Pregnancy and Low Back Pain
Kristen Markett, PT, OCS,
Women's Health Specialist
Obstetric low back pain is a common complaint during and following
pregnancy. Although some think low back pain in pregnancy is just
fatigue, the fact is, there are biomechanical aid hormonal changes,
which can cause this prevalent problem It is often the doctor, nurse or
midwife who first hears the complaint. PHYSICAL THERAPY cans often
prevent or correct the musculoskeletal dysfunction.
Because of the high incidence of low back complaints, this condition
may seem "normal" to both the patient and medical practitioner.
Unfortunately, pain during pregnancy is always a sign of an underlying
condition and needs to be addressed appropriately. Some lower back
symptoms may include:
• Generalized pains anywhere along the spine from the sacrum to
the occiput
• Central pain across the low back
• Difficulty in straightening up after bending over
• Pain located on one or both sides of sacrum and perhaps into
the buttocks
• Numbness and tingling sensation down into the leg and foot
• Pain down the front or sides of the thighs
• Pain in the grown region or pubic symphysis area
Lumbar spine and pelvic misalignments are common during pregnancy
and are caused, from a variety of situations. Malalignments can occur
because of ligamentus laxity, muscle imbalances stemming from
weakness or tightness to the torso and LE's causing torsions; weight
gain with center of gravity shift, and generalized fatigue during
pregnancy.
Sources of Low Back Pain
Postural Pain: Pain caused by faulty posture and poor body
mechanics. Muscles and ligaments can get imbalanced (shortened or
lengthened) for too long causing postural dysfunction or postural pain
syndrome.
Joint Dysfunction: If soft tissue imbalances are not corrected they
can lead to joint dysfunction. Joint dysfunction or disturbance of
normal joint movement can occur in the lumbar spine, pubis, sacrum
or coccyx regions. Joint laxity in these areas is also common during
pregnancy. Patients complaining of pain in these areas most likely
have experienced a joint subluxation or lock. Therefore, their
symptoms mast likely will not pass without physical therapy
intervention.
Disk Derangement/Sciatica: These may be suspected if a woman
has some neurologic signs such as muscle weakness and specific
sensory changes. Other signs may be decreased deep tendon reflexes,
radiating pain into the legs and a positive straight leg raise. Sciatica is
often present with low back pain end sacroiliac dysfunction. As the
sciatic nerve passes anterior to the sacroiliac joint it can become
inflamed with any joint dysfunction.
Piriformis Syndrome: Persistent, severe radiating pain that extends
from the sacrum to the hip joint over the gluteal region and posterior
portion or the upper leg characterizes the piriformis syndrome. The
involved hip may present with excessive external rotation when the
patient lies supine. This is due to the shortened piriformis muscle. A
note to remember is that the sciatic nerve passes under or through
this muscle and can become compressed or entrapped giving rise to
leg symptoms.
Coccydynia: A painful coccyx usually presents if there was a prior
injury or dislocation. These can occur during delivery and can also be
an indication of a pelvic floor dysfunction.
POSSIBLE ADL CAUSES OF LOW BACK PAIN:
• Standing up and turning while lifting something
• Stepping over an obstruction while carrying a heavy load
• Missing a curb or step and landing hard on one foot
• Tight hip muscles from sitting at a desk all day
• Sexual intercourse with legs widely abducted
• Sitting on soft, squishy or very low chairs
• Crossing legs while sitting or standing with more weight on one leg
than the other, as when carrying an infant on the hip.
• Driving in a car for long distances
Because of the high incidence of low back pain complaints, this
condition may seem "normal" to both the patient and medical
practitioner. Unfortunately, pain during pregnancy is always a sign of
an underlying condition and needs to be addressed appropriately. Early
intervention is critical to decrease the severity of pain and disability
and avoid the development of a chronic condition. Speedy
identification, diagnosis treatment can tremendously help the pregnant
woman continue with her daily activities and work.
At Advanced Rehabilitation Clinics a physical therapist with advanced
training in Women's Health is educated on exactly what to do for this
very special population. Please contact us for more information..