Pregnancy massage
Pregnancy is a wonderful and exciting time of life but the drastic changes to a woman’s body can leave her feeling tired and sore. Luckily, remedial massage can have a positive effect, on not only the pregnant woman but also the unborn baby.
What happens during pregnancy?
There are a lot of changes that occur in a woman’s body during pregnancy. These changes affect almost all organ systems. One of the major changes during pregnancy is the production of the hormone relaxin. In preparation for childbirth, this hormone relaxes the ligaments in the pelvis and softens and widens the cervix. As a result, joint mobility increases, and the biomechanics of the body are changed in which pregnant women can see changes in posture, such as exaggeration of lumbar lordosis (inward curvature of the spine). This often results in back pain throughout the pregnancy, especially towards the end of the pregnancy, which most women (about 80%) will experience. [1]
Symptoms during pregnancy
Many women complain about lower back pain throughout their pregnancy. This can have a negative impact on their quality of life. Lower back pain usually presents itself in two different forms in pregnancy. The first is pelvic girdle pain between the posterior iliac crest and the gluteal fold. The other presents itself as lumbar pain over and around the lumbar spine. It is important to differentiate between the two sources of pain early so that the most appropriate treatment can be applied to reduce the pain and improve pregnant women’s quality of life.
One of the main causes of lower back pain during pregnancy is mechanical factors. This is due to weight gain during pregnancy, the increase of the diameter of the abdomen, and the shifting of the body gravity center anteriorly which increases the stress on the lower back. In addition, the stretching of the abdominal muscles to accommodate the enlarging uterus causes extra load on the spine. Weakness of the gluteus medius is also strongly related to lower back pain during pregnancy.
Pelvic girdle pain is four times more common in pregnancy and the postpartum period than lumbar pain. This pain presents between the posterior iliac crest and the gluteal fold and can radiate down the thigh, to the knee, and calf. This pain can affect one side or both sides of the body, be recurrent or continuous, and is described as deep, stabbing pain. This lower back pain often minimizes physical activity and causes withdrawal from social interactions. Pregnancy-related lower back pain has a good prognosis if it is identified early so that the most appropriate treatment can be applied and lead to the best possible outcome. [2].
Treatment
Pregnant women may seek treatment for many symptoms during pregnancy including back pain, nausea, sleeplessness, stress, and anxiety. Often pregnant women do not have as many medication-based options to relieve their symptoms, so they seek nonmedication-based treatment. As a result, allied health modalities, such as massage, are highly sought-after treatment options. It has been reported that up to 36.8% of Australian women visit an allied health practitioner during pregnancy, with close to half of those seeking massage.
The treatment for the client should be completed in a side-lying position. This is to ensure placental and fetal circulation. The client should lay on the left side as this is safest because it allows maximum cardiac function and oxygen for the fetus. Lying on the back can leave the client feeling dizzy, weak, nauseous, and short of breath due to compression of the vena cava. Clients should not be placed on their backs for long periods of time and if it is necessary to lay on their back, place a pillow under the right hip to tilt them to the left. In the early stages of pregnancy, a pregnancy pillow can be used so that the client can be in a prone position. However, side-lying is the safest position and should be utilized the most.
A treatment plan would be developed after relevant tests are completed and the results are determined to make a specific treatment plan for the specific needs of the person. If the tests conducted point more towards lumbar pain over the lumbar spine, then the treatment plan would include treating the muscles along the lumbar spine, the spinal erectors, and the quadratus lumborum. The treatment could continue into the gluteal muscles if necessary. If the complaint is more in the pelvic area, then the treatment would look at treating the lower back region including quadratus lumborum and the gluteal region, treating gluteus maximus, minimus and medius, looking at tensor fasciae latae, and even going down to the upper and lower leg if the complaint travels down the leg. [3, 4].
Considerations
Some major considerations to consider when working with pregnant women would be to make sure it is not a high-risk pregnancy. This includes diabetic mothers, cardiac disorders, chronic hypertension, previous pregnancy problems, asthmatic mothers, vaginal bleeding, dizziness, shortness of breath, chest pain, decreased fetal movement, pre-eclampsia, deep vein thrombosis, placenta problems, and neurological impairment. Medical assessment must be sought for any of these symptoms. Once medical clearance is received from a doctor and massage is deemed safe, massage can be performed [4, 5].
Benefits of massage
Massage provides many benefits to women during their pregnancy. This can include:
- Relieving stress and anxiety
- Relieving lower back pain by relaxing muscle tissue which reduces painful contractions and spasms
- Reducing nerve compression
- Reducing depression and improving sleep quality, not only during pregnancy but also in the postpartum period
- Newborns are less likely to be born prematurely or low birth weight, and have lower cortisol levels [6, 7].
[2] Fogarty, S, McInerney, C & Hay, P, 2020. Pregnancy-related Pelvic Girdle Pain and Pregnancy Massage: Findings from a Subgroup Analysis of and Observational Study. Int J Ther Massage Bodywork 13: 2, pp. 1-8.
[3] Fogarty, S, Barnett, R & Hay, P, 2020. Safety and Pregnancy Massage: a Qualitative Thematic Analysis. Int J Ther Massage Bodywork 13: 1, pp. 4-12.
[4] Salamon, M, 2018. Massage and Pregnancy: A Powerful Combination. Massage Therapy Journal.
[5] Webb, L 2018, Effectiveness of massage to treat pain during pregnancy. Massage Schools of Queensland.
[6] Woolston, C, 2016, Massage for Pain Relief, HealthDay.
[7] Field, T, Diego, M, Hernandez-Reif, M, Deeds, O & Figueiredo, B, 2009. Pregnancy massage reduces prematurity, low birth weight, and postpartum depression. Infant Behaviour and Development 32: 4, pp. 454-460.