As you may have heard on sports news, one of the devastating injuries feared by athletes is the “terrible triad”, the combination of a torn ACL, MCL, and medial meniscus of the knee. Often requiring surgery, this injury can knock athletes off the field or court for 6 months to nearly a year, or force them into retirement. In pregnancy, there is a terrible triad that is not a surgical emergency jeopardizing a 4-year contract, but it is unpleasant just the same. The Terrible Triad of Pregnancy is the following:
1. Weight gain: Predominately occurring in the third trimester, women will naturally gain weight as the developing baby adds 3.5 pounds and 5.5 inches of growth during this phase. The growth of the baby also compresses the diaphragm and ribs, making a full inhalation seem impossible. Swollen ankles, varicose veins, hemorrhoids, and indigestion round out the consequences of weight gain in the third trimester.
2. Foundational shifts in alignment: As the center of gravity for mother shifts forward and upward with her weight gain, the weight distribution to her joints changes. The new postures and stresses to her knees, hips, and low back can create changes to her entire spine. The lumbosacral spine and hip joints are most commonly challenged. Gait alterations may occur as well, altering the load on her spine and increasing the incidence of strain/sprain injuries to her spinal segments and supporting structures (Ohm, 2013).
3. Ligament changes due to hormones: The hormones relaxin and elastin are critical to allowing the pelvis to successfully deliver the fetus. While integral to a successful birth outcome, these powerful hormones can cause shifts in alignment and gait alterations in the third trimester. The effect of these hormones does not only reach the ligaments and structures of the pelvis, but the entire body. Mom may notice an increase prevalence of turning her ankle and changes in her overall posture as her mid-back and neck compensate for her shifts in weight. Chiropractic care is extremely effective during pregnancy, but the doctor needs to be highly aware of the changes in the spine and ligaments as they deliver the chiropractic adjustment. The same adjustment given to a woman before pregnancy and in her third trimester may have different outcomes if the doctor is not familiar with prenatal chiropractic care.
The combination of these three factors adds to the likelihood of pelvic distortion or misalignment, intra-uterine constraint, and low back or hip pain. Pelvic distortion relates to a change in the normal alignment of the pelvis. Intra-uterine constraint refers to any changes in sacral positioning that could interfere with normal positioning or movement of the baby. Low back pain has been reported in 42.5% (Clapp, 1993) to 90% (Revelli, 1992) of pregnant women. “There are no known contraindications to chiropractic spinal and pelvic adjustments throughout pregnancy other than those affecting any non-gravid (non-pregnant) individual (Ohm, 2013).”
The Terrible Triad in Pregnancy is a complex of changes that occur during pregnancy to ensure a successful birth. They are necessary physiological and biomechanical processes, but they can cause challenges if foundational alignment is not maintained. Our office supports the normal functioning of the spine and nervous system to create a healthy pregnancy and birth environment.
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Dr. Evan Pulver