Pregnancy-Related Hormonal Influences on the Musculoskeletal System, Lumbo-Pelvic Structures and Peripheral Joints: Some Practical Considerations for Manual Therapists

Abstract

The effects of maternal hormones upon the spine and pelvis, is not very well defined in the literature with evidence conflicting. Reports of hormonal effects (relaxin), appear to have mainly focused on the anterior cruciate, wrist ligaments, and anthropomorphic foot changes. Pregnancy hormonal influences upon peripheral joint capsulo-ligamentous structures, particular those of the lower limb, may also have indirect effects upon lumbo-pelvic structures by transferring ground reactive force (GRF) further up to kinetic chain. Objective: Review the current evidence base to increase awareness among clinicians managing maternal pain populations of how hormonal influences may affect the musculoskeletal system. Method: Literature published between 1982 and 2016 was reviewed through NCBI, Pubmed, Medline, and Ovid search engines. Additionally, a Google search of online media was conducted using the same terms. Conclusion: Hormonal changes occurring during pregnancy may affect the female musculoskeletal system in a number of ways, with potential later in life consequence. Pregnancy associated lower limb changes such as maternal reduction of the plantar arch, may indirectly contribute to lower back pain, by causing redistribution of ground reactive force (GRF) centripetally, thereby increasing axial load upon already hormonally-compromised lumbo-pelvic structures. Future research is warranted to validate and verify hormonal influences upon musculoskeletal pain and dysfunction in this population group. Despite the popularity of manual management (chiropractic/osteopathy) for pregnancy back pain management, the evidence base for this is sparse. Though a review of available literature indicated manual therapies are probably both safe and effective means of management further research is imperative support clinical practice.

Ergonomic Stressors Among Pregnant Healthcare Workers

“…[19][20][21][22] Backache and waddling gait occur due to increased levels of relaxin and oestrogen hormones, joint laxity, hypermobility and spinal curvature; in turn, this Frincy Francis, Sheeba E. Johnsunderraj, Divya K. Y, Divya Raghavan, Atiya Al-Furgani, Lily P. Bera and Aniamma Abraham increases the rate of falls among pregnant women. [23][24][25][26] In the second trimester, several symptoms cease while other physiological adaptations continue. 23,24,27 Abnormal conditions can cause anaemia, fluid retention and physiological oedema, thereby compressing the nerves and resulting in numbness and pain in the extremities.…”

“…18,19,25 Many pregnant women also experience increased levels of tiredness, varicose veins, back pain, muscular cramps, Braxton Hicks contractions and poor sleep quality. [26][27][28] Pregnancy ailments are often exacerbated by the presence of ergonomic stressors at work. 14 A pregnant employee is more vulnerable to certain occupational hazards, such as radiation exposure (at >100 millirems), infectious bioagents, heavy lifting and prolonged working hours (>12 hours per shift), due to their impact on fetal development.…”