through (no jumping now!) from downdog to standing forward bend, or bringing it back from warrior II to plank, I get a zapping pain shooting down my leg. So it's either somebody explain to me what's going on so I can do things correctly and solve this problem or I may have to stop doing most of my yoga practice.  I'm complaining, aren't I? How annoying.  Thanks for any input from you all.
btw, Green Jello, I'm totally with you on the no explanation thing. I've learned _especially_ with medical care that if they can't or won't explain something, go somewhere else. But it doesn't mean the whole chiropractic care is wrong for me - just this one particular office. |
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Expert Yogi
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Location: Somewhere in the Mountains of Western NC | GreenJello - 2006-03-10 10:49 PM
I always makes me nervous when somebody says "because I said so". Generally it means they don't know the reason. In this case it might be good, it might be bad. There's a lot of rote learning and rule of thumb in most disciplines.
Hey GJ, I say this to my kids all the time. When I feel that I should NOT have to give an explanation. I know the answer, when I say "because I said so", means you need to listen to your Mother, follow directions and you are not ready for that answer yet,  Besides, usually my kids figure it out on their own. As a parent, it is not an option whether my kids obey and listen to me or not....it is a requirement while they are in my care. Sometimes we have time to sit down and go over the instructions with the answers, and sometimes we don't have time and sometimes we have spontaneous situations that arise. The times we don't have time or when those spontaneous situations arise, they KNOW it's better to listen and obey. On the other hand, my kids feel safe and nurtured, I'm with them every day, they look to me for guidance, therefore, it is easy for them to perform this task with me.
This is the same principal when you have a guru. If you don't trust that guru or feel nurtured and guided, then it is so easy to break away and have a judgement about the teacher. Then the relationship is destroyed and it ends up being useless. That is why so many people here in the West are confused. They want all these answers right now, instead of having faith in what is happening to them. I think this principal could be applied to everything. Problem I see, is that we don't have much faith in anyone do we?? Not even Chiropractors.
I see Joan's situation as very scary, because she is already questioning her faith in her Doctor...therefore, I would suggest you quit that doctor or have a better understanding about what you are trying to achieve with this Doctor. That is a very important factor in healing. If you can't trust your doc, then you better run like hell, far away. Maybe this is not the appropriate time for you to be seeing a Chiropractor while your pregnant. I know I would be very reluctant to try something new, now that I have another life to consider. I would stick to a good OB/GYN and Baby specialists, rest, relax and have a wonderful 9 months. Find a good Yoga teacher like Zoebird who likes to teach pregnant women - stick to restorative asanas. Then I would get out my decorating books and start doing shopping asana's...those are really fun and can be restorative, if you let them. Be careful with paint, use quality paints and don't breathe fumes. Congratulations. |
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Expert Yogi
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| Joanna - one way to deal with that sort of pain is to do each pose individually and not be working on flow right now. Go into down dog, come back out, then go into your next standing pose starting from tadasana again. The movements between poses in flow can be awkward and doing one pose at a time might give you more control and hence less pain. My second pregnancy was a lot more uncomfortable as well. They are just really different! I hope you find a practitioner that works better for you. All of my chiros and other workers have been able to answer all my questions. When I first went for accupuncture over 25 years ago, I had a guy like your chiro and I quit going to him after a couple of visits. I knew it wasn't the treatment that was the problem, just the person doing it.
Cyndi - my kids knew there were times to comment or get an explanation and times to "just do it." I liked to explain things to them but they had to know there were times when they had to respond and not ask questions. I would just say "no editorial comment!" WE all need to know when it is ok to question and when, like emergency situations, it is not ok. |
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| Cyndi, you're correct that we need to give people a chance to prove themselves, and have a little faith that they know more than we do. When I see or hear something that raises a red or yellow flag, I usually wait a little bit and see what comes of it. Sometimes it's nothing, sometimes it the tip of the iceberg. |
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Location: London, England | Hi Joanna,
I have a degree in chiropractic from the oxford college of chiropractic which teaches a gentle form of chiropractic.
i'm not surprised to a certain extent why the chiro couldn't answer your question, seeing as she may not have had any experience in yoga. As far as i can determine, twists are not recommended during the earliest stages of pregnancy because of the dangers of lifting the pressure in the abdomen to a degree that would be harmful to the foetus-at the stage of pregnancy that you are at, this isn't a consideration. I would be careful of staying in any position for any length of time, in case you cut off the blood supply to the foetus, and would avoid high intensity exercise for long periods to avoid foetal hypoxia, and also any classes which involve long periods of lying down, again because of foetal hypoxia.
Incidentally, I believe some chiropractic schools recommend not manipulating pregnant women in the first trimester, again because of the changes in pressure in the abdomen, so there is a link between chiropractic manipulation and yoga twists and the practice thereof-but I think that many chiropractors choose to ignore these guidelines, which are not universal by any means.
Take care, enjoy your pregnancy
Nick |
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| Thank you, Nick, this is actually probably the answer I was looking for. No one told me why I shouldn't do twists in yoga - funny how I blindly took this advice but not the chiro's! Well, that's the conservative me, I suppose. Hmmm...so there's really NO danger in spinal twists anymore? I mean, with the precautions you mentioned and I follow, of course. ?? |
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Location: London, England | Hi Joanna,
I think that it is very difficult to give guidelines because one size does definitely not fit all as far as exercise during pregnancy is concerned. Whether something is dangerous or not can depend on the anatomy and function of your venous and reproductive systems, and also how experienced at exercise or how you perform the exercise can all make a difference to the outcome.
I have never seen a satisfactory explanation of why women shouldn't do twists in yoga-in chiropractic manipulation, where the adjustment is very sudden, it is easy to see that there is a big increase in intra-abdominal pressure which might be harmful to a young foetus. But unless you swing into the twist as fast as yuo can, this wouldn't apply to yoga practice. As I said before, it's pretty difficult to do any exercise without raising the IAP, because if you are breathing deeply, the IAP will be raised.
I think to a large extent it depends on how careful you like to be, or if you have a history of miscarriages. I think I mentioned once here that newly pregnat woen are advised to sneeze with their mouths open, to avoid the build-up of too much IAP. Whilst this might be good advice in general, it is hard to believe that every woman who sneezes with her mouth closed will suffer a miscarriage. But these are general guidelines to be applied to 50% of the population.
If, for example, you are not allowed to do twists, then that should mean that all pregnant women in their first trimester would be banned from driving-you would not be able to look over turn your body to look around when driving. If you were to reverse into a police car and told them that you did it because your yoga teacher told you that you would miscarry if you twisted, they would probably stick you and your teacher straight in to the local asylum.
I sometimes think that the advice that is given to women in yoga classes is not necessarily based on medical fact, but is used in the absence of knowledge to make the teacher, or method, appear wise. You probably get bigger increases in IAP if you have a poo than during most yoga postures!
Take care
Nick |
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Expert Yogi
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| I love the sneeze thing, Nick - it is one of those ideas that makes me shake my head and laugh. One more thing for expectant mothers to fret about and take on as guilt before the baby is even born. As if we don't have enought guilt already... 
The yoga advice on twists is in fact, form the Iyengar standpoint, only for "closed" twists such as maricyasana III (which is very much like the chiro adjustment) and not for open twists such as bharadhvajasana I and shoulder checking while driving.
I do try to err on the side of caution as a teacher (liability insurance is not cheap!) but I also accept the advice of my teachers on this. OTOH, there were times I would have had pretty much any adjustment to make my back feel better when I was pregnant. I just don't know if I would have liked to have it done by someone who wouldn't/couldn't explain it to me. |
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Location: London, England | Hi tourist,
Yes, it's a difficult one, I don't think that science can give a definite answer, because each woman is unique in so many different ways. So each twist will be done differently by each woman. The effects will therefore be dependent on the technique that she uses. i wonder what the effects of pregnancy are on the ability of the woman to use her oblque abdominals in their function as rotators of the trunk. i imagine that their mechanical advantage is severely compromised by the increased curvature that a foetus will impose on the abdominal wall. Still, I would have thought that by practicing twists, it could be argued that a pregnant woman could train her abdominal muscles so that a quicker rehab is experienced after the birth of their child. I'm just thinking out loud, really, hope you don't mind!
Take care
Nick |
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Expert Yogi
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| No, I don't mind There is also a huge difference between pregnancies in an individual woman so what was good last time around may not be good the next. My first "carried high" and so I got heartburn and breathlessness etc. The 2nd, probably because I did not exercise between them but also due to god-knows-what, carried low. So low that walking in the later months was painful - it seemed to cut off circulation in my thighs. So there would undoubtedly be variables there as well, not to mention the individual risk factors, as you say, for miscarriage etc. Big and interesting topic. These threads are making me miss all my old childbirth and lactation consultant friends! |
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Location: London, England | Hi Joanna,
Is the zapping pain that shoots down your leg on the front or the back? Pain running down the back of the leg would suggest irriatation of the sciatic nerve which emerges from the lower lumbar spine and upper sacrum, and pain running down the front of the leg would suggest impingement of the femoral nerve, which comes from the upper lumbar spine (L1-L3).
I'm going to presume the pain is running down the back of the leg because of the movements you were describing. Leg raises are used as a means of strtching the sciatic nerve to determine the level of involvement of the sciatic nerve. Really severe sufferers can often lift the foot only a few inches off the table. I believe the pain is of a level that encourages suicidal tendencies, so my heart goes out to these people.
I would guess that in your case a mixture of aggravating factors ay be at work-hormonal influences can encourage joint laxity-in the sacroiliac (and L5-S1) joint, where it is so important to have a minimal amount of movement, pregnancy can cause the area to become too loose, and the passage of the nerve as it emerges from the spine can be interrupted by the surrounding tissue-think of how an earthquake throws trees across the road, creates fissures, landslides-this all distorts the signals that travel up the sensory nerves, making you feel pain even when there is no stimulus.
The addition of the weight of the foetus which pulls this area forwards creates an additional load on the joint which probably doesn't help!
It's difficult to tell you to give up, but i would say go to classes or do exercises at home where it it may be easier for you to devise a practice which does not aggravate the leg. I think it is important that if you do seek chiropractic care that you also seek rehabilitative care-I think this makes a powerful combination that both therapies alone cannot answer as well (sorry for the bad English!).
The trouble that I perceive with adjusting pregnant women is that if there are hormones which are basically loosening up the joints, why use a therapy which loosens them further? The problem is that the therapies can seem to work temporarily, causing a 'click addiction' which means that the woman has to go back to the therapist again and again.
Try to use a support for your lumbar spine (and use it properly!). You may ask a physio about the use of a trochanteric belt, which helps to squeeze the sacroiliac joint. Take up exercise which strengthens the postural setting of the area, and begin to regard yoga not as an exercise which produces movement in this area, but as an exercise during which you seek to prevent movement in this area despite the external forces that are built up during the postures and movements. This is similiar to the underlying foundations of pilates, where the abdomino-pelvic floor muscles are contracted and then the arms and legs are moved around, with movement in the lower back being regarded as a failure. In this way, yoga becomes a means of protecting the lower spine whilst promoting the flexibility, posture, and strength of the hips and shoulders, and consequently the legs and arms.
I'm a big fan of glucosamine and chondroitin sulphate, and also MSM, which might be relatively cheap aids in your combatting the pain.
Will add to this later, I just have to go and torture some deserving ladies at the health club with some Astanga!
Nick |
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| Nick - 2006-03-16 4:33 AM
Hi Joanna,
Is the zapping pain that shoots down your leg on the front or the back? Pain running down the back of the leg would suggest irriatation of the sciatic nerve which emerges from the lower lumbar spine and upper sacrum, and pain running down the front of the leg would suggest impingement of the femoral nerve, which comes from the upper lumbar spine (L1-L3).
The pain is down my lower back, buttock, and sometimes down to my toes. Right now it is particularly bad - I tried VERY hard in yoga this a.m. to be gentle, gentle, gentle but i did something "wrong" - I just don't know what. I am headed to another chiropractor in half an hour, so your email is timely.
It's difficult to tell you to give up, but i would say go to classes or do exercises at home where it it may be easier for you to devise a practice which does not aggravate the leg. I think it is important that if you do seek chiropractic care that you also seek rehabilitative care-I think this makes a powerful combination that both therapies alone cannot answer as well (sorry for the bad English!).
Your Engilsh is fine! Again, this email is timely. I have printed it and will bring it with me to the chiro. I dont' really know anything about "rehabilitative care" - but I am assuming they will.
The trouble that I perceive with adjusting pregnant women is that if there are hormones which are basically loosening up the joints, why use a therapy which loosens them further? The problem is that the therapies can seem to work temporarily, causing a 'click addiction' which means that the woman has to go back to the therapist again and again.
Yes - I'm very apprehensive if I hear "you have to come back twice a week for the next six months at least." But, then again, I'm no M.D. or chiropractictioner, so I guess I don't really know. It's good to hear this from someone who DOES know.
Try to use a support for your lumbar spine (and use it properly!). You may ask a physio about the use of a trochanteric belt, which helps to squeeze the sacroiliac joint. Take up exercise which strengthens the postural setting of the area, and begin to regard yoga not as an exercise which produces movement in this area, but as an exercise during which you seek to prevent movement in this area despite the external forces that are built up during the postures and movements. This is similiar to the underlying foundations of pilates, where the abdomino-pelvic floor muscles are contracted and then the arms and legs are moved around, with movement in the lower back being regarded as a failure. In this way, yoga becomes a means of protecting the lower spine whilst promoting the flexibility, posture, and strength of the hips and shoulders, and consequently the legs and arms.
This paragraph is most helpful. I don't really understand exactly how to find an exercise to strengthen the "postural setting" of the sacroiliac area, but hopefully someone at the studio or at the Dr.'s office will. I wish, wish, wish I knew more about my anatomy this pregnancy. I'm reading quite a bit, but it's not really helpful without a knowledgable PERSON to reinforce or direct.
You've been most helpful - much thanks,
Joanna |
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| Nick - sorry for the confusing post. Apparently, I don't know how to use the "quote" function correctly! My comments are in there, between paragraphs.  |
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Location: London, England | Hi Joanna,
I don't know how to use the quote function properly either, so don't worry! You asked how you would find exercises that protect your lower back, or at least find good posture whilst you were exercising. The only feasible way to find good back posture by yourself is to invest in a pressure biofeedback device-these are inflatable cushions which can be placed under the lower back and you lie down on the bag. A tube connects to the device and a meter measures the pressure that is being placed on the bag. You are supposed to inflate the bag until the meter reads the correct pressure, and then try to maintain that pressure as you move your arms and legs. Another good way to find the neutral spine would be to do cat pose-http://www.stumptuous.com/cms/displayarticle.php?aid=8
This website gives some basic instructions on doing this properly-if you search for anything with'stuart mcgill' on it, he seems to be the top person in the world for giving back advice that is pertinent to yoga students (and he doesn't even realize it!).
It would seem sensible at this time to stop the classes for a bit, or ask the teacher if they can give you a private class so that you can develop your own safe practice. Get the problem resolved, do rehab to whipe the problem off the face of this earth, and then return to yoga with the intention of using it as a tool for improving your spine-this is easier said than done-if i ever manage to complete my book I'll send you a copy-should be useful for using as a yoga block or for wedging doors open.
Take care
Nick
Edited by Nick 2006-03-16 1:01 PM
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Location: London, England | Hi Joanna,
The thing that you will notice with these exercises is that the effort is in finding a neutral spine and pelvis-with yoga, this is a vital but easily overlooked aspect which would by itself greatly reduce the problems faced by those suffering from back pain. The trouble is, there's usually a tight hip muscle that is responsible for making a neutral spine difficult to acihieve-usually the psoas in backward bends and one of the hamstrings in forward bends (the hamstrings are muscles of the hip, as well as of the knee).
How did it go with your chiro? Great success, I hope!
Nick |
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| i love stumptuous.com web site. she's an amazing gal.
i was taught that the compression, if held, could be problematic on the abdomen. most people do twists 'high' rather than low, and some feel compressed during the twist--even when they're not pregnant. i want to keep my pregnant ladies abdominals open and comfortable, so we do 'low twists' like the one i described. |
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Expert Yogi
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| Stumptuous looks very cool. Great sense of humour! I would love to give her some alignment tips, though  Pelvic tilt good, collapsed chest bad... |
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Location: London, England | Hi tourist,
Her alignment is awful, isn't it? it was the first site I came across and I was in a hurry-will try to find some good pics
Take care
Nick |
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Location: London, England | Hi Zoebird,
I think this is an interesting subject and I hope that you don't take offence with my questioning of the perceived wisdom in Yoga which contra-indicates twists for pregnant women. I haven't been convinced by the idea that compression is bad-you would probably get much more compression by breathing in deeply, climbing the stairs, getting into, or out of, a car. Given the hard physical work that women in some parts of the world have to do, and given the millions of western women who compress their abdomens every day with the activities of their lives, I would expect a lot more miscarriages-practically no one would make it to full-term, unless they stayed in bed!
Also, why keep the'abdominals open and comfortable'? A woman with awareness, endurance and strength in her abdominals is a woman with a stronger back to withstand the weigth of the foetus, and is a woman who rehabilitates more successfully after the childbirth, and is also going to recover more quickly from a c-section, and is aslo going to provide a better effort in squeezing the baby out due to the increased pressure that she can sustain. I'm probably mis-reading what you mean by open and comfortable, or it may be that the women you teach get benefit from the relaxed approach that you use which may then outweigh the benefits of having strong abs.
Take care
Nick |
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pregnancy & chiropractic
