Pregnancy-Related Low Back Pain

Pregnancy - Related Low Back Pain

  - Dr. Jeffrey Luebbe

As most women who have been pregnant know, lower back pain is a very common malady during those exciting, but trying months.  It is estimated that 50%-75% percent of pregnant women suffer lower back pain, and some reports say that nearly all will suffer low back pain.  In a study done in 1988 involving 2,862 pregnant women, all had some level of lower back pain, and 79 of them suffered pain that disabled them. Approximately one-third of untreated pregnancy-related lower back pain (PRLBP) results in chronic lower back pain long after delivery.  

While PRLBP is related to the various musculoskeletal (joint, ligament, and muscle) structures of the mother’s body, some lower back pain may be of a more serious nature.  Severe lower back pain with vaginal bleeding or pain in the pelvic organs needs to be assessed quickly by the OB/GYN.  Pain that is from a musculoskeletal origin can generally be relieved by some position or movement or stretch, but pain that cannot be relieved in any way is more serious and needs to be examined immediately.

PRLBP may impair the woman’s ability to perform everyday activities such as caring for herself, dressing, walking, etc. as well as interrupting normal sleep patterns.  Most often, the intensity of the back pain increases with time as the pregnancy progresses.  Unfortunately, some women – especially in the early stages of pregnancy – may think of pain in the low back pain as a catastrophic event and thus avoid any and all activities.  This causes significant emotional and physical problems for the mother. 

A quick look at the anatomy of the lumbopelvic spine (lower back and pelvic areas) is helpful in discussing lower back pain. (see figure1)  The typical pain sensitive structures include the joints in the spinal column (facet joints and lumbar discs), the joints of the pelvis (sacroiliac joints), and the muscles of the lower back.  As a woman’s baby grows in size, more and more weight is gained in the lower abdomen.  This causes her body to be pulled forward.  In order to counter that forward pull, she naturally leans backward to balance her weight, and therein lies the problem. 

Backward leaning of the lower back is called “hyperlordosis” and puts an extra heavy load on the facet joints and sacroiliac joints.  With time, these joints become dysfunctional and begin to hurt.  As the mother goes about her daily activities, she invariably needs to bend forward and that can lead to more stress on the muscles and ligaments of her lower back, causing muscles to strain and ligaments to sprain.  This scenario may cause painful muscle spasms. 

Another major physiological factor in the pregnant woman’s body is the hormone, relaxin.  During the third trimester, relaxin is release in order to prepare the pelvis for the expansion needed to grow and deliver the baby.  It affects the ligaments and muscles of the lumbopelvic spine by (as the name implies) relaxing them.  The effect is often problematic as the ligaments that hold the pelvic bones to the sacrum (tail bone) allow for excessive movement and misalignment.  This results sacroiliac joint (SIJ) pain.  It is estimated that 54% of women with pelvic pain during pregnancy have an SIJ imbalance.  Even after the delivery of the baby, the relaxin levels remain high for awhile and may result in SIJ pain.    

So what is a woman to do about her lower back pain?  Fortunately, there are several, drug-free options available which have proven to be helpful.  Chiropractic treatment is one frequently used and effective therapy.  A systematic review of recent studies showed that chiropractic care reduced pain levels in patients with PRLBP. Chiropractic treatment improves biomechanical function of involved joints, resulting in more normal movements and reduction of pain and spasms.  Acupuncture has also been shown to reduce lower back pain levels in pregnant women.  Abdominal supports such as the Prenatal Cradle from Prenatalcradle.com help to distribute the weight load and decrease the stress on the sacroiliac joints and lumbar spine.  Sleeping on her side with a pillow between her knees and another under her abdomen helps to reduce night-time and resting pressure on the low back and pelvis.  Avoiding prolonged standing and staying out of heels will help to diminish the load on the facet joints of the lower back. 

Exercise is very effective for preventing and reducing PRLBP.  If she is already active, the pregnant mom should continue to stay active.  Cardiovascular exercise goes a long way in reducing back spasm and pain.  Water aerobics or water gymnastics is a great way to work out many muscles and joints of the body in a near weightless environment.  The “cat/camel” exercise (see figure 2) helps keep mobility in the lumbar spine, reducing spasms and maintaining function of the lumbar discs and facet joints, as well as exercising the abdominal muscles.  The gluteus medius is an important pelvic stabilizing muscle on the side of the hip.  The “clam” exercise (see figure 3) helps to keep it strong and active, reducing the stresses on the lumbosacral joints.

With proper professional treatment and self-care, pregnancy-related lower back pain can be controlled and most often eliminated, making this time as pleasant as possible.  

What to do for back pain during pregnancy:
1. See a health professional to ensure that the pain has a musculoskeletal cause.
2. Try to maintain your level of activity and keep a positive attitude about your health.
3. Review your drug-free treatment options.
4. Learn specific exercises designed to strengthen your low back and pelvis.

Jeffrey Luebbe, DC, CCRD, CCSP® has practiced with Cole Pain Therapy Group since 1985. Dr. Luebbe is a Certified Chiropractic Rehabilitation Doctor and a Certified Chiropractic Sports Physician® with extensive postgraduate education in chiropractic orthopedics.

References:
- Berg, et al. Low back pain in pregnancy.  Obstetrics and Gynecology. 1988;71:1.
- Olsson C, Buer N, Holm K, Nilsson-Wikmar L. Lumbopelvic pain associated with catastrophizing and fear-avoidance beliefs in early pregnancy. Physiotherapy. 2007;93(S1):S505
- Laslett M. Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Man Manip. 2008;16:142-152.
- Stuber KJ, Smith DL. Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence. J Manip Physio Therap. 2008;31(6):447-54.