Why are low back pain and pregnancy so closely correlated? The most obvious answer is that women gain weight during pregnancy, typically between 25-35 pounds. The spine is then tasked with supporting the extra weight of the baby and the uterus, a job it is not used to doing The increase in weight in these structures can begin to irritate nerves in the low back, causing pain down one or both legs and sometimes even into the feet and toes. If you have never suffered from low back pain prior to pregnancy, your core muscles could simply not be strong enough to support the additional weight necessary to grow a baby. For many women, back pain will subside once the baby is born. Unfortunately, however one in three women will continue to experience symptoms of low back pain up to one year postpartum.
The life changes that occur with having a baby are significant and the stress of having back pain only adds another layer of complexity to life with a new baby. Be proactive. Physical therapy can be a safe and effective treatment to provide the necessary tools in order to manage and eradicate your symptoms so that your time and energy can be focused on the new life you have created. Physical therapy can also be a useful treatment to facilitate a smoother pregnancy and birth.
A study published in 2014, in the Journal of Orthopedic and Sports Physical Therapy examined the most effective treatments for women experiencing low back pain during pregnancy. Although we will explore several different treatment options in this blog post, research has found the most effective therapy to be exercise and patient education. Specifically, patient education surrounding activity modification and lifestyle changes [1].
If you are experiencing low back pain with pregnancy here are several options to consider discussing with your health care provider and physical therapist.
Specific Exercise: These are exercises prescribed by your therapist including (but are not limited to) strengthening of the pelvic floor, core, and posture muscles. An exercise program tailored directly to your needs and muscle imbalances, while working closely with your therapist will ensure you are getting the best care for your specific condition. This may also include education on things you should NOT be doing during episodes of pain.
Perineal Massage: This type of massage involves the gentle stretching and massaging of the skin between the anus and vagina (perineum) during the last few weeks of pregnancy. This treatment has been shown to reduce the episode of perineal tears during birth. Perineal massage also prepares you for the pressure and stretching that occurs when the baby’s head crowns and enables you to relax, leading to a quicker delivery.
SI Belt: The pelvic girdle is a region of ligaments and muscles where the ilium (our hip bone) and the sacrum meet to form three joints at the base of the spine. In order for these bones to have some movement when we walk, muscle and ligaments must work to stabilize them. Important muscles that aide in stabilization of the pelvic girdle include the transverse abdominus, psoas major, multifidi, and the pelvic floor muscles. During pregnancy these muscles can become less efficient due to increased loads placed upon them. When exercise alone is not enough to increase stabilization in this region, a sacroiliac belt may be used to help stabilize the lower back.
Treatments that are contraindicated (aka: Not Safe): There should be no modalities used during physical therapy. Ultrasound and ESTIM, two commonly used passive modalities in physical therapy clinics, are contraindicated during pregnancy. Ultrasound, a therapeutic modality used for the deep heating of tissues through high frequency sound pulses can expose the fetus and result in overheating. ESTIM should also be avoided early in pregnancy due its potential to cause abortion. The effects of TENS on a developing fetus is uncertain and clinicians should use extra caution when considering potential risk vs. benefit for application to distant sites (non-abdominal areas) [2].
Many women are nervous to exercise during pregnancy but research has shown it is not only safe and healthy for mom and baby, but it can also help to reduce the length of labor and delivery and cause less painful contractions. According to the American College of Obstetricians and Gynecologists (ACOG) pregnant women should exercise at least 3-4 times a week at a heart rate no higher than 140-150 beats/min. Women should avoid high impact activity such as jumping and heavy lifting that results in bearing down [1].
Citations:
- Evenson, Kelly R, et al. “Guidelines for Physical Activity during Pregnancy: Comparisons From Around the World.” American Journal of Lifestyle Medicine, U.S. National Library of Medicine, Mar. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4206837/.
- Rennie S. Electrophysical Agents- Contraindications And Precautions: An Evidence-Based Approach To Clinical Decision Making In Physical Therapy. Physiother Can. 2010 Fall; 62(5): 1–80.
Tags: physical therapy, health, wellness, low back pain, pregnancy
