Baby & Pregnancy
Pregnancy and Back Pain
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.
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
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
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
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
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
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
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
approved and fitted by a licensed healthcare provider.
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
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.
Although the majority of back pain and muscle pain
experienced during pregnancy is biomechanical and may be treated
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,
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.