Friday, April 1, 2005

Philosophy: Preparing for Pregnancy

by Timothy J. Maggs, DCIssue:April 2005
Chiropractic Products

Benefits of adjusting women before pregnancy

As a father of four boys, I am clearly aware of the traditional approach to pregnancy and delivery in this country today. Having been a chiropractor for 26 years, I am also clearly aware of the unwritten rules that exist in working with pregnant women. As time has passed, the experiences from these two chapters of my life have merged and led me to a conclusion that should be offered to every potential mom out there.

Present Standard Care for the Pregnant Woman
As we all know, many pregnant women also suffer from a variety of neuromusculo-skeletal symptoms during pregnancy. It is well-assumed that the increase in weight, as well as how a woman carries herself due to this increase in weight, is reason enough to stress some muscles and joints, thus leading to symptoms.

The standard and accepted protocol has always been to do whatever testing you can do without exposing the patient to x-ray, and then work hard to reduce the symptoms to a tolerable level. This is all done with the hopes that the baby will be born before the symptoms become intolerable.

I have recently received several referrals from my wife’s obstetrician and gynocologist; and in speaking with his physician assistant, I get the sense that they feel “free” in a way, as though they “get” what the rest of the world does not. They have seen good results with chiropractic, and then feel the freedom and confidence to send some of their pregnant patients who are suffering from back pain to our office for help.

Procedural Shift

What this office did not understand is that I have changed my protocol with regard to pregnant women. I have taken a stand, and I am now unfolding my plan in an effort to change the way we work with pregnant women. First, there must be a general assumption out there that, prior to pregnancy, all women are structurally sound and physically in great shape. After all, there is no “prepregnancy” program that helps women prepare for this event—and it is an event.

For the past 26 years, we have been x-raying every new patient who comes into our office. The variances in sacral base angles, Ferguson’s gravity lines, disc integrities, and cervical lordoses have shown me that most people have significant structural imbalances; and this is prior to becoming pregnant. Aren’t we the professionals who believe that imbalances in the skeletal system produce abnormal irritation to the nervous system? And isn’t that detrimental to one’s health, especially one who is about to go through 9 months of pregnancy and then the delivery process? Doesn’t it make sense that we should seek more involvement with the woman prior to her getting pregnant than just offering some pain relief when the symptoms appear during pregnancy?

The Structural Fingerprint® Examination

This examination is ideal for any woman who is considering getting pregnant within the coming 12 months. The examination has nothing to do with symptoms, and it should be done while the patient is without symptoms. It begins with a consultation to determine if the patient has had any prior structural injuries, and what tests and treatments have been done. For the most part, the majority of patients have never been through any type of structural examination, and do not have recent standing x-rays that could be used for this evaluation.

The examination begins with an evaluation of the patient’s feet in the standing position to determine the foot type. Foot type is critical, as most people have abnormal medial arches, which produce abnormal weight-bearing throughout the other joints of their body. This certainly would impair the pregnancy process, as weight imbalances would only increase over the 9-month period. Range of motion, muscle compliance, leg length, and other tests are also performed. Standing x-rays should always be done to determine biomechanical defects that need to be improved and corrected. We recommend an A-P, lateral cervical, and L-S x-ray. The A-P cervical should include an open-mouth view.

Once all of this information is collected, then a corrective program can be designed. The goal, or objective, has to be more than just symptom relief. Assuming that the patient is a 24-year-old woman who hopes to become pregnant in the next 12 months, then the goals should be to:
  • improve overall structural balance;
  • improve joint mobility; and
  • improve muscle flexibility.

Now, if the patient has one crest higher than the other and the measurement of the leg lengths is the same, then we need to check out what the foot types are. Typically, in a situation like this, you will find that the medial arch of the foot on the side of the low crest (as seen on x-ray) will be more pronated than the other arch. Obviously, custom-made orthotics would work well here.
If the sacral base angle is greater or lesser than normal, then a sudden increase in weight could produce structural problems. The same applies to Ferguson’s gravity line, which represents the center of gravity as seen from the side. On your later L-S x-ray, if the weight-bearing line is either anterior or posterior to normal, that means the weight of the body is going through areas that are unable to tolerate it, and the capacity of the lumbo-pelvic region is reduced. If this is the case and a woman hopes to become pregnant, predictably she will be more prone to back problems as well as potential delivery problems.

In our office, we set patients up on a 6-month program we call our Advanced Conditioning Program. This program includes 40 chiropractic visits, beginning with 3 times per week, and ending with once every 2 weeks. In addition, we recommend custom-made orthotics to 95% of all patients, as our goal is to improve and maintain structural balance over the course of one’s lifetime. This objective becomes much easier when the patient wears quality orthotics.

In addition to creating a symmetrical angle in the two medial arches, there is also a shock-absorption benefit when wearing certain types of custom orthotics. I tell my patients, “The more shock that is absorbed in the orthotic, the less that goes up through the body.” For a woman who is gaining weight each and every day for 9 months, this has to be a welcomed recommendation. In addition, the better condition a woman is in, the easier this journey will be. We recommend foundational-type exercises, such as core muscle, flexibility, cardio, and fitness-type exercises.

When a program like this is provided to a patient, this certainly does not totally eliminate the possibility of back pain, hip pain, or sciatica; however, it certainly reduces the likelihood. If a patient does become symptomatic during pregnancy, I can assure you they will respond much quicker and better if that they have already gone through the Advanced Conditioning Program.

Marketing This Concept

You need to have a procedure that will help to detect structural imbalances and defects, and then a report that will allow you to articulate the message to the patient.

The Structural Management® Program is one program available to doctors that will help them build their confidence in working with nonsymptomatic patients and then managing these patients through a structural-correction program. Once this confidence is in place, then release the hounds.

Obviously, one great resource is the obstetrician and gynecologist offices in your community. I have found that most of these offices have physician assistants, and they might be the more appropriate personnel with whom to meet. With whoever you get to meet, simply be prepared to inform them that women enter pregnancy with no knowledge of their structural wellness or integrity.

As a chiropractor who works with pregnant women, it is extremely difficult to only see women after they are pregnant. Second, having to work on someone without having the benefit of seeing their structural x-rays puts everyone at a disadvantage. Third, the care provided is almost too little, too late. No one wants to see a pregnant woman suffer needlessly. So, the goal is to hold an educational class, at the gynecologist’s office if possible, for those women who want to be more prepared physically for their next delivery.

Once you set this up, conveying the message is usually pretty easy. A PowerPoint presentation or flip charts can easily show the range of imbalances seen on many low-back x-rays, and the goal is to improve these imbalances before the pregnancy occurs.

This concept also can flourish by informing your current patients. Many of them are intimately connected—either through work, being related to, or knowing—with moms-to-be. Encourage these contacts to have the young woman set up a consultation in your office, and then give her a one-on-one presentation. I have found that the smaller the group, the more personalized the consult can be. Seldom will someone walk out of this consult without making an appointment for an examination.


As you can see, this approach requires energy and improved skills to get the message out there, and then to sell the program once the patient comes in. However, the alternative is to continue to function under the current medical model of care rules, which only address musculo-skeletal issues after an acute onset or chronic return of symptoms. Once you become proficient in this preonset approach, and begin informing your community of the tremendous services you now provide, the world becomes your oyster—and chiropractic moves one step closer to becoming mainstream. CP

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements.