Low back pain during pregnancy

Approximately 70% of pregnant women suffers backache, commonly in the second half of pregnancy (between the fifth and seventh month of pregnancy). It is usually due to normal changes that occur in pregnancy but sometimes it is good to pay attention if it is accompanied with other signs and symptoms you need to know!

Low back pain (LBP)

Is a backache in the lumbosacral spine region, it can be localized and sometimes, it can radiate to the extremities. It can occur at any time during pregnancy. Backache can be acute if it’s less than 3 months, chronic, or recurrent. In some cases, troublesome pain may persist for years after the pregnancy but rare.

LBP increase with the progression of gestation resulting from a shift in the center of gravity and thus in swayback posture from increasing lordosis, which strains the back muscles; produced by the weight of the enlarging uterus and responsible for the pain.

Increased incidence  

  1. In grand multiparas (more than 5 births) who did not exercise her abdominal muscles after each pregnancy and her muscle weakened. Primigravidas (first time pregnant) usually have excellent muscle tone, because her muscles have not been stretched before. Backache, thus, in most cases increases in severity with parity.
  2. Obese women usually have a little loose muscle, failing to give any support to the heavy enlarged uterus, which curve down increasing the curvature of the back still further producing pain. It happens that musculoskeletal strain on to the curve of the lower back, can be due to the weight gain in the abdomen.

Risk factors

  1. Sedentary lifestyle; poor body mechanics and strength of abdominal and back muscle.
  2. Work-related factors such as repetitive motion, heavy lifting (carrying of a child) or significant bending, also workplace/job satisfaction.
  3. Walking without rest periods or strenuous exercise

Etiology

  1. Hormonal changes may cause inflammation and backache due to relaxin (a hormone secreted by the placenta which prepares the mother for childbirth).
  2. Venous congestion in the pelvis and hypoxia in the pelvic and lumbar spine, due to the increased fluid volume from fluid retention during pregnancy, plus the compression by the uterus on the vena cava, are responsible for the low back pain, especially when it’s exacerbated at night and is severe enough to wake the mother up.
  3. Compression of sciatic nerve, gives numbness sensation in lower back
  4. Sacroiliac joint problem
  5. Natural history of low back pain related to age and gender (controversial).
  6. Psychological factors such as depression, anxiety or emotional stress.

Important to pay attention, go to the hospital!

  1. First half of pregnancy (less than 20 weeks) Experiencing persistent low back pain, cramps and vaginal bleeding

Warning: can be a threatened abortion

2. Urinary tract infection (frequent urination with a burning feeling, little pee comes out, pain in back and lower abdomen) and left undiagnosed or untreated can lead to pyelonephritis (a kidney infection, presents with fever) which can complicate pregnancy

Warning: can lead to premature labor (back pain, colicky cramping, may have bleeding)

3. If you fall or have a car accident (At any time during pregnancy)

Warning: possible placental abruption

Management

Obstetrical care (midwife or doctor) plus multimodal therapy (combination of chiropractic therapy, exercises, and patient education)

Result: Less pain and greater improvement in daily activities.

Non-pharmacological Treatment

  1. Massage/back rub
  2. Application of ice on the back
  3. Warmth (not too hot) on the back (e.g., heating pad, warm bath, sitting in a warm shower)
  4. Hydrotherapy
  5. Pelvic rock /pelvic tilt or hip wiggles (like tail wagging) to keep the lower spine flexible.
  6. Good body mechanics: Stoop and squad, rather than bend.
  7. “Belly Band” A pregnancy support harness or girdle
  8. Good support brassiere
  9. Supportive low-heeled shoes (avoid high-heeled shoes, unstable and further exaggerate the problem of the center of gravity and lordosis)
  10. Physical therapy program to improve strength and conditioning
  11. Chiropractic manipulation in selected women
  12. For resting or sleeping: Use a pillow back support in lumbar area when sitting, or between legs when lying on side. A supportive mattress can be helpful too.

Pharmacological Treatment

Acute pain

  1. Tylenol may be used as needed
  2. Nonsteroidal anti-inflammatory drugs (NSAIDs): ibuprofen, naproxen (used with precaution to avoid fetal secondary effects)
  • Muscle relaxants may be added when needed: like cyclobenzaprine, baclofen

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