Is it safe to have manual treatment during pregnancy?
Yes. Manual treatment during pregnancy, when performed by an experienced practitioner, is both safe and effective. Sarah Monaghan, BSc DC with over 20 years of clinical experience and a GCC-registered chiropractor, has treated pregnant patients throughout her career and developed a particular focus on pregnancy care since becoming a mother herself.
Pregnancy-related musculoskeletal pain is extremely common. A 2004 study published in Spine found that up to 76% of pregnant women experience lower back pain, and approximately 45% develop pelvic girdle pain. These aren’t minor inconveniences. They can affect sleep, walking, work, and daily activities significantly, particularly in the second and third trimesters.
The key is technique selection. High-velocity spinal manipulation is modified or avoided where clinically appropriate, and treatment positions are adapted as the pregnancy progresses. Costa Health uses pregnancy-specific cushioning that allows patients to lie comfortably face down even in the third trimester, removing the need to compromise on treatment quality.
What is pelvic girdle pain, and why does it happen during pregnancy?
Pelvic girdle pain (PGP) describes pain across the sacroiliac joints (at the back of the pelvis), the pubic symphysis (at the front), or both. It ranges from mild discomfort to severe, disabling pain that makes turning in bed, climbing stairs, or walking short distances genuinely difficult.
The primary driver is hormonal. Relaxin, produced from early in the first trimester, increases ligamentous laxity throughout the body. This is necessary to allow the pelvis to expand during birth, but it reduces the stability of joints that normally rely on tight ligamentous support. The sacroiliac joints are particularly affected.
A common misconception is that PGP simply has to be endured until delivery. This isn’t true. Research from the European Spine Journal (2008) demonstrated that manual therapy combined with exercise significantly reduced pelvic girdle pain compared to standard obstetric care alone. Treatment doesn’t aim to fight the natural hormonal changes. Instead, it focuses on restoring balanced mechanics across the pelvis and building muscular support to compensate for the increased ligamentous laxity.
At Costa Health, osteopathic techniques work particularly well for PGP. Gentle sacroiliac joint mobilisation, muscle energy techniques to rebalance the pelvic musculature, and soft tissue work through the hip flexors and gluteal muscles can produce meaningful improvement, often within two to three sessions.
When should treatment start during pregnancy?
There is no need to wait for pain to begin. Early treatment, ideally from the second trimester, can address developing imbalances before they become painful. But patients present at every stage, and treatment is adapted accordingly.
First trimester patients often present with pre-existing spinal problems exacerbated by early hormonal changes and fatigue. Treatment during this phase is gentle and supportive, focusing on maintaining comfortable movement.
Second trimester is when most pregnancy-related musculoskeletal symptoms emerge. The growing uterus shifts the centre of gravity forward, increasing lumbar lordosis and loading the lower back and sacroiliac joints differently. This is the most productive window for treatment because the problems are developing but not yet entrenched.
Third trimester presentations tend to be more acute. The pelvis is under maximum load, the ribcage is expanding, and sleep positions become limited. Treatment at this stage focuses on pain management, comfort, and preparing the pelvis for labour. Gentle chiropractic pelvic adjustments can help optimise pelvic alignment, which some evidence suggests may contribute to more straightforward labour and delivery.
Sarah Monaghan sees patients up to and including their due date. There is no point at which treatment becomes unsafe, though the techniques used and the goals of treatment evolve as the pregnancy progresses.
What techniques does Costa Health use for pregnancy pain?
Treatment selection depends on the presentation, the stage of pregnancy, and the patient’s preferences. Costa Health doesn’t apply a single protocol to every pregnant patient.
Chiropractic care during pregnancy uses modified techniques. The Webster technique, a specific sacral adjustment, addresses sacroiliac dysfunction and pelvic imbalance. Side-lying and seated adjustments replace prone positioning where needed, though Costa Health’s pregnancy cushioning system allows comfortable prone treatment for most patients well into the third trimester.
Osteopathic treatment is particularly well suited to pregnancy. Cranial osteopathy, visceral techniques, and gentle articulation work with the body’s changing mechanics rather than against them. For patients experiencing rib pain, breathlessness from thoracic restriction, or upper back tension from postural changes, osteopathic mobilisation of the thoracic spine and rib cage provides relief that medication cannot safely offer during pregnancy.
Sports massage adapted for pregnancy addresses the muscular tension that accumulates through the gluteals, hip flexors, thoracic spine, and calves. Positioning is modified (side-lying or semi-reclined), and pressure is adjusted. Regular maintenance massage during the second and third trimesters helps manage the cumulative physical demands.
Manual therapy techniques including dry needling can be used safely during pregnancy in specific areas, avoiding certain acupuncture points traditionally associated with labour induction. This can be effective for persistent muscle spasm and trigger points, particularly in the upper back and shoulders.
What other pregnancy-related pain does Costa Health treat?
Pregnancy pain extends well beyond the lower back and pelvis. Round ligament pain produces sharp, stabbing sensations in the lower abdomen or groin, typically during sudden movements, and is common from the second trimester onwards. While this doesn’t always require treatment, manual therapy addressing the surrounding musculature and pelvic alignment can reduce the frequency and intensity of episodes.
Carpal tunnel syndrome during pregnancy results from fluid retention compressing the median nerve at the wrist. It affects up to 62% of pregnant women (Padua et al., 2010, Muscle and Nerve). Gentle mobilisation of the wrist, forearm, and cervical spine, combined with night splinting, often provides sufficient relief without the need for corticosteroid injection.
Rib pain and costal margin discomfort become increasingly common as the uterus expands upward in the third trimester. The lower ribs are pushed outward and the intercostal muscles stretched. Osteopathic articulation of the affected ribs combined with breathing exercises can significantly improve comfort.
Sciatica during pregnancy follows the same nerve root irritation pattern as non-pregnant sciatica, but treatment must account for the postural changes and hormonal laxity that make certain positions and techniques less appropriate. Costa Health modifies the standard sciatica treatment protocol accordingly.
When should pregnant patients seek urgent care?
Most pregnancy-related musculoskeletal pain is mechanical and treatable. However, certain symptoms require obstetric assessment rather than manual therapy. Sudden onset of severe abdominal pain, vaginal bleeding, significant swelling in the face or hands, visual disturbances, or persistent headache that doesn’t respond to normal measures should prompt immediate contact with a midwife or obstetrician.
Unilateral leg swelling with calf pain may indicate deep vein thrombosis, which is more common during pregnancy. This requires medical assessment, not massage.
Costa Health works alongside obstetric care, not as a replacement for it. Sarah Monaghan communicates with patients’ midwives and obstetricians when clinically appropriate, ensuring that manual treatment complements the broader maternity care plan. The goal is always the same: to help patients move through pregnancy with less pain, better function, and confidence in the support they’re receiving.