Back Pain During Pregnancy

As your pregnancy advances and your uterus enlarges, you're likely to feel some discomfort. Back pain is a common complaint.

But you don't have to grin and accept back pain as a normal part of your pregnancy. You can take steps to stop the soreness. It's a good idea to learn these techniques now, because you'll probably need them again later when your back is bearing the strain of constantly lifting your 7- to 10-pound baby or your 20-pound toddler.

What causes back pain in pregnancy?

At least 50 percent of women experience back pain during pregnancy. Pregnant women are prone to backaches and back pain for a number of reasons:

* Extra weight. The weight you gain during pregnancy is good for your baby, but it can be bad for your back.

* Change in center of gravity. As your uterus grows, your center of gravity shifts forward. Gradually - and perhaps without notice - you begin to adjust your posture and the way you move. These compensations can lead to backaches and back pain.

* Your hormones. During pregnancy, the hormone relaxin causes the ligaments between your pelvic bones to soften and your joints to loosen in preparation for your baby's passage through your pelvis during birth. As the structures that support your pelvic organs become more pliant, you may feel considerable discomfort on either side of your lower back, often with walking, especially up and down stairs.

Back pain can occur at any time during pregnancy. For many women, it interferes with daily activities and the ability to get a good night's sleep.

Later in pregnancy, as your uterus enlarges, you naturally pull your shoulders back farther to offset the weight of your uterus pulling you forward. This can actually cause back strain. Talk to your doctor about adjusting your posture to accommodate your growing belly.

* Make adjustments when sitting or standing. Sit with your feet slightly elevated, and don't cross your legs. Change position often, and avoid standing for long periods of time. If you must stand for a while, rest one foot on a low step stool.

* Strategically place your pillows. Sleep on your side, with one or both knees bent. Place a pillow between your knees and another one under your abdomen. You may also find relief by placing a specially shaped total body pillow under your abdomen.

* Avoid lifting heavy objects or children. When lifting a smaller object, don't bend over at the waist. Instead, squat down, bend your knees and lift with your legs rather than your back. Try to avoid sudden reaching movements or stretching your arms high over your head.

* Get the right gear. Wear supportive, low-heeled shoes and maternity pants with a low, supportive waistband. Or consider using a maternity support belt.

* Try heat, cold or massage. Apply heat to your back. Try warm bath soaks, warm wet towels, a hot water bottle or a heating pad. Some women find relief by alternating ice packs with heat. A back massage also may help.

* Stay fit. As long as your health care provider approves, an exercise program can keep your back strong and may actually relieve back pain. Some women enjoy swimming, and doctors highly recommend it - the body's buoyancy in the water offers relief from the extra weight of pregnancy. You also might like walking or taking a prenatal exercise or yoga class. On your own, you can try an exercise called a pelvic tilt or cat stretch: Kneel on your hands and knees with your head in line with your back. Pull in your abdomen, arching your spine upward. Hold the position for several seconds, then relax your abdomen and back. Repeat three to five times, working gradually up to 10.

If these self-care steps aren't working or your back pain is severe, talk to your health care provider. He or she may suggest a variety of approaches, such as special stretching exercises, that can alleviate pain without causing concern for your unborn baby.

Pain in your back may be a sign of a more serious problem if it's severe and unrelenting or if it's accompanied by other signs and symptoms. A low, dull backache may be a sign of labor or preterm labor. So, it's best not to ignore your aching back.

---

In approximately 80% of women who are pregnant, back pain is prevalent. Back pain and the causes in pregnant patients are not entirely understood. Therefore, the treatment recommendations are poor. By educating both the physician and the patient, treatment options can be improved.

Peripartum Pelvic Pain

Pain in the pelvic region, for which a clear-cut diagnosis has not been made, is termed peripartum pelvic pain. This pain may start during pregnancy, or within three weeks of delivery.

Anatomically, pain presents itself most commonly in the following areas: sacroiliac joints at the posterior superior iliac spine (42%), the groin areas (53%), coccyx (33%), pubic symphysis anteriorly (77%), and occasionally other areas of the pelvic and upper legs. Rarely does pain occur below the knee. Pain tends to be influenced by posture and is associated with a waddling gait.

In approximately 80% of pregnancies, back pain is usually localized, but the site may vary. Although long-term pain is very rare, short-term pain tends to be dominant. Usually during the third trimester, 50% of pregnant patients will experience back pain. The prevalence of postpartum period pain falls to approximately 9% in decreasing order as follows: sacral, lumbosacral, lumbar, cervicothoracic, and remaining areas.

Disc Herniation

The prevalence of pain during the first nine months is thought to be 90% versus non-pregnant controls for the same period of time to be approximately 20%. Although the pain may be severe, disk herniation, which is exceedingly rare during pregnancy, is not to be blamed. Disk herniation presents at the same rate as non-pregnant women or at approximately 1:10,000 (one in 10,000).

Pain Indices

With respect to age and smoking, there has been no demonstrated difference in pain indices. However, a slight increase in peripartum pain has been demonstrated with higher body mass, more pregnancies, a previous history of pain during pregnancy. Also, younger women tend to have more intense pain when compared to older women. A third of women describe their pain as disabling, restricting their activity, and a costly handicap. Approximately 10% of women describe their pain as extremely disabling.

Etiology of Pain

The etiology of pain is probably related to a combination of mechanical, metabolic, circulatory, and psychosocial contributing factors. One-third of the patients who experience pain starting during the first trimester when mechanical forces are not a significant force, are highly indicative that the most probably cause is due to a change in hormonal influence.

It is believed that hormones cause change at the insertion point of ligaments to the bone. A higher concentration of ligaments in the lower spine may suggest the cause for a higher incidence of back pain in the multiparous mother who has had more exposure to hormonal influences.

Furthermore, an increase in premenstrual pain has occurred in a large majority of women whose pain has been suggestively influenced by hormonal changes. There has also been found to be higher serum relaxin levels in women with peripartum pelvic pain. There is some evidence to suggest that a different set of receptors is sensitized in the lower spine during pregnancy by hormones. Therefore, it is believed that most of the pain is secondary to hormonal changes rather than actual chemical stresses.

Lumbar Lordosis

It has been thought that lumbar lordosis is increased during pregnancy. However, in reality with x-ray studies, it has been demonstrated that lordosis decreases during pregnancy. Therefore, overall pain may be due to the muscles and ligaments combined with some alteration in blood flow to the pelvic musculature and ligaments.

Treatment

The treatment recommendations for pelvic pain in most obstetrical and gynecological textbooks are poor. Patients are instructed to avoid excessive weight gain, exercise to strengthen the back muscles, maintain correct posture, and to wear sensible shoes (not high heels).

Some activities do cause or aggravate pain. The most common are: 30 minutes of standing or walking, carrying a full bag of groceries, standing on one leg, climbing stairs, turning over in bed, intercourse, bending forward, stepping in or out of bed, and driving for 30 minutes.

Many treatment options are available including a pelvic belt (by prescription), exercise, appropriate rest, medication, massage, and standard back exercises. It is interesting to note the percentage of women who found relief using these treatments.

The pelvic belt helped approximately 50% of women during pregnancy and 66% after pregnancy.

Bed rest and exercise appeared to be the best treatments resulting in the rapid recovery of 65%.

Bed rest alone: only 40% got better

Exercise alone: only 35% improved -- 20% of the patients worsened without appropriate bed rest included

Manual Therapy: 20% of the patients indicated their pain was worse

Medication and Massage: 70% of experienced only temporary relief

Good News

The good news is that the median time for back pain to resolve was within six months. Approximately 35% of patients continued to describe intermittent back pain lasting 1-1/2 months after partum. At the first postpartum visit, only 15% of patients continued to have low back pain regardless when the symptoms started during pregnancy. Therefore, in most cases, pain does improve after the postpartum period.