01 Feb Can Physio Help Pregnant Women with Back Pain?
Lumbar Pain During Pregnancy
Between 50% and 80% of women experience some form of back pain during their pregnancy, ranging from mild pain associated with specific activities to acute back pain that can become chronic. Lower back pain usually occurs between the fifth and seventh month, but can begin as early as eight to twelve weeks. Women with pre-existing lower back problems are at higher risk for back pain and it can occur earlier in the pregnancy. Women with low back pain in one pregnancy are at greater risk for low back pain postpartum and in subsequent pregnancies.
However, a substantial number of the women do not recover after delivery. Lumbopelvic pain, especially after delivery, may be a serious problem for the individual, her family, and society. Effective management to relieve pain and prevent a chronic condition thus becomes an issue of importance for all concerned with women’s health.
Lumbar pain during pregnancy is generally L2- L5 in origin and may be concurrent with radiating pain into the leg. Pain typically increases with prolonged postures or repetitive lifting. Tenderness and spasm may also be present in the Erector Spinae muscles during pregnancy.
A few women, less than one per cent, will have sciatica during pregnancy. Inflammation or pressure on the sciatic nerve causing pain, pins & needles. Statistics are similar to non pregnant women in the same age bracket.
Posterior Pelvic Pain – Pelvic Girdle Pain During Pregnancy
Pelvic Girdle Pain is four times more prevalent than lumbar pain in pregnancy. It is a deep pain experienced between the posterior iliac crests and gluteal folds, particularly in the vicinity of the sacroiliac joint and may be either uni or bi- lateral. The symptoms may begin either during the first trimester of pregnancy, at labour or even during the postpartum period.
The pain does not quickly resolve with rest, and morning stiffness may also be present. Unlike many other forms of lower back pain during pregnancy, a previous high level of fitness does not necessarily prevent this problem. It can also be associated with pubic symphysis pain and it may radiate to the groin, perineum or posterior thigh, lacking a typical nerve root distribution. A precise localisation of the pain is often impossible and may also change during the course of the pregnancy.
Around 30% of women have lumbopelvic pain up to 3 months postpartum, with 8-10% experiencing pelvic girdle pain for 1-2 years postpartum. With each pregnancy, further laxity may develop with SIJ mobility increasing up to x2.5 fold.
Symphysis Pubis Dysfunction
The increased mobility either anteriorly or laterally of the fibrous joint- pubic symphysis – during pregnancy may cause inflammation and pelvic girdle pain. Sufferers may walk with a characteristic waddling gait and have difficulty climbing stairs, problems with leg abduction and adduction, pain when carrying out weight bearing activities, difficulties carrying out everyday activities, and difficulties standing for extended periods.
It is thought to affect up to one in four pregnant women to varying degrees, with 7% of sufferers continuing to experience serious symptoms postpartum.
A related condition is diastasis symphysis pubis (DSP), in which the gap in the pubic joint widens beyond 10mm. It is normal during pregnancy for the pubic symphysis to widen 2-3 mm from the normal range of a non-pregnant woman of 4-5mm.
Causes of pregnancy Back Pain
Lumbo-sacral, Pelvic girdle and pubis symphysis pain may be caused by several factors related to changes that naturally occur in the body while pregnant.
- Weight gain – adds stress to the lumbo-pelvic structures.
- Centre of gravity changes during pregnancy. Secondary to weight gain, the centre of gravity moves anterior creating muscular imbalances and muscle fatigue.
- Hormonal surges of relaxin and oestrogen can cause problems by creating joint laxity, especially in the pelvis.
- Postural changes, as the foetus grows an associated tendency to pelvic tilt cause a posterior posture and increased muscle activity of the extensors
- Weakness of the abdominal muscles may occur as they are stretched during advancing gestation thus an excessive lordosis in standing.
- Changes in pelvic floor musculature during pregnancy due to hormones and stretching may also contribute to Back Pack during gestation.
Hormonal surges, along with the additional weight, change in centre of gravity and postural positions, contribute to weakening the structural support of the spine.
Treatment of Low Back Pain in Pregnancy
Physiotherapy is effective to help minimise or alleviate musculoskeletal back pain and dysfunction during pregnancy.
Conservative Physio management of back pain in pregnancy generally includes:
- identifying and addressing the cause of back pain
- joint and soft tissue mobilisation
- performance of appropriate & specific exercise
- education on use of proper body mechanics.
These efforts promote and support proper posture, which is essential to avoiding unnecessary stress to supporting structures.
A Physiotherapist will conduct a thorough examination and evaluation to design an exercise programme that will safely restore strength to the core muscles; as well as safely guide the pregnant woman in both weight bearing and non weight bearing exercise for a healthy pregnancy and birth.
Pelvic Floor exercises when performed correctly can also decrease the strain on the pelvic girdle; as well as minimise the problem of incontinence both during pregnancy and post partum.
A sacral belt may be required to support the pelvis during pregnancy – these can be fitted by a Physiotherapist to enable the woman to perform some of her activities. It is important to encourage
appropriate exercise as back and joint pain has been shown to respond favourably to movement and activity and adversely to rest.
Individually tailored, supervised physiotherapy is reported to be more effective for treating back pain in pregnancy than general back and/or pelvic pain therapies.
Physiotherapy can benefit pregnant and post-natal women with:
- Pregnancy-related back or neck pain
- Pregnancy related pelvic girdle pain (Pelvic Instability)
- Abdominal muscle separation (DRAM)
- Carpal tunnel and wrist pain
- Coccyx pain
- Rib pain
- Mastitis and blocked ducts
- Exercise during pregnancy
- Return to sport and exercise after childbirth
- Pre & Post natal Pilates
All HNA Physiotherapists are highly skilled in assessing and diagnosing back pain in pregnant women.
We offer a complete solution to your patients’ problem including treatment, activity modification and specific rehabilitation pre and post partum.
We are able to fit and supply sacral belts and also stock pregnancy pillows designed to offload the lumbosacral for a more pain free sleep.
Information compiled by HNA Physiotherapist Kelly J Woosnam. References available on Request.