For many women, pregnancy is a wonderful experience. There are, however, many changes and challenges the mom-to-be can expect, and back pain is one of them. The good news for pregnant women is that the development of severe or debilitating low back pain is very rare.
The incidence of symptomatic low back pain that is severe is about 1 to 2 percent. This may be associated with a condition known as sciatica that is usually caused by a herniated or bulging disc in the lower part of the spine.
The many physiological changes that occur in a pregnant woman’s body can predispose her to developing or acknowledging back pain that she may not have recognized or experienced previously. Luckily for most women, back pain often resolves soon after giving birth.
The development of back pain during pregnancy primarily relates to the weight gain associated with the growing fetus. The extra weight gained adds stress to the pregnant woman’s spine.
The discs or cushions within the spine serve as effective shock absorbers but can fail due to weight gain. A pregnant woman may experience low back pain depending on either the amount or intensity of activity she is undertaking. Often times, simply resting — either lying down or getting into a reclining position — is sufficient to relieve or lessen the pain because this keeps the low back muscles from working harder to keep the pregnant woman upright.
The next common cause of low back pain is weakening of the abdominal muscles that results from the growing uterus. The abdominal muscles (core muscles) tend to thin out or separate, giving the pregnant woman less abdominal strength. These muscles are what hold us upright and in a vertical position, so once they are weakened or separated a necessary support structure is lost, and the back muscles, discs, and bones have to work overtime. Pain is most recognized with moving and activity and is relieved when resting.
As the baby grows during pregnancy, a pregnant woman may notice her posture changing, particularly the back flexing forward as her center of gravity shifts — this is not normal for spinal alignment. Ideally, the spine is balanced, but a flexed forward spine, also known as kyphosis, is well known to cause low back pain. Kyphosis is common in the aging spine but occurs in a pregnant woman from the constraints placed on her from her growing baby.
The third major cause of low back pain in pregnant women is hormonal changes. To prepare for the passage of the baby through the birth canal, a hormone relaxes the ligaments in the joints of the pelvis. These changing hormones can cause the ligaments to become lax or weaker. Ligaments hold the bones from moving too much, and their weakening may result in back pain.
Lastly, an often overlooked cause for pain in the low back is stress. With effective management, limiting stress as much as possible may relieve or lessen the pain.
How can a pregnant woman ease her back pain? Getting regular exercise is important. Exercise that strengthens the back and core muscles is a safe and effective way to both prevent back pain from occurring later in pregnancy as well as relieve the symptoms once they appear. Other exercises that can be helpful include a stationary bike and pool activities. Chiropractors, physical therapists, acupuncturists, and massage therapists may also play a role in treatment of pregnant women with back pain. Applying heat or cold to the painful area may also help. And be sure to use the legs to squat rather than bending over and avoid sleeping on the back.
Pregnant women should talk with their doctor if their back pain persists and should never take pain medications unless advised by a doctor. Acetaminophen (Tylenol) is usually safe for most women during pregnancy and is probably the most used medication. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil or Motrin) and narcotics are not usually recommended.
Low back pain in pregnancy can be tough for some pregnant women, but there are several things that can be done to minimize the pain. As with most medical issues, prevention is the key and treatment that is started early will often be more successful. Consistent exercise and monitoring of back pain may help to prevent the acceleration of damage to the back and spine. Remember: a healthy mom-to-be is an important factor for ensuring a healthy baby.
Matt Ammerman is a neurosurgeon.
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