The back pain complex, to include neck pain, back pain and sciatica, is one of the most common complaints among mothers-to-be during pregnancy. The spine is made up of two primary and two secondary curvatures. The secondary curvature of the lumbar region is most affected during pregnancy. The lumbar curvature, established after birth and responsible for our ability to walk upright, comes under tremendous pressure during pregnancy. Back pain is quite common during pregnancy with as many as 80% of all women experiencing neck pain, back pain and/or sciatica in varying degrees. The back pain complex is expressed from mild to acute and may become chronic if not properly addressed. We will discuss some of the reasons why back pain is so prevalent during pregnancy and offer a few solutions, as well.
While women with previous back problems are at greater risk for neck pain, back pain and sciatica, it is common among all women beginning as early as two months and continuing through, and well after, the completion of the pregnancy. During pregnancy the body produces a number of hormones, some in much higher quantities than typically found. One of the principal hormones having the most dramatic impact during pregnancy is called Relaxin. Relaxin’s function it is to make the ligaments associated with birth, and the pelvis aperture itself, softer and more pliable. The reasons for this are obvious, it is vitally important for the baby, particularly the baby’s cranium or skull, to be able to pass through the birth canal with relative ease, Relaxin makes this possible. Additionally, as the uterus grows and weight shifts forward, the center of gravity changes and the relaxation of the uterine ligaments impacts the spine and the surrounding musculature. The core muscles, to include key abdominal muscles, spinal muscles, and para-vertebral muscles, are also stretched and taxed beyond normal capabilities. The combination of hormonal and structural factors often contribute to varying degrees of neck pain, back pain, and sciatica.
Obesity, always a significant factor in diagnosing and treating the back pain complex, becomes an even greater issue during pregnancy. Normal weight gain, not to be confused with obesity, may also negatively affect mothers-to-be. The combination of an exaggerated spinal curvature, called lordosis in the lumbar region, a shift in the center of gravity, additional weight carried forward, and a weaker core muscle complex are also contributory factors. The core muscles, as well as other synergistic muscle groups, may be strengthened through a program of exercise and stretching. It must be recognized that back pain during pregnancy is the rule rather than the exception, the challenge is to deal effectively with the underlying cause or causes with an intelligent and individualized treatment program.
Two of the most common back pain expressions during pregnancy, are lumbar pain, centered primarily in the lower back, and posterior pelvic pain, with symptoms very much like those associated with sciatica. The low back or lumbar pain is generally centered in the lower back and may radiate unilaterally, one side, or bilaterally, both sides, across the iliac crest, which is the region to each side of the spine at the upper level of the pelvis. Once again, pain may range from mild to acute and grow increasingly intense the deeper into the pregnancy the mother-to-be is. Back pain in this region is exacerbated by extended periods of standing, particularly in one place, sitting for long periods of time, and by poor posture, as in the old military idea of “stomach and chest out” which simply does not work for obvious reasons. Posterior pelvic pain can be quite severe and may be four to five times more prevalent than any other back pain expression during pregnancy. Posterior pelvic pain, as noted above, may be indistinguishable in its expression from sciatica. Pelvic pain may be felt as a deep ache or even a burning sensation, may radiate across the buttocks and into the legs, unilaterally or bilaterally, and in its worst configuration or state may also be felt in the feet and toes, very much like sciatica. The biggest distinction between posterior pelvic pain and sciatica is that posterior pelvic pain is more commonly experienced bilaterally. Sciatica, on the other hand, is generally a unilateral expression affecting the buttocks, legs, feet, and toes.
While quite common, neck pain, back pain and/or sciatica, including posterior pelvic pain, should not be taken lightly. If the back pain complex is not addressed properly, it may have negative consequences throughout the pregnancy and felt in virtually every aspect of the new mom’s life. It is not uncommon for women who experience severe back pain throughout the pregnancy to continue to have problems well into the post partum period. Pregnancy can be, and usually is, a wonderful time in both the family’s life and in the life of the mother-to-be. However, if back pain is not addressed it may have a negative impact during and afterwards, in some cases for years after the pregnancy.
As noted above, there may be a myriad of causes and consequences associated with the back pain complex, as it relates to pregnancy. An intelligent, individualized, and medically supervised program of exercise and stretching is not only advisable it is absolutely necessary. Certain exercises, such as the pelvic tilt and crunches, at least until the latter stages of the pregnancy, may be appropriate and advisable. However, it is usually the case that such self-treatment programs of exercise are not only misguided but fail to achieve any real and lasting relief or benefit. Additionally, because of the shift in the center of gravity and the exacerbated lumbar curvature, a complete program focusing on the core muscles may be the best approach. Improper posture, standing for long periods of time, sitting for long periods, and even remaining inactive for extended periods of time may have a negative impact, ultimately leading to even greater pain. Finally, it is advisable for pregnant women, particularly those who work deep into the pregnancy or have other children, to take special care when lifting anything heavy. Because of the number of physiological and anatomical changes that take place during pregnancy, a program that seeks to strengthen the musculature and to improve endurance, so fatigue doesn’t lead to other problems and injuries, should be initiated as soon as possible. Only through a comprehensive program of treatment and exercise can a prospective mom hope alleviate or eliminate neck pain, back pain, and sciatica.