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Orthopedic/Injury>>Low Back Pain and Pregnancy - 1/4/2007

Why does your back hurt?

There are a combination of factors which may cause back pain or other orthopedic problems during pregnancy and postpartum.  One factor is includes the release of a maternal hormone, relaxin, which results in increase of elasticity of the soft tissues (ligaments, tendons, and cartilage) in the body.  This may contribute to hypermobility of the sacroiliac joint which is a common cause of low back pain.  This laxity of the soft tissues may remain for up to 4 months after delivery.

 

Understanding the normal musculoskeletal changes that occur during pregnancy is useful for targeting and treating the different sites of your back pain.

 

   Lumbar pain:  Lumbar pain during pregnancy can come from multiple sites.  Most commonly, these areas are the facet joints, paraspinals, supporting ligaments, or possibly discogenic sources.

 

As the abdominal muscles stretch to accommodate the growing fetus, their ability to help stabilize the pelvis decreases.  The burden of support then shifts to the back muscles (paraspinals) which become strained at a time when they may be shortened from the increased lordosis or sway back posture of the low back.  Lumbar or low back pain can occur with or without radiation to the legs.

 

    Sacroiliac pain:  The sacroiliac joint (SI joint) is extremely stable in the non-pregnant state; however, during pregnancy, movement in the SI joint can increase dramatically due to the hormonal influences that increase joint elasticity.  Pain is caused when these pain-sensitive structures are stretched and/or if the SI joint is shifted.  Symptoms of SI joint pain can continue several months after delivery.

 

   Nocturnal pain:  This pain only occurs at night while in a recumbent position. There are a few theories to why this occurs.  One thought is that muscle fatigue accumulates throughout the day and causes the pain at night.  Another thought is that daylong biomechanical stress from SI dysfunction or mechanical low back pain from altered posture produces low back symptoms at night.  A third thought is that this particular type of pain is caused by cardiovascular changes due to pregnancy.

 

How to manage your back pain: A physical therapy prospective

 

v     Posture: Proper posture can prevent unnecessary mechanical stresses on the low back.  Your physician or physical therapist can teach you the neutral spine posture that avoids excessive lumbar lordosis or sway back posture and excessive reversal of the normal lumbar curve. 

 

v     Ergonomics:   Basically this means positioning your body in postures during daily activities that reduce stresses to your low back.  An example is when you have to stand for a longer period, place on foot on a stool which will relax your hip flexor muscle and tilts your pelvis forward.  This will decrease the strain on your low back.  Ergonomics can be applied to sitting or  for any activity that you encounter on a daily basis.

 

v     Exercise programs:  Low back stabilization exercises improve the strength and conditioning of your supportive muscles which help you in maintaining a neutral spine posture, promote biomechanic efficiency and minimizes stresses on the back.

 

v     Supports/belts:  For those who have SI pain with evident biomechanical dysfunction, a nonelastic trochanteric belt may be helpful in decreasing pain for prolonged periods of walking.

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