Expert: Dr. J. Shawn Leatherman - 6/19/2006

Question
http://forums.delphiforums.com/SIJD/messages/?msg=3981.1  This is physical therapist that reseaches amd writes about Sacroilac joint dysfunction and is very against side lying position I mentioned. Can be read about at Kalindra.com athttp://forums.delphiforums.com/SIJD/messages/?msg=3981.1 That is why I was op worried!!!! Thansk for help!
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Followup To

Question -
Is chiropractic safe during pregnancy. Is it safe to manipulate Si joint when already lax due to hormones.

Answer -
Dear Jo,

Chiropractic care is absolutely safe during pregnancy.  This is actually a growing and expanding part of our clinic.  We are getting 1-2 referrals a week into our clinic from local OB/GYN's in our community due to the effectiveness in eliminating, reducing and managing low back pain for pregnant women.

Manipulation of the SI joint as well as the lumbar joints is a bit different with pregnancy.  First of all light pressure and force should be used due to the actual ligamentous laxity that you mentioned.  When pregnant, a woman's body releases a hormone called relaxin that effects all ligaments, but specifically pelvic ligaments to allow for the expansion of the pelvis and birth canal. The round ligament of the uterus is also effected and should be addressed as well.  (see below)

When a woman starts to "show" around the fourth to fifth month, it is important to stop side posture adjustments and move to more conservative manipulative techniques such as prone and supine drop table adjustments or instrument assisted adjustments. This is because the myofascial slings in the pelvis can become torqued or twisted in a manner that actually increases labor difficulty and restricts the movement of the baby in the birth canal.  Also, the belly is becoming larger and will obstruct normal patient positioning for that type of adjustment.

It is also important to have a chiropractic table with a break away pelvic/abdominal piece...this allows the belly and consequently the baby to remain unresrticted during the adjustment, and it is much more comfortable for the mother as well. **After the fourth-fifth month, Never lay on your stomach for an adjustment without this type of table, or without the use of a pregnancy cushion! -It creates too much stress on the internal environment of the fetus.**  

In addition it is important for pregnant women to have their symphysis pubis adjusted as well as the low back.  This adjustment is performed with the woman flat on her back with her hips bent at 45 degrees and the knees at 90 degrees.  It is a light force adjustment that allows the pubic joint at the front of the pelvis to remain unrestricted and allows for an easier delivery. Also the doctors hand placement is not compromising for the woman, the doctors hands are at the knees for this adjustment.

Many chiropractic physicians are not trainned in this type of adjustment, so it is important to ask about advanced trainning they may have received...make them explain it to you.  If they can't explain it to you, get another chiropractor who can concerning pregnancy.  Look for chiropractors who have advanced trainning in cranio-sacral therapy, pediatrics, and fascial unwinding.  Chiropractors that have been trained by Dr. Carol Phillips or Dr. Upledger are good choices.

Now back to the round ligament.  Some women have fetuses that are not positioned correctly for an unobstructed move into the birth canal (occiput posterior position).  A technique of adjusting for this problem is called the "Webster Technique."  This technique aids in opening up the pelvic basin for delivery.  By doing so it will allow the baby to turn inside of the birth canal so that it is positioned properly for delivery.  This is accomplished with an adjustment to the sacral base on either the right or the left- determined by the presentation of the patient- as well as a myofascial release of the round ligament of the uterus on the opposite side of the body.  Again ask your chiropractor about their training and make sure they explain it to you...many doctors do not know how to perform the Webster Technique properly.

Respectfully,
Dr. J. Shawn Leatherman  

Answer
Dear Jo,

Thank you for the follow-up information.  I will definitely look at the website you mentioned and read over the information presented as well as any research that may be presented.  Some PT's don't like chiropractic adjustments because they are prohibited from performing them under their liscense. Hopefully this is not the case with your source, but I will check it out.

I am guessing that you may be pregnant due to the questions you have asked and your review of website information.  If so congratulations on your soon to be "new edition".  Best wishes!!

Dr. J. Shawn Leatherman