Should Pain be Expected when Expecting?

Pregnancy by definition is a span of about 9 months in which a woman’s body undergoes many, many changes-- some changes being more comfortable than others.

Although we often picture pregnancy as a blissful and wonderful expectation as we grow a new life, the physical changes a woman’s body goes through can feel anything but miraculous. Over 50% of pregnant women report their biggest complaint during pregnancy is low back pain, sometimes lasting over 3 months! Additionally, up to three-fourths of women will experience low back pain at some point during their pregnancy.(1,2)

Add to this pelvic girdle pain (pelvic pain, SI joint pain, pubic symphysis dysfunction), which is experienced by up to 20% of women at some point during pregnancy,(3), and it’s no wonder that pregnancy can be physically exhausting!

Although pain is usually experienced sometime between the 5th and 7th months of pregnancy, it can begin as soon as eight to twelve weeks after becoming pregnant.(2).This was Dr. Kristen’s experience. What she has also noticed with pregnancy is that any past injuries tend to resurface during pregnancy.

Why we Experience Pain during Pregnancy

But why? Well for starters a woman's body begins releasing a hormone necessary for pregnancy called Relaxin-- and it does just that--Relaxes the ligaments and smooth muscles of a woman's abdomen and pelvis so that your body can grow with the baby. Then the uterus and fetus begin to expand and grow. This growth makes a woman’s center of gravity change to accommodate--shifting forward to accommodate for the growth of the baby. The abdomen stretches, and the woman’s belly moves forward and out accordingly to increase in the baby’s weight and development. This shift in gravity of a woman’s weight (3) adds pressure and weight on her low back, pelvis, knees, ankles, and feet.

In fact, the thoracic (mid-back) and lumbar (low back) spine curvature can change during pregnancy, causing an increase in pain in the low back and pelvic regions. This can also cause changes to a woman's balance and gait patterns (i.e the way you walk).(3)Think of the pregnant “waddle” that some women do while walking, and you have an idea as to the changes that take place in the abdomen, low back, pelvis, and sacrum!

This can, and often does, place additional stress and strain on the joints in the low back and posterior pelvis, known as the lumbar and sacroiliac areas. Expansion of the pelvis and abdomen stretch a ligament used to hold the uterus called the round ligament and many women will experience pain in the front lower abdomen and pubic regions. These postural changes lead to increased pain, muscle tightness, tenderness, and discomfort.(2)

Low back and pelvic pain can also be major deterrents in a woman who could, and would, be otherwise motivated to continue working and taking care of both herself and her home. Pain has shown to influence pregnant women’s daily lives in the challenges they encounter concerning their physiological, psychological, occupational, and social functions.(4)

And it doesn’t always stop there. Sometimes women can experience low back and pelvic region pain the year after birth, and even up to three years after labor and delivery. (1,5) Pregnancy-related low back and pelvic pain, as well as post-partum mechanical spinal disorders, are not only common, but they can impede recovery, nursing, and caregiving – three very important components in taking care of the newborn after labor and delivery.(5)

How will a pregnant woman know if her pain is being caused by her pregnancy?

What is pregnancy pain like? Some women describe it as a deep discomfort. Others describe it as stabbing, continuous, recurrent, and intense.(6) The discomfort can also vary in intensity; some days can be more difficult than others, and there may be times when the pregnant woman feels like even basic tasks are difficult to do.

Where might pregnancy-related pain be felt on the body?

For some, the pain in the front, by the pubic bone. Others may feel discomfort directly at the low back above the gluteal area – sort of around the beltline. And for others still, the pain also occurs between the hip bones.

Sometimes this discomfort even travels down the back of the thigh to the knee and the calf (6), or even down to their feet. (2,7) Most women say that their pelvic and low back pain is more intense during pregnancy than after labor and delivery, and it is still physically limiting as it may cause a pregnant woman to withdraw from activities that she would normally gravitate toward, such as social interactions or work.(6)

Since pregnancy can drastically change a woman’s body in such a relatively small period of time with lasting effects, how can chiropractic care help with physical changes encountered during pregnancy, especially ones that contribute to pain?

How can a Chiropractor help with Pain during Pregnancy?

While a chiropractor cannot help with changes in hormones that naturally occur with fetal growth, the resulting biomechanical changes that occur in a woman’s body during pregnancy can be lessened or alleviated by the help of a knowledgeable chiropractor.

A chiropractor who is well-versed in addressing pregnancy-related issues will be able to accurately assess, diagnose, and treat low back pain and pelvic girdle pain.

Treatment during Pregnancy

Some options for treatment include chiropractic spinal manipulation of the joints in the lumbar spine, pelvis and other areas, soft tissue therapy of the surrounding low back and pelvic musculature, exercises to strengthen, and ergonomic advice to eliminate discomfort at home, as well as encouraging regular visits to her obstetrician and pelvic floor therapist.

Treatment can improve functional activities such as sitting, traveling comfortably in a car, walking, taking care of other children, household activities, sleep, exercise and more. (3) And, addressing this discomfort sooner rather than later is preferred, especially if employment or maternity leave is a concern. Low back pain is the most common cause of sick leave after delivery! (7)

Maintaining optimal function and reducing pain levels to more manageable levels are goals that should be discussed when it comes to pregnancy-related pain.(2)

A knowledgeable chiropractor will be able to accurately assess changes in pelvic function, curvature changes in the upper and lower back, stress on the lower back including muscle tension and tightness in the lumbosacral area, and any radiating (shooting) pain that can travel from the low back into the legs or lower extremities.

A chiropractor can also help identify any areas of stiffness (7) that may accumulate in weak areas of the body (8), contributing to an increase in back pain during pregnancy. This may be the case if poor posture, excessive standing, and bending over triggers or escalates any back and pelvic pain.

Pregnant woman under Chiropractic care may benefit from:

· Decrease in spinal pain including low back pain and sciatica

· Reduced pelvic and round ligament discomfort

· Shorter labor times

· Decreased opportunity for Breech baby positioning

· Decrease in need for C-Section

· Less back labor

· Reduced need for pain medications during labor

· More comfort while breastfeeding

· Greater production of breast milk

· Less incidence of postpartum depression

Low back pain and pelvic pain do not have to be an inevitable part of pregnancy. If you are one of the 50%+ of pregnant women experiencing pain during your pregnancy, there are options for treatment available to help make your pregnancy more comfortable and productive!

Even as your body changes, a well-trained chiropractor will be able to give you conservative management options for your low back and pelvic pain. Your doctor will work with your OB/GYN to make sure that your options for treatment are safe and effective.

References

1. Yoo, H., Shin, D., and Song, M. (2015). Changes in the spinal curvature, degree of pain, balance ability, and gait ability according to pregnancy period in pregnant and nonpregnant women. J Phys Ther Sci. 2015 Jan; 27(1): 279–284.

2. Montgomery, S.P. “Management of back pain during pregnancy.” (2009). Retrieved March 2020 from: https://www.spine-health.com/conditions/pregnancy-and-back-pain/management-back-pain-pregnancy

3. Verstraete, V.H., Vanderstraeten, G., and Parewijck, W. (2013). Pelvic Girdle Pain during or after pregnancy: a review of recent evidence and a clinical care path proposal. Facts Views Vis Obgyn. 2013; 5(1): 33–43.

4. Bernard, M., and Tuchin, P. (2016). Chiropractic management of pregnancy-related lumbopelvic pain: a case study. J Chiropr Med. 2016 Jun; 15(2): 129–133.

5. Maiers, M., et al. (2018). Chiropractic in Global Health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic. Chiropr Man Therap. 2018; 26: 26.

6. Katonis, P., et al. (2011). Pregnancy-related low back pain. Hippokratia. Jul-Sep; 15(3): 205–210.

7. Sabino, J., and Grauer, J.N. (2008). Pregnancy and low back pain. Curr Rev Musculoskelet Med. 2008 Jun; 1(2): 137–141.

8. “Back pain during pregnancy: causes, treatment and prevention.” American Pregnancy Association. Retrieved March 2020 from: https://americanpregnancy.org/pregnancy-health/back-pain-during-pregnancy