Chiropractic care decreases postpartum pelvic pain 2015 case study suggests

A recent case study indicates that a combination therapy including chiropractic adjustments can improve pain and reduce diastasis for pubic symphysis separation in postpartum women.

Chiropractic care including stabilizing exercises, home care advice, a sacroiliac belt, as well as specific chiropractic adjustments to reduce joint dysfunction appears to decrease the pain and immobility associated with postpartum pelvic pain associated with pubic symphysis diastasis, a recent study shows.

This March 2015 study, “Chiropractic management of postpartum pubic symphysis diastasis: A case report,” involved treatment of a 30-year-old female with severe postpartum pain.¹ “Existing literature concerning chiropractic care for symphysis pubis dysfunction during pregnancy is limited,” the study author says, but it “indicates a potential benefit.”

A reduction in pain

In this study, the patient’s pain improved immediately following treatment. This involved “chiropractic adjustments, trigger point release, electrical stimulation, moist heat, sacroiliac belt and specific stabilizing exercises.” The patient’s pain diminished from 2 on the VAS pain scale on the first visit to 2 on the fourth visit. She resumed normal activities after reaching a final pain level of 1.

Additionally, the diastasis was reduced from 17 millimeters to just under 10 millimeters, the study states.

The author conducted a literature search using the Chiropractic Literature and PubMed.gov as part of this study. No previous literature was found concerning the chiropractic care of a patient with diastasis, and only two articles describing pelvic pain during pregnancy were found.

Other solutions for symphysis pubis diastasis

Symphysis pubis diastasis is defined as “a complication of pregnancy and vaginal delivery in which the pubic symphysis separates, resulting in acute pelvic pain.” In some cases, severe long-term consequences have been observed.²

While it is considered a rare cause of pelvic pain in pregnancy, it could be under diagnosed, the author suggests. Diagnosis is made based upon symptoms and radiography. Conservative treatment, where possible, is recommended, according to the study author.

Surgical intervention may be warranted for separations measuring greater than 25 millimeters, but it will interfere with breast-feeding due to analgesics, antibiotics and thromboembolic prophylaxis. Such intervention involving plate and screws necessitates caesarian section for future pregnancies, the study states.

Small study sizes and low-quality study designs has made the use of TENS for specific conditions, such as back pain, controversial. This despite their analgesic affect on acute pain has been demonstrated through randomized control trails.³

Conclusions drawn

According to this study, chiropractic care and specific stabilizing exercises reduced joint dysfunction at the lumbar, sacral and pelvic areas and appears to help reduce. This facilitated a return to normal activities for postpartum women.

The author acknowledges that there is no way to know what intervention helped in this patient’s improvements or whether reduction in pain and decreased diastasis resulted from natural history. That said, the potential for long-term pain and disability indicates the need for further investigation. Continued collaboration between obstetricians, midwives, and chiropractors is encouraged.

References

¹ Henry, Lucian, BSc, DC. Chiropractic management of postpartum pubic symphysis diastasis: a case report. J Can Chiropr Assoc. 2015 Mar;59(1): 30-36.

² Scriven MW, Jones DA, McKnight L. The importance of pubic pain following childbirth: a clinical ultrasonographic study of diastasis of the pubic symphysis. JR
Soc Med. 1995;88:28–30.

³ DeSantana JM1, Walsh DM, Vance C, Rakel BA, Sluka KA. Effectiveness of
transcutaneous electrical nerve stimulation for treatment of hyperalgesia and
pain. Curr Rheumatol Rep. 2008 Dec;10(6):492–9.