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Baby & Pregnancy
Pregnancy and Back Pain
By Joel T. Groft, D.C.
June 2005

Pregnancy Back PainJennifer is a healthy 29-year-old woman who, in her 14th week of pregnancy, was in pain and concerned about the health of both her and her baby. She consistently was having sharp pains in her low back that seemed to increase when she would try to bend forward, stand for any period of time, or sit. She even started to notice some of the pain traveling into her left buttock. Dedicated to the health of her baby, Jennifer was trying to refrain from anything that could potentially harm the development of her child. She had quit drinking coffee, strictly refrained from alcohol, and made sure to stay clear of any cigarette smoke. She also didn’t want to take any medications while pregnant, unless absolutely necessary. Her back had bothered her once or twice before she was pregnant, but it had not been this consistent or painful. She was concerned, in pain, and needed help.

Jennifer’s story is not uncommon. It is estimated that approximately 50% of all pregnant women will experience some sort of back pain either during their pregnancy or within six months following delivery. During pregnancy, many of the medical treatments for back pain are not available to patients due to a potential negative affect on the developing fetus. Even if indicated as safe, pain medications don’t address the factors triggering the pain, but rather work only to mask symptoms until our bodies are able to repair themselves. If you are pregnant or planning on becoming pregnant, you need to know some of the causes and contributing factors to back pain as well as some of the possible non-pharmaceutical options for the management of this common problem.


Fig 1

Why do Pregnant Women Develop Back Pain?
As a woman progresses through pregnancy, her body goes through many changes. These changes include increased body weight (av. + 22-26.5 lbs) increased abdominal size, increased breast size, and increases in ligament flexibility. As the fetus grows, postural changes occur to allow the woman to maintain her balance while walking. In general, the hips roll slightly forward, and the center of gravity changes, moving both inferiorly and backward. These changes can result in a “jamming” of the spinal joints of the low back. This pain is most usually noted when twisting or arching backward. Often this condition is referred to as “facet syndrome” see fig 1.


Pregnant women commonly develop pain where the pelvis and the sacrum/tailbone join (sacroiliac joint). This joint is typically a very strong stable joint. It is reinforced in both the front and back with strong thick tissues called ligaments. This reinforcement is necessary due to the large amount of force experienced by this joint when we are standing, sitting, walking, or running. When healthy or uninjured, these ligaments, along with a rough joint surface, allow for a strong stable joint that maintains the amount of movement needed to allow for normal weight-bearing activities.

During pregnancy, a chemical substance called relaxin is produced by the body at a level ten times the normal non-pregnant level. When present in these high amounts, relaxin causes the ligaments throughout the body to become more flexible and lax. These higher levels are needed to allow the woman’s body the ability carry and deliver her child.

Relaxin affects the entire body and, therefore, has the potential to create joint laxity where joint stability is needed. This is what happens in the pelvic joints. Due to the increased amounts of relaxin, the ligaments become lax, allowing for increased movement in the joints. This increased movement combined with the other physical changes (change in weight and weight disposition) can lead to increased joint load resulting in abnormal movement and pain.


Sacroiliac joint

Abdominal strength, endurance, and tone are important factors in both controlling and preventing back pain. During pregnancy, these muscles stretch to accommodate the increasing size of the fetus. This “stretch” results in decreased strength and muscle tone, in turn limiting the ability of these muscles to stabilize the low back. This decrease in muscle function has the potential to compound the previously mentioned low back problems/complaints. Unfortunately, it may take some time following delivery for these muscles to regain their strength and coordination. Some of the back complaints experienced by women following delivery are attributed to this delayed return of abdominal strength. Surgeries such as cesarean section and episiotomy can increase this period of abdominal weakness and deconditioning.

What can be done to Control Back Pain during Pregnancy
If you have back pain prior to becoming pregnant, there is a good chance that you will have either increased frequency or intensity of your symptoms during pregnancy. It is therefore important to have yourself evaluated, treated, and put on some type of exercise program aimed at improving the strength of the muscles that support the spine. Secondly, any woman considering becoming pregnant should maintain an active lifestyle prior to pregnancy. Pregnancy is a condition that affects every aspect of a woman’s body; it makes sense to try to enter pregnancy in good physical condition. There are now pre-pregnancy exercise classes offered by several local trainers as well as yoga and palliates instructors. Most exercise programs must be modified during pregnancy, but, otherwise, they can be maintained throughout most of the pregnancy. Any exercise program that you perform during pregnancy should be discussed with your obstetrician, midwife, or primary care provider.

Ergonomics and Posture
Poor posture, poor ergonomics, and the repetitive nature present in many of today’s jobs are common contributors to back pain, neck pain, shoulder pain, and hand pain. Due to the physical changes previously mentioned, many of these factors are compounded during pregnancy. Workstation ergonomics may have to be evaluated and altered during pregnancy in the goal of minimizing their potentially negative affects. As previously stated, the physical changes of pregnancy are going to affect posture and possibly put excess stress on the joints, ligaments, and muscles of the spine, shoulders, and hips. Learning proper postural poses or strengthening exercises can decrease the intensity and frequency of symptoms related to these problems. If you are planning on working throughout the majority of you pregnancy, it is important to make sure that your “office” setting allows for proper ergonomics.

Stretches and Massage
Many massage therapists offer pregnancy massage. This type of massage is aimed at relaxing the mother as well as improving blood circulation, increasing mobility, and breaking up any scar tissue or improper connective tissues present in the muscle bellies and their attachments. Special pillows, tables, and supports have been developed to allow the pregnant patient to rest comfortably during massage.

Braces
Several different types of back supports have been developed to help support the woman’s back as she progresses through pregnancy. They work by guiding the woman into the proper posture while adding support to the lumbar spine and simultaneously reinforcing the weak stretched abdominal muscles. Although the use of braces is a viable option during pregnancy, it is important to have the brace approved and fitted by a licensed healthcare provider.

Chiropractic Care
Chiropractors use a wide variety of techniques to treat musculoskeletal complaints. Manipulation of the pelvis and spine during pregnancy is considered to be very low risk and a good modality for management of back pain during pregnancy. Generally, a doctor of chiropractic medicine will take a detailed history of your complaint, followed by a thorough physical examination. Following examination, the doctor may perform manipulative therapies, specific muscle massage, prescribe specific exercises and/or stretches and postural poses. Ultimately, the goal is to find ways that the patient can be actively involved in decreasing the frequency, intensity, and duration of her complaints.

Medical Care
Although the majority of back pain and muscle pain experienced during pregnancy is biomechanical and may be treated conservatively, it is important to have a medical provider monitor your pregnancy in the chance of any complications. Generally, low back pain during pregnancy is not a sign of pathology. Acute pain, especially when accompanied by vaginal bleeding or any hemorrhaging, needs to be evaluated by your obstetrician.

This article is to be used only as an informative guide and in no way should be substituted for an evaluation from a qualified healthcare provider.

Dr. Joel T. Groft, of Athens Chiropractic Healthcare specializes in the diagnosis, treatment, and rehabilitation of musculoskeletal injuries and cares for patients of all ages and activity levels. He can be reached at (706)227-3292.

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