Researchers estimate that between 45-90% of pregnant women will experience low back pain at some stage of their pregnancy. (1-5,117,121,128,132,138) Up to 33% rate their pain as severe. (6) Pregnancy-related low back pain (P-LBP) leads to lower quality of life, restricted activity, and disability – with almost 25% of pregnant women taking sick leave for LBP. (2,7-11) The recurrence rate for pregnancy-related low back pain is 85-90%. (11-14) Consequently, almost 1 in 5 women who report P-LBP during an initial pregnancy will avoid future pregnancies due to fear of returning symptoms. (15)
Pregnancy-related low back pain is not generally the result of true structural disease, like disc lesion or spondylolisthesis, but rather a combination of “functional” stressors, including weight gain, gait changes, and postural strains that occur contemporaneously with hormone-induced ligamentous laxity. (16-20,128) Pregnancy creates the perfect firestorm of progressively increasing load with diminishing stability. (21) The average woman gains between 20-40 pounds throughout pregnancy. (13,22) This predominantly frontal weight gain advances the center of gravity, forcing an anterior pelvic tilt and lumbar hyperlordosis- placing excessive stress on the ligaments, discs, lumbar facet joints and sacroiliac joints. (23-25) Since an excessive lumbar lordosis diminishes the spine’s capacity to absorb axial load, the intervertebral discs undergo excessive compression, likewise exacerbated by weight gain. (26-28) The abdominal muscles, which are an integral support mechanism for the lumbar spine, are stretched to accommodate the expanding uterus, thereby compromising their ability to maintain posture and support. (13) Biomechanical stressors are compounded by the hormone relaxin, which increases tenfold during pregnancy. (13) Relaxin triggers lumbopelvic hypermobility and threatens core stability. (26) Not surprisingly, pain and disability tend to gradually worsen throughout pregnancy. (120,128)
The extremes of activity seem to contribute to P-LBP. (29,30) Sedentary lifestyles increase the risk of developing low back pain. Unfortunately, regular exercise and physical activity typically decrease throughout pregnancy. (31-38) Conversely, lifestyles and occupations that are “physically demanding” also carry an increased risk of developing pregnancy-related low back pain. (13,131) A history of lower back pain doubles the risk of developing P-LBP. (13) Additional risk factor include pre-pregnancy body mass index >25, pelvic girdle pain in pregnancy, and depression in pregnancy. (113)
Pregnancy-related low back pain typically starts between the fifth and seventh months. (39) Nevertheless, a significant proportion of women experience pain in the first trimester before mechanical changes could play a significant etiological role – early onset pain may be related to hormonal and/or emotional stressors. (13,40)
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What we do in our office to help this condition:
1. Perform a detailed exam, assessing the alignment of the spine and its extremities. We take extra time to assess the alignment of all pelvic bones, as this is an important area for the growing baby. Improper alignment in any of these areas, especially during pregnancy, may be detrimentally affecting the low back and its surrounding structures, compromising its ability to function normally. It is common for women to get their spines checked throughout the duration of their pregnancy as the body is changing so rapidly.
2. As indicated, adjust areas of spinal and extremity subluxations (misalignments), restoring proper nerve system function which facilitates healing and ease in the body. We have adjusting tables that allow women to comfortably lie face down, even in the later stages of pregnancy.
3. Prescribe stretches and exercises in conjunction with chiropractic care to strengthen the structures and surrounding soft tissues of the low back and pelvis.