Prevalence:
It is estimated that approximately 50% of pregnant women will experience some kind of low back pain during their pregnancy, or during the postpartum period. Of those that experience low back pain, only about 50% of them will seek advice from a healthcare professional; with only 70% of those women actually receiving treatment.
Causes:
- Mechanical: Weight gain during pregnancy, increased abdominal size, shifting of the center of mass forward; all can increase the stress on the low back. When the abdominal muscles stretch to accommodate the growing uterus, muscle fatigue typically occurs which results in an increased load on the spine. Another common finding is weakness of their gluteus medius, or the outer glute/hip muscle.
- Hormonal: Relaxin is a hormone secreted during pregnancy, and it causes your ligaments to get lax, which in turn can cause your pelvis to become unstable. This includes not only the SIJ (sacroiliac joint), but the entire low back resulting in instability of the pelvis and poor alignment of the spine.
Symptoms:
Pain is typically found over and around the lumbar, or lower spine, and above the sacrum. Typically tenderness over the paravertebral muscles is common.
Risk Factors:
Factors that may put someone at risk to experience low back pain during pregnancy may include the following: history of pelvic trauma, chronic low back pain or low back pain during a previous pregnancy, and low back pain during menstruation. 85% of women with low back pain in a previous pregnancy will develop pain in a subsequent pregnancy.
Exercise on a regular basis prior to the becoming pregnant seems to reduce the risk of suffering from low back pain during pregnancy. This is especially important as low back pain during pregnancy often leads to postpartum low back pain.
Management:
Conservative management is the gold standard for care of low back pain during pregnancy. It includes exercise, individualized physical therapy, stabilization belts/taping techniques, acupuncture, massage, relaxation, and yoga; depending on the case.
Why See a Physical Therapist?
Differential diagnosis: Physical Therapists can accurately determine if symptoms are coming from the low back or perhaps a different area, such as the pelvic girdle. The diagnosis is determined through a series of special tests and is critical as treatment for each condition is different, and should be individualized based on the case.
Treatment: Education on how to maintain a proper posture (i.e. how to stand and bend without causing extra stress on the spine or muscle fatigue, or how to get in and out of a bed so the spine is supported and not stressed) can be taught to you by a physical therapist. They can also give advice on how to use a foot stool and/or back support while sitting. It may also be advisable to avoid work that can cause increased muscle fatigue. Typical treatments may include any of the following:
- Exercising; i.e. walking, swimming
- Back support while sitting
- Use of foot stool
- Rest at midday
- Avoidance of prolonged sitting
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