Facts:
- Researchers estimate that between 45-76% of pregnant women will experience low back pain at some stage of their pregnancy. (1-5,117)
- Up to 33% rate their pain as severe. (6)
- Pregnancy-related low back pain leads to lower quality of life, restricted activity, and disability – with almost 25% of pregnant women taking sick leave for LBP. (2,7-11)
- The recurrence rate for pregnancy-related low back pain is 85-90%. (11-14)
- Consequently, almost 1 in 5 women who report back pain during an initial pregnancy will avoid future pregnancies due to fear of returning symptoms. (15)
What are the symptoms of pregnancy related low back pain?
- localized to the lumbosacral region but may radiate to the buttock and posterior thigh.
- Symptoms extending into the calf are possible (41
- Most patients describe their pain as mild to moderate (42,43)
- Symptoms are often provoked by activity, including standing, sitting, coughing, sneezing, and straining during a bowel movement (44).
- Symptoms often increase throughout the day. (23,45-47)
- Many patients report nighttime pain that disturbs sleep. (23,39)
Pregnancy-related low back pain is not generally the result of structural disease, but rather a combination of “functional” stressors (16-20):
- weight gain
- biomechanical changes
- gait changes
- postural strains
- hormone changes and ligamentous laxity
Weight Gain:
- The average woman gains between 20- 40 pounds throughout pregnancy. (13,22)
- This predominantly frontal weight gain advances the center of gravity, forcing an anterior pelvic tilt and hyperlordosis- placing excessive stress on the ligaments, discs, lumbar facet joints and sacroiliac joints. (23-25)
- The abdominal muscles, which are an integral support mechanism for the lumbar spine, are stretched to accommodate the expanding uterus, thereby compromising their ability to maintain posture and support.
- (13)
Biomechanical/Postural changes:
- Since an excessive lumbar lordosis diminishes the spine’s capacity to absorb load, the intervertebral discs undergo excessive compression, likewise exacerbated by weight gain. (26-28)
Hormone changes:
- The hormone relaxin increases tenfold during pregnancy. (13)
- Relaxin triggers lumbopelvic hypermobility and threatens core stability. (26)
- Not surprisingly, pain and disability tend to gradually worsen throughout pregnancy. (120)
When does pregnancy related back pain typically start?
- Pregnancy-related low back pain typically starts between the fifth and seventh months. (39)
- Nevertheless, a significant proportion of women experience pain in the first trimester before mechanical changes could play a significant etiological role- early onset pain may be related to hormonal and/or emotional stressors. (13,40)
What is the source of my back pain with pregnancy?
- Sacroiliac joint dysfunction is a common source of P-LBP. One study of 1500 pregnant low back pain sufferers identified the SI joint as the culprit in 79%. (120)
- Over 90% of prenatal healthcare providers are willing to recommend non-pharmacologic treatment, including alternative therapies. (68) Common therapies for the management of pregnancy-related low back pain include exercise, manual manipulation, education, acupuncture, and pelvic belts. (12,31-33,55,69-78,112,113)
- A multi-modal approach that includes patient education, exercise, muscle strengthening, and manual therapy has shown superior outcomes with lower disability compared to standard obstetric care. (32,33)
Can I have Xrays while pregnant?
In almost all cases, X-rays are not needed for pregnancy related back pain treatment at Creekside Chiropractic and Rehabilitation. However, according to the American College of Radiology, exposure to a single x-ray procedure would not threaten the well being of a developing pre-embryo, embryo, or fetus. (60) A single diagnostic procedure has no known risk for fetal abnormality including congenital malformation or mental retardation. (59) Exposure to a single x-ray procedure during pregnancy is not a reason to terminate the pregnancy. (62,63)
Is conservative care O.B approved?
- Over 90% of prenatal healthcare providers are willing to recommend non-pharmacologic treatment, including alternative therapies. (68) Common therapies for the management of pregnancy-related low back pain include exercise, manual manipulation, education, acupuncture, and pelvic belts. (12,31-33,55,69-78,112,113)
- A multi-modal approach that includes patient education, exercise, muscle strengthening, and manual therapy has shown superior outcomes with lower disability compared to standard obstetric care. (32,33)
What are the goals of manual therapy?
- The goal of manual therapy is to restore normal joint mobility and reduce muscle tension. (55)
- Manual therapy, including chiropractic manipulation, demonstrates medium to large benefit for the management of pregnancy-related low back pain. (75,110,111)
- Additionally, nearly 4 in 5 women undergoing manual therapy report reduced pregnancy symptoms; i.e, heartburn, nausea, vomiting, dizziness, headache, insomnia, neck pain, hyperosmia and hypersalivating. (119)
- Spinal manipulation is an important component in the management of pregnancy-related low back pain.
- Almost 75% of women undergoing chiropractic manipulation report significant pain reduction and clinically significant improvements in disability. (51,110)
Can Chiropractic decrease labor times?
Women who seek chiropractic care throughout pregnancy may have an added benefit of shorter labor times. (79,109)
What about low back pain after pregnancy?
Incidentally, postpartum LBP also responds to spinal manipulation- approximately 10 times greater than watchful waiting. (115)
Treatments provided here at Creekside:
- Spinal Manipulation
- Spinal mobilization
- Myofascial release including Active Release Technique
- Stretching
- Exercise Rehabilitation
- Cryotherapy
Other treatment options:
- TENS Units: TENS has been shown to be safe and beneficial for treatment of lower back pain during pregnancy with no reported adverse affects on the newborn. (98-100,102,103)
Treatments to avoid during pregnancy:
- Continuous or pulsed therapeutic ultrasound is contraindicated over the low back, abdomen, and uterus during pregnancy (97)
- Electrical stimulation over the low back, pelvis, or abdomen should be avoided during pregnancy. (97)
- The use of low-level laser therapy is contraindicated during pregnancy due to possible light-induced effects on fetal growth and development. (97,104)
- Pregnant women should avoid application of heat to the trunk or full body (i.e. hydrotherapy tank) as elevation of maternal body temperature is known to cause fetal malformations. (105,106)
Can I exercise throughout my pregnancy?
- Patients may benefit from continuing aerobic exercise throughout pregnancy.
- The US Department of Health and Human Services exercise guidelines concerning pregnant patients suggest that healthy women may begin or continue moderate intensity aerobic exercise for at least 150 minutes per week.
- Women should not begin vigorous exercise during pregnancy, but those who were pre-conditioned to vigorous exercise may continue. (78)
- In addition to musculoskeletal benefits, ongoing exercise during pregnancy decreases one’s risk of excessive weight gain, pre-eclampsia, gestational diabetes, and pre-term birth, while improving self-image and pain tolerance. (85-93)
- In particular, water aerobics (83,94) and yoga (95,96,114) have shown benefit.
Ways you can help yourself:
- Attempting to minimize the lumbar hyperlordosis
- Take frequent breaks from sitting or standing
- Use of a small footstool to alternate feet when standing
- Sleeping with a pillow between the knees in a side lying posture is often well tolerated.
- Patients should use on proper footwear
- The use of a sacroiliac/pelvic support belt is effective and relieving pregnancy-related low back pain. (107,108)
- Acetaminophen is generally an acceptable OTC medication; however, aspirin and ibuprofen are contraindicated. (13)
At Creekside Performance Center, we are highly trained to treat this condition. We are the only inter-disciplinary clinic in Sheboygan county that provides chiropractic, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves.
Evidence Based-Patient Centered-Outcome Focused
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