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The ChiroUp protocol, “Pregnancy Related LBP” provides a concise summary on safely and effectively managing this problem. Here’s an excerpt that addresses employing physiotherapy modalities during pregnancy:

“The use of continuous or pulsed ultrasound is contraindicated over the low back, abdomen, and uterus during pregnancy, as potentially teratogenic sound waves may pass through amniotic fluid. (1) Clinicians should avoid most forms of electrical stimulation over the low back, pelvis, or abdomen during pregnancy. (1) Unwanted uterine contractions are the primary risk associated with e-stim. (2-5) The effect of electrical current on a developing fetus is uncertain and clinicians should use extra caution when considering the potential risk vs. benefit for application to distant sites. (1) Clinicians may, however, consider the use of a sensory-level TENS unit to sites remote from the uterus and abdomen. TENS has been shown to be safe and beneficial for treatment of lower back pain during pregnancy with no reported adverse affects on the newborn. (2-4,6,7) The use of low-level laser therapy is contraindicated during pregnancy due to possible light-induced effects on fetal growth and development. (1,8) Application of superficial heat to distant sites is safe, however clinicians should avoid application of heat to the trunk or full body (i.e. hydrotherapy tank) as elevation of maternal body temperature is known to cause fetal malformations. (9,10) The application of superficial ice is a safe alternative. (1) The use of thermal or non-thermal forms of short-wave therapy is strongly contraindicated during pregnancy. (1)”

Clinicians must use exceptional discretion when considering treatment options for pregnant patients. Perhaps the wisest approach comes from our distinguished board member, Dr. David Flatt, who tells his pregnant patients: “I’ve not seen conclusive evidence that modalities are safe or unsafe in the presence of a pregnant uterus. Therefore until I am certain, I consider them off limits while you are pregnant. But, don’t be discouraged, I have plenty of other options to effectively treat your pain.”

1. Rennie S. Electrophysical Agents- Contraindications And Precautions: An Evidence-Based Approach To Clinical Decision Making In Physical Therapy. Physiother Can. 2010 Fall; 62(5): 1–80.
2. Belanger AY. Physiological evidence for an endogenous opiate-related pain-modulating system and its relevance to TENS: a review. Physiother Can. 1985;37:163–8.
3. Chapman CR, Benedetti C. Analgesia following transcutaneous electrical stimulation and its partial reversal by a narcotic antagonist. Life Sci. 1977;21:1645–8. doi: 10.1016/0024-3205(77)90243-0.
4. Immediate influence of transcranial electrostimulation of pain and ß-endorphin blood levels: an active placebo-controlled study. Am J Phys Med Rehabil. 2003;82:81–5.
5. Dunn P, Rogers D, Halford K. Transcutaneous electrical nerve stimulation at acupuncture points in the induction of uterine contractions. Obstet Gynecol. 1989;73:286–90.

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