[x_author title=”About the Author”]
Pregnancy induced low back pain (PLBP) is a common complaint and is estimated to be prevalent in at least half of pregnant women, with some studies stating a high 90%. Although it frequently begins between the 4th to 7th months of gestation, it can occur earlier or later
Pregnancy Induced Back Pain (PLBP) and Pelvic Girdle Pain (PGP)?
PLBP, which is usually described as a dull aching pain at the lower back above the buttocks, should not be confused with pelvic girdle pain (PGP). PGP is a more intense pain that is described as stabbing, aching or shooting across the buttock area that may spread around the hips to the front or to behind the thigh. Some women may experience both PLBP and PGP at the same time.
Are you predisposed to back pain during pregnancy?
If you are experiencing PLBP now, it might be because you had pelvic trauma in the past or are used to experiencing LBP during menstruation. 85% of women who experience PLBP will experience it again in a future pregnancy. PLBP is not related to height, weight, age, time since last pregnancy or previous usage of contraceptive pill. A quarter of women will continue to have LBP even after pregnancy though majority will subside within the first 3 months.
However, a research showed a small portion of these women continued to have LBP aggravated by exercise or housework 3 years post delivery. The circumstances that cause the continuation of LBP after delivery include high weight gain during pregnancy and subsequently lack of weight lost post delivery.
A study by To W. and Wong M. showed women who had higher levels of pain earlier on in the pregnancy were more likely to continue having back pains 2 years post delivery. Mode of delivery and epidural anesthesia did not affect the outcome.
Is back pain just a way of your body adapting to pregnancy?
Structurally, as your uterus accommodates for your growing fetus and you gain weight, the muscles of your abdomen (rectus abdominis) stretches and becomes weak. This causes your back muscles and spine to be the primary load bearer of your upper body. Thus it is not surprising why women reported the most intense PLBP during their third trimester when the baby is at its largest.
As your lower abdomen moves forwards and downwards, this shifts your centre of gravity anteriorly. Although you are prevented from falling forwards during daily activities by the increased tension in your lower spine, your posture is skewed for the worse.
On top of that, during pregnancy a hormone called relaxin is released 10X more than during non-pregnancy. Relaxin is not all bad, it dilates your blood vessels thus increasing the blood volume to your fetus, which is vital to ensure sufficient nutrients is being supplied for his growth. It also relaxes the joints of your pelvic bone to accommodate the increase in size of your baby making it easier when the times comes to delivery the baby. However, your pelvis, which was previously a source of strength, now becomes loose and mobile.
Thus, distribution of weight from the upper body to the lower body becomes ineffective leaving the lower back to carry all the strain. Yikes! Talk about double trouble!
How to minimize back pain during pregnancy?
Part 1: Comfort first and strengthen your muscles.
Even though PLBP is not preventable, there are some ways to minimize the discomfort you may be experiencing.
Common advice given by the midwives include wearing comfortable shoes that are low heeled, avoiding lifting heavy objects or weights and using a pillow to support your low back during sitting. You can perform certain exercises to strengthen your pelvic floor and core muscles. Kegels come in handy here! Imagine yourself passing urine but resist and try to hold it in for 10 seconds and repeat. Pelvic tilt is another excellent and safe exercise that activates your abdominal muscles.
It is important to be consistent with these exercises and perform them multiple times daily as it can take up to 3 months to strengthen the muscles. Most women experiencing PLBP find it comfortable to sleep on their side, instead of their back, surrounded with pillows supporting their abdomen and back with one in between their knees.
Part 2: Calm the mind.
Since women who experience PLBP are more likely to have a job requiring constant concentration and report higher anxiety at work, it is important to prioritize time everyday to unwind and ease the mind. Yoga and Tai Chi are excellent examples of relaxing activities.
Their slow repetitive movements encourage mindfulness and evoke calming effects on the body. Those who did an hour of yoga 3 times a week from the 20th week of gestation until their delivery were significantly less stressed compared to those who performed other types of exercises for the same duration.
Supportive or Acupuncture?
A supportive belt had no added advantage compared to exercise and advice in one study. To date, there is no study investigating the use of a maternity belt alone compared to no other intervention thus its reliability in pain relief remains questionable. Acupuncture is seen to be the most effective method of reducing PLBP compared to supportive belts or physiotherapy. Even a 30-minute session once a week for 2 months is seen to benefit PLBP.
Average back pain decreased by at least 50% in the acupuncture group compared to those who controlled their pain using medication such as paracetamol. However, it is important to find a licensed practitioner to perform acupuncture as certain points that are able to induce labour are to be avoided.
Can I exercise during pregnancy, especially if I have back pain?
Since weight gain is a cause of PLBP, aerobic exercise is encouraged during pregnancy. The American College of Obstetricians and Gynecologists recommends moderate intensity exercises such as brisk walking for 30 minutes a day most days of the week, which is similar to the recommendations of non-pregnant women.
However, it is important not to overdo it, as even though there is no sufficient evidence to confirm that fetus blood supply is cut off during strenuous activity levels, keeping the maximum heart rate at 70% is advised during exercise.
Achy knees and back pain preventing you from keeping active?
Water aerobics is a safe exercise that is gentle on the joints. In one study, women who took part in weekly water aerobics had significantly reduced PLBP compared to those who did land based aerobics such as walking. These same women also reported no sick leave during their pregnancy. There are certain conditions that contradict aerobic exercises during pregnancy. These include but are not limited to hypertension, Type 1 diabetes and severe anaemia. Thus, it is important to speak with your healthcare professional before starting any exercise regime.
So, PLBP (different to PGP) is just your bodies’ natural way of accommodating the growing baby inside you. It is common and can be reduced with certain lifestyle measures. Prioritizing comfort, engaging in regular exercise and strengthening your core and pelvic muscles are a few healthy habits. Importance of unwinding daily cannot be stressed enough and consider acupuncture to manage severe PLBP.
Sources:
Vermani, E. et al. (2010) Pelvic Girdle Pain and Low Back Pain During Pregnancy : A Review. Pain Practice. 10(1). Pg 60 -71
Noren, L. et al. 2001. Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. European Spine Journal. 11(3). Pg 267-271.
To, W.W. and Wong, M.V. (2003) Factors associated with back pain symptoms in pregnancy and the persistence of pain 2 years after pregnancy. Acta Obstetricia et Gynecologica Scandinavica. 82(12). Pg.1086-1091.
Granath, A. et al. (2006). Water Aerobics Reduces Sick Leave due to Low Back Pain During Pregnancy. Journal of Obstetric, Gynaecologic and Neonatal Nursing. 35(4). Pg.465-471.
Artal, R. and O’Toole M. (2003). Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. British Journal of Sports Medicine. 37(1).
Guerreiro, J.B. et al. (2004). Acupuncture for low back pain in pregnancy–a prospective, quasi-randomised, controlled study. Journal of the British Medical Acupuncture Society. 22(2). Pg. 60-67.
Richens, Y. et al. (2010). Lower back pain during pregnancy: advice and exercises for women. British Journal of Midwivery. 18(9). Pg. 562-566.
Katonis, P. et al. (2011). Pregnancy-Related Low Back Pain. 15(3). Pg. 205-210.
Ho, SS. et al. (2009) Effectiveness of maternity support belts in reducing low back pain during pregnancy: a review. Journal of Clinical Nursing. 18(11). Pg.1523-1532.
