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Back Pain in Pregnancy

Pregnancy is a wondrous time for prospective parents. For most women, the changes that occur in their body during pregnancy are an endless source of interest over the 40 weeks. As the mother’s body changes every day during pregnancy, it is not surprising that some physical discomfort is common, even normal. The pelvic region undergoes most change as the ring of pelvic bone tips outwards to provide space and support for the growing baby. Abdominal muscles and other tissues stretch… and stretch… and stretch. Postural compensations occur because of the bony and soft tissue changes in the pelvic region. Changes in posture can be tiring, as muscles are forced to work in different patterns. This is one reason for tiredness to be a common symptom both in the first trimester and again later in the last 1/3 as the weight of the womb and its contents increase.

Avoiding muscular discomfort is relatively straightforward. While sitting, securely support the back with pillows or cushions. This makes a huge difference to comfort. In the office environment, sitting fully back into the chair ensures the weight of the abdomen is carried by the chair, not the lumbar muscles. At home, slouching in a deep low sofa can tend to worsen discomfort and in late pregnancy can prove impossible to get out of, so switch to a kitchen chair or even an old style rocking chair to lessen lumbar discomfort. In terms of footwear a moderate heel supports the weight of the tummy better than either high heels or perhaps surprisingly, flatties.

Back discomfort is also relatively common throughout the pregnancy, though, as you would expect, more so in the later weeks.

There are four main types of back discomfort in pregnancy:
Aching related to postural changes
Discomfort related to position of the baby
Discogenic back pain
Sacroiliac pain from alteration in pelvic position
The first two are obvious and natural. To balance the growing weight of the baby, many women automatically respond by leaning slightly backward to counterbalance the increasing size and weight of the tummy on the bony framework of the lumbar spine. This slight postural alteration increases lumbar muscle activity, leading to local aching of the back muscles, the symptom of extra muscle activity. It usually occurs towards the end of the day and is relieved simply by rest or a night’s sleep.

The mother’s posture is also influenced by where and how the baby lies. A baby’s elbow or knee poking into a ribcage can be uncomfortable in the short term, but generally relieves when the baby moves.

More serious is discogenic pain, which is thankfully rare in pregnancy. Here a disc becomes torn or inflamed, pressing on the sciatic nerve. This causes back and leg pain, which can be debilitating. The ‘Gold Standard’ assessment for disc problems is MRI, a radiological test which is usually not undertaken in pregnancy, so assessment is made on clinical signs alone. Treatment of true disc inflammation or rupture is complicated during gestation as most drugs and some other treatments are contra-indicated at this time. Physiotherapy treatment involves a combination of manual therapy, specific exercise, postural advice and rest, all with a view to assisting disc healing. Disc problems in pregnancy often necessitate time off work, as without sufficient rest when the acute inflammation is present, it can be very difficult to get it to settle.

Sacroiliac pain is the most common type of backpain in pregnancy. The two sacroiliac joints are at either side of the lower spine. These joints are normally held virtually rigid by very strong ligaments. However the hormones of pregnancy relax these ligaments to allow the pelvis splay outwards to support the weight of the growing baby. This process brings instability to a usually stable region. Pain is felt around the pelvic ring: in either buttock, either groin or even at the centre of the pelvic ring in front.

Sacroiliac instability affects many women, most often in the second half pregnancy. It can show as difficulty transferring weight from one leg to the other, so walking, climbing stairs, getting in or out of the car are symptoms associated with this problem, as is difficulty in turning in bed.

Even up to very late stages of pregnancy sacroiliac instability can be successfully treated by skilled musculoskeletal Chartered Physiotherapists. Treatment involves manual mobilisation (allowed right up to the end of the pregnancy), specific exercises to actively tighten local muscles and use of a small neat but highly structured belt that mechanically pulls the pelvis together. Sometimes problems can persist after birth due to ongoing muscle laxity. Again physiotherapy can cure this speedily.

So if you or someone close to you is pregnant and complaining of back discomfort, may I suggest that assessment by a skilled physiotherapist can be helpful to sort out the underlying cause of the dysfunction. Finally remember that moderate physical activity is recommended for all medically fit pregnant women. Being fit implies better muscle function, which is more likely to protect the back before, during and after birth.
Mairead O’Riordan, MSc, MISCP is a senior Chartered Physiotherapist & CEO of TherapyXperts, an allied health network dedicated to clinical excellence.
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