Tuesday, February 16, 2010

Back Pain and Pregnancy: How Can We Address the Problem

It has been a while since my previous post and I am hopeful that with practice settling a little, I'll be able to contribute regularly. On with the show...

I have been inspired to share this with you because of the increasing number of friends who have decided to start a family. 'Tis the season I suppose! :) For those of you who are pregnant, know someone who is pregnant, know someone who is planning on having a baby sometime in the near future, or is just interested in how to decrease the chance of back pain during or after pregnancy, this will be of interest to you!

Back Pain and Pregnancy: How Can We Address the Problem

Pregnancy is one of the most gratifying experiences in life. However, back pain is often a common symptom of many pregnant and post-partum women, and in severe cases, can be debilitating. A recent study by Mens and colleagues looked at the prevalence of low back pain during and after pregnancy and found that 67% of women experienced low back pain leading up to and at the time of delivery, while 37% reported that they experienced low back pain within 18 months after delivery. A possible explanation for this may be a combination of factors including hormonal changes, increased weight due to the presence of a fetus, and a forward shift in the centre of gravity. However, women have also reported low back pain very early in their pregnancy when the weight of the fetus is insignificant. As a result, researchers now believe that the major contributing factor is the increase in the hormone relaxin which promotes loosening of ligaments of the pelvis to allow for ease of passage through the birth canal. The everyday wear and tear that your joints experience is therefore amplified during pregnancy as a result of a decreased supportive and dampening role that is usually provided by ligaments in your pelvis and low back. As a result of this, your ligaments have an increased range of motion which may place extra stress on the associated ligaments causing pain.

What to Avoid

What can we do, or NOT DO, to prevent the severity of the back pain during pregnancy? Some of the things that have been shown to be associated with low back pain during pregnancy include the following:

• Standing for more than 30 minutes (90%)
• Carrying a full shopping bag (86%)
• Favoring weight on one leg/leaning on one leg (81%)
• Walking for more than 30 minutes (81%)

The percentages represent the number of pregnant women that experience low back pain as a result of the stated activity. As you can see from the above activities, these are things that are done on a daily basis and should therefore be avoided to prevent low back pain. This is not to say that one should lie in bed and do nothing, but it does serve as some leverage next time your partner requests that you do help carry the groceries in the house!

How Can We Prevent It?

In terms of intervention and rehabilitation, van Wingerde and colleagues propose that an emphasis must be placed on muscles of the low back region. They investigated whether or not muscles of this area contributed to stabilization of the joints of the pelvis and low back. They found that the hamstrings, gluts, lats and your deep low back muscles all contribute to stabilizing the joints that are often the culprits in low back pain during pregnancy. But it is important to realize that strengthening these muscles using machines or free weights will often times, NOT do the trick. What needs to be implemented is a specific exercise program to improve the endurance and strength of these muscles and those of the pelvic floor.

A knowledgeable health professional such as a chiropractor, physiotherapist, athletic therapist, or massage therapist will be able to demonstrate exercises such as the bird-dog, planking, side-planking, kegel and pelvic bridge. All these exercises involve nothing but your own body weight and a floor mat, and should be included in any pregnancy exercise program as long as it is tolerated by the patient. It is difficult to describe these exercises in writing and they are only really appreciated when they are demonstrated and performed under supervision. As such, if you currently have a chiropractor or physical therapist, please follow up with them regarding these exercises.

So, if you are planning on having a child, are currently pregnant, have had a child in the past, or have recently given birth to a baby, first of all, congratulations, and secondly, ensure that these exercises are included in any exercise program in which you may be participating. If you have any further questions, feel free to contact me at info@saudeclinic.ca or visit www.saudeclinic.ca for more information on where you can find a qualified health professional to help with back pain in pregnancy or any other musculoskeletal issue that you may have.

Henry Candelaria, BPHE, Dip. Acu., DC © 2010


McGill, S. (2004). Ultimate Back Fitness and Performance. Waterloo: Wabuno Publishers.

Mens, J. M. A., Vleeming, A., Stoeckart, R, Stam, H. J., and Snijders, C. J. (1996). Understanding Peripartum Pelvic Pain: Implications of a Patient Survey. Spine, 21(11): 1363-1369.

van Wingerden, J. P., Vleeming, A., Buyruk, H. M., and Raissadat, K. (2004). Stabilization of the sacroiliac joint in vivo: verification of muscular contribution to force closure of the pelvis. Eur Spine J, 13:199–205.