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Low back pain is common during pregnancy and can occur in about 50% of pregnant woman. Low back pain includes pelvic girdle pain as well as lumbar pain. All too often, women are told that this is a normal part of pregnancy, but common and normal are not the same thing. Although it occurs frequently, women are not supposed to have back pain while pregnant or after delivery. Typically, this happens because pregnant women release hormones that cause their ligaments to become more lax. Ligaments are the soft tissue structures that connect bone to bone, so it is beneficial for these to become more pliable to aid in the delivery of the baby. Relaxation of soft tissue allows for the bones to move apart with less difficulty so the baby can pass through.
The downside of this is if the mother has underlying instabilities, lack of core strength, or mobility restrictions in her back or hips. Then, an advantageous hormonal response can cause unnecessary pain. A pregnant woman’s pelvis can shift into abnormal alignment, preventing her from being able to walk or function without pelvic or low back pain.
When this happens, women often complain of:
- Sharp, stabbing or dull pain localized to one side of the pelvis, low back, groin, or tailbone
- Pain that may radiate down to the knee
- Pain with movements, such as standing up from sitting, rolling over in bed, or bending or twisting
- Muscle tightness or tenderness in the hip or buttock
- Pain with walking, standing, or prolonged sitting
- Pain that is worse with walking or standing and eases with sitting or lying down
When pain occurs, a physiotherapist can help to resolve the problems. A tailored treatment approach should be devised depending on the woman’s symptoms, her trimester or post-partum status, and her current mobility or motor control limitations.
This treatment might include:
- Manual therapy, which might involve massage of tight muscles, mobilization of stiff joints, or muscle energy technique to improve the alignment of the pelvis, tailbone, or lumbar spine
- Flexibility exercises to decrease the chance that any one muscle group puts undue stress on the pelvis, tailbone, or lumbar spin.
- Strengthening exercises to improve the stability of the pelvic and spinal joints and targets abdominal, pelvic floor, and buttocks muscles
- Education to help the woman understand how she can alter her daily activities to reduce stresses on her low back or pelvis. This may include body mechanics training focusing on proper form with standing, sitting, lifting, or carrying. It may also encompass educating a woman on compensations that she has learned to avoid pain and how to stop making those compensations after her pain is relieved so that these compensations do not cause further problems.
Low back or pelvic pain should never be described as something a woman just needs to endure during pregnancy or after delivery. The earlier a problem is treated, the easier it is to resolve; but it is never too late to address problems that arose due to pregnancy or childbirth. Don’t be afraid to ask for help.