Pregnancy changes everything about how your body carries weight, and for many women that shows up as low back pain, a sharp pelvic pain when turning in bed or climbing stairs, aching ribs, a stiff neck or sciatica-like pain down the leg. Gentle osteopathy can ease most of these. As an osteopath, I use adapted, comfortable techniques in side-lying and seated positions to free the pelvis, spine and ribs, and I give you practical ways to cope between sessions and in the weeks before birth.
I am Aloïs Ruetsch, an English-speaking osteopath and manual therapist in central Nice, with 15 years of practice and more than 10,000 consultations. If you see a chiropractor or a manual therapist back home, a French osteopath is the closest equivalent.
This article explains what causes pain in pregnancy, what osteopathy can and cannot do, how it fits with your midwife or obstetrician, and the warning signs that need medical care.
The essentials
- Back pain and pelvic girdle pain are the most common complaints in pregnancy, caused by hormonal loosening of the ligaments, a shifting centre of gravity and the extra load on the spine and pelvis.
- Osteopathy uses gentle techniques adapted to each trimester; some trials show less back pain and better function in late pregnancy, though the evidence is moderate and limited.
- One to three sessions usually ease a specific pain; some women come once a month in the last trimester for comfort.
- Keep walking and swimming, sleep on your side with a pillow between the knees, sit down to dress, and keep the knees together when turning in bed.
- Bleeding, fluid loss, reduced baby movements, constant abdominal pain, contractions before 37 weeks, severe headache with vision changes or a swollen painful calf need your maternity unit or emergency care. In France, dial 15 or 112.
What causes back and pelvic pain in pregnancy?
Pregnancy hormones soften the ligaments of the pelvis and spine so the body can make room and prepare for birth, and at the same time the growing bump shifts your centre of gravity forward and adds load to the lower back. The result, for many women from the second trimester on, is low back pain, pain at the back of the pelvis or in the pubic bone, known as pelvic girdle pain, and sometimes sciatica-like pain into the buttock and leg.
Higher up, the ribs flare and the breasts grow, which strains the mid-back, the neck and the shoulders, and rib pain under the bra line is common in the third trimester. Carpal tunnel symptoms in the hands, leg cramps and heartburn are also frequent. Life in Nice adds its own load: the hills, the steps of the old town, long walks on the Promenade des Anglais, and for expectant mothers who are far from family, the stress of a first pregnancy abroad. None of this means something is wrong, but it does not have to be endured in silence.
What does an osteopath actually do during pregnancy?
I begin with your history, your stage of pregnancy and any complications your midwife or obstetrician has flagged, then I assess how the pelvis, lower back, ribs and neck are moving and what provokes the pain. Treatment is done in comfortable positions, on your side with pillows, seated or on your back with the head raised in early pregnancy, never lying flat on your front.
The techniques are gentle: soft-tissue work on the buttock, lower back and hip muscles, slow articulation and mobilisation of the pelvic joints, the lumbar spine and the ribs, and muscle energy techniques in which you push lightly against my hand to rebalance the pelvis. Under French law, osteopaths perform no internal pelvic or obstetric manipulations and no internal examinations, and thrust manipulations of the neck require a medical certificate of no contraindication, so I use gentle methods on the neck. I avoid pressure on the abdomen. Every session ends with advice on sleep, dressing, stairs, driving and daily life in Nice with a bump.
Does osteopathy work for pregnancy back pain?
Manual therapy has good evidence for low back pain in general, and a small number of trials have looked specifically at osteopathic treatment in pregnancy. Those studies suggest that women who receive osteopathy in the third trimester report less back pain and less deterioration in daily function than women who receive usual care alone. The evidence is moderate at best, the trials are few, and I do not promise an outcome, but most women I see find real relief within a session or two.
For pelvic girdle pain, guidelines recommend exercise, advice and sometimes a support belt, and manual therapy fits alongside these. For heartburn, carpal tunnel symptoms and leg cramps, the evidence that osteopathy helps is limited; some women find it eases them, and I say so plainly. Osteopathy complements your antenatal care; it does not replace it, and osteopaths in France do not make medical diagnoses.
How many sessions will I need?
A specific pain that has appeared recently, such as pelvic pain on stairs or a back that seized getting out of the car, usually settles in one to three sessions of manual therapy, two to three weeks apart. The advice you take home does a lot of the work between visits.
Many women then choose to come once a month in the last trimester, as the load increases and sleep gets harder, with a final session a few weeks before the due date to keep the pelvis and back as free as possible. That is a choice for comfort rather than a medical necessity, and I am clear about the difference. If a pain is not responding or something does not fit, I refer you to your midwife or doctor rather than continuing.
What can I do myself in the meantime?
Keep moving within comfort. Walking on the flat Promenade, swimming and aqua classes are kinder to a pregnant back than the hills of Nice, and standing or sitting for long stretches in one position is often worse than gentle activity. Wear flat, supportive shoes on the pebbles and the cobbles of the old town.
For pelvic pain, keep the knees together when turning in bed and getting out of the car, sit down to put on trousers and shoes, take stairs one at a time if needed, and ask your midwife or pharmacist about a pregnancy support belt. Sleep on your side with a pillow between the knees and another under the bump. Heat on the lower back, never on the abdomen, relaxes tight muscles. Small, frequent meals and avoiding lying down straight after eating help heartburn. Your sage-femme can teach pelvic floor exercises, which are worth starting now.
When should you see a midwife or doctor instead?
Contact your maternity unit or call for emergency help straight away if you have vaginal bleeding, a gush or steady trickle of fluid, reduced or absent baby movements, constant or severe abdominal pain, regular contractions before 37 weeks, a severe headache with vision changes, sudden swelling of the face and hands, or chest pain and breathlessness. A painful, swollen, warm calf can be a blood clot, which is more common in pregnancy and after a long flight into Nice. In France, dial 15 (SAMU) or 112.
See your midwife or doctor promptly, rather than an osteopath, for fever, pain or burning when passing urine, numbness in the saddle area or difficulty controlling the bladder or bowels, weakness in a leg, or back pain that is constant and unrelieved by any position. If you have a high-risk pregnancy, placenta praevia, a history of early labour or any complication, I ask for your doctor’s or midwife’s agreement before treating, and I refer on whenever the picture does not fit.
Osteopath, chiropractor, physio or midwife: who should I see in Nice?
Your pregnancy is followed by a sage-femme (midwife) or a gynaecologist-obstetrician, and in France you can consult a midwife directly for most antenatal care and for pelvic floor advice. For back, pelvic, rib or neck pain without warning signs, an osteopath is a sensible first stop, and no referral is needed. Osteopaths and chiropractors are very similar hands-on professions; in France the osteopath is the everyday equivalent, with a five-year state-recognised degree, and chiropractors are far fewer.
A physiotherapist (kinésithérapeute) can provide a supervised exercise programme for pelvic girdle pain on prescription, and I often suggest combining the two. Your médecin généraliste can see you without a referral, pharmacies advise on belts and safe pain relief, SOS Médecins visits homes and hotels, and 15 or 112 are for emergencies. Osteopathy complements this care; it does not replace it.
How do I see an English-speaking osteopath in Nice?
Message me on WhatsApp at +33 7 71 27 24 25 or book online via Doctolib. My clinic, Pôle Ostéo, is at 22 rue Gounod in the Musicians’ quarter of central Nice, with a lift and comfortable treatment rooms. A session lasts about 45 minutes and costs €90 at the clinic. I am open seven days a week, often with same-day availability, and I consult in English, Spanish and French.
If getting around is hard in late pregnancy, I visit homes, apartments, villas and hotels in Nice and along the nearby Côte d’Azur coast for €120, with no surcharge for evenings, weekends or same-day calls. I take card or cash and give you a receipt for your insurance or mutuelle, in English on request. No referral is needed in France to see an osteopath or manual therapist.
In practice
Illustrative example, details changed. An American expat in her first pregnancy, 30 weeks along and living on the third floor of a building in Cimiez without a lift, came in with a stabbing pain at the back of the pelvis every time she climbed her stairs or turned in bed. Her midwife had found nothing worrying. The pelvic joints were irritable and the buttock muscles in spasm, with the rest of the examination normal. Two gentle sessions in side-lying, with mobilisation of the pelvis and lower back, soft-tissue work and muscle energy techniques, plus a support belt and new habits for stairs and bed, brought the pain down to a manageable level, and she came back once a month until the birth for comfort.
Frequently asked questions
Is an osteopath the same as a chiropractor?
Is osteopathy safe during pregnancy?
When in pregnancy can I start osteopathy?
Can osteopathy turn a breech baby or make labour easier?
Will I have to lie on my stomach?
Book an English-speaking osteopath in Nice
Clinic at 22 rue Gounod (€90) or a visit to your hotel, villa, yacht or home in Nice (€120, no surcharge). Seven days a week, often same day. Write in English, Spanish or French.