Osteopathy during pregnancy in Paris 16
Muscle and joint pain during pregnancy & after birth
Charbel Jean Kortbawi, osteopath in Paris 16
Former osteopath at the American Hospital of Paris (Maternity Unit)
Causes and contributing factors to joint and muscle pain in pregnant women
Mechanical and postural changes during pregnancy
Pregnancy is a period of profound physiological changes that have a significant impact on the body mechanics and posture of the pregnant woman. Understanding these changes enables us to take better care of you, so as to prevent and effectively treat the associated pain and discomfort.
During pregnancy, the progressive increase in the weight and volume of the uterus leads to an anterior shift in the center of gravity. This postural change manifests itself in an accentuated lumbar lordosis (arching of the lower back), an anterior tilt of the pelvis and a stretching of the abdominal muscles. These changes can lead to increased stress on the lumbar and pelvic regions, frequently resulting in lumbar pain, symphysis pubis pain or sacroiliac pain. The lower limbs are also subject to increased stress, due to increased body weight and the postural adaptations required to maintain balance. This can lead to pain in the hips, knees and feet.
Hormonal changes impacting the musculoskeletal system
During pregnancy, major hormonal changes occur which have a significant impact on the musculoskeletal system. Among these hormones, relaxin plays a predominant role, accompanied indirectly by progesterone and estrogen.
Relaxin, produced initially by the ovarian corpus luteum and then mainly by the placenta, peaks during the first trimester. It causes marked ligament laxity, particularly in the pelvis, facilitating the passage of the fetus during delivery. This increased laxity can also extend to other joints, increasing their mobility and potentially exposing them to the risk of joint instability and musculoskeletal pain such as low back pain or pelvic pain.
Progesterone, although primarily involved in uterine smooth muscle relaxation, can indirectly amplify general muscle relaxation and slightly influence ligament laxity, without however constituting the major hormonal effect.
Estrogens, on the other hand, induce fluid retention and increased soft-tissue vascularization, which can lead to increased joint sensitivity and exacerbate muscle or ligament discomfort, without however directly causing significant ligament laxity.
Indications of osteopathy during pregnancy
Low back pain and pelvic girdle pain
Lower back and pelvic pain is one of the most common complaints during pregnancy, affecting up to 50% of pregnant women. A systematic review by Franke et al (2017) in the Journal of Bodywork and Movement Therapies indicates that osteopathy significantly reduces this pain and improves functional pelvic mobility. These findings are corroborated by another randomized controlled trial conducted by Licciardone et al. (2010) published in the American Journal of Obstetrics & Gynecology, which reports a substantial improvement in symptoms in women who received osteopathic treatment compared with a control group. The PROMOTE study by Hensel et al (2015), published in the American Journal of Obstetrics & Gynecology, found significant improvement in low back pain and functional improvement in pregnant women receiving osteopathic treatment.
Preparing for labour
Osteopathy offers a complementary, non-invasive approach to helping pregnant women prepare for childbirth.
Osteopathic treatment aims to relieve mechanical stress by working gently on joints, muscles and ligaments. These gentle, non-invasive techniques facilitate pelvic mobility, optimize posture, improve blood and lymph circulation, and reduce musculoskeletal tension. In this way, osteopathy also helps prepare the body for a more harmonious childbirth.
Several scientific studies underline the value of osteopathic consultations in the prenatal period to improve the general well-being and quality of life of the mother-to-be, promoting better adaptation of the body to the changes of pregnancy (Sheraton et al, 2018; Correia et al, 2023, Correia, M. L. A. et al, 2024.).
Pregnancy rib pain
Rib pain during pregnancy is common and mainly related to the expansion of the uterus pushing against the rib cage, the position of the baby and the action of relaxin relaxing the ligaments. The diaphragm may also be compressed, causing breathing difficulties or additional tension. Osteopathy can help relieve these pains by reducing muscular and diaphragmatic tension, thus improving thoracic mobility and respiratory comfort. These pains usually disappear after childbirth.
Sciatica
Sciatica is a pain that radiates along the sciatic nerve, starting from the lower back or buttock and travelling down the thigh, calf, and sometimes the foot. It affects many pregnant women, particularly from the second and third trimester onwards.
During pregnancy, several factors contribute to compression or irritation of the sciatic nerve. The increasing volume of the uterus places direct pressure on the pelvic structures, while postural changes — accentuation of lumbar lordosis and pelvic tilt — create increased stress on the lumbar vertebrae and sacrum. The ligamentous laxity induced by relaxin can further destabilise the sacroiliac joints, aggravating nerve irritation.
Frequently Asked Questions (FAQ)
When should I start seeing an osteopath during pregnancy?
Osteopathic treatment is generally initiated from the end of the first trimester, around 12 to 14 weeks of amenorrhoea. This precaution is justified by the naturally elevated risk of spontaneous miscarriage during the first trimester: according to the American College of Obstetricians and Gynecologists (ACOG, 2018), approximately 10% of clinically recognised pregnancies end in spontaneous miscarriage, with 80% of these occurring during the first trimester. While osteopathy has no formally documented contraindication at this stage, clinical practice recommends, as a precautionary and ethical measure, waiting until the end of the first trimester before treating lumbar and sacroiliac pain, in order to avoid any confusion with an independent obstetric event.
Is osteopathy safe during pregnancy?
Yes. Osteopathy is a non-invasive manual medicine whose safety during pregnancy has been evaluated in several reference clinical trials. The PROMOTE study (Hensel et al., J Am Osteopath Assoc, 2016), conducted in 400 pregnant women in their third trimester, identified no increase in the risk of obstetric complications in the treated group. The techniques used are specifically adapted to each trimester — with no direct manipulation of the uterus or pelvic examination. Absolute contraindications include high-risk pregnancies, severe gestational hypertension, placenta praevia, active metrorrhagia, and threatened preterm labour. Outside of these situations, osteopathic treatment has been shown to be a safe and effective modality for improving pain and spinal function throughout pregnancy (Licciardone et al., 2010; Hensel et al., 2015).
When should I see an osteopath after giving birth?
There is currently no official recommendation establishing a precise timeframe. Based on current clinical practice, a consultation is generally considered from 6 to 8 weeks postpartum, in line with standard obstetric follow-up. It may be brought forward in cases of persistent coccyx pain, lumbosacral pain, postural difficulties related to breastfeeding, or following a caesarean section.
Several verified scientific references support the value of manual therapy in the postpartum period. The narrative review by Zhang et al. (Medicine (Baltimore), 2024; 103(40):e39869) confirms that manual myofascial therapy effectively reduces postpartum pain by acting on deep muscle strength, postural realignment, and the remodelling of myofascial structures. The randomised controlled trial by Schwerla et al. (J Am Osteopath Assoc, 2015), conducted in 80 women with persistent low back pain for at least 3 months after delivery, demonstrated a significant reduction in pain and functional disability following four osteopathic sessions. Finally, the systematic review and meta-analysis by Franke et al. (BMC Musculoskelet Disord, 2014) concludes that osteopathic treatment produces clinically relevant effects on postpartum pain and spinal function. The authors note, however, that larger randomised trials are needed to establish standardised treatment protocols.
How do I make an appointment?
You can book an appointment directly online via Doctolib or by phone at 06 01 77 09 97. The practice is located at 7 rue Georges Ville, Paris 16th, Monday to Friday from 9am to 7:30pm and Saturday from 9am to 1pm.