Around 50 per cent of women, at some point during their pregnancy or even the postpartum period may encounter back pain. But most women feel it is normal discomfort and an inevitable part of pregnancy, making it one of the most neglected issues, said Dr Shivani Sabharwal, gynaecologist, Apollo Spectra Hospital, Karol Bagh, Delhi.
Low back pain (LBP) in pregnancy has been reviewed extensively, however, there is still much ambiguity with regard to identifying appropriate investigations, considering safe treatment options, and decision-making pertaining to the use of neuraxial analgesia and anaesthesia during labour and delivery.
Back pain in pregnancy
“LBP is one of the most common reasons for women taking leave from work or their daily routine. This also leads to increased chances of ceaserean sections,” said Dr Sabharwal. Pain can be either hormonal, stress-induced, mechanical, or because of associated pathological disorder like underlying disk herniation. Mechanical pain can be due to weight gain in pregnancy, and shifting of the central cavity, which makes women lean backward. The abdominal muscle in a pregnant lady stretchesto accommodate the growing uterus. This causes muscle fatigue and puts an extra load on the spine which pressurises the back. An important hormone that is released 10 times more during pregnancy, called relaxin, causes laxity and discomfort not only in the joints but the entire back.
Pain can either be in the pelvic region anteriorly, that is on the pubic bone which is just above bladder, or the whole pelvic girdle which includes the lumbar region — the lower back posteriorly and also the lateral side. Pain can also be unilateral, bilateral, or radiating down to the thighs or calves.
Low back pain should not be ignored (Source: Getty Images/Thinkstock)
But, anterior pelvic pain is more common compared to posterior. The type of pain and origin of same can be differentiated by performing examinations on the woman. Sciatica, is a rare entity in pregnancy and occurs only in one per cent of females. So early identification and treatment gives a better outcome.
The risk factors include history of LBP during the previous pregnancy, history of previous trauma, history of pain during menses, and hypermobility of joints. It needs to be understood that spinal anesthesia or epidural anesthesia doesn’t increase the risk of chronic or acute back pain. Prevention is important to reduce the incidence of back pain.
Few tips that can help
*Maintain a proper posture while performing day-to-day tasks.
*Use a good chair that supports the back.
*Prolonged sitting and lying down is not recommended. Limbs must be moved after every 25 minutes.
*Practice yoga, aerobics, and physiotherapy exercises. Exercises like kegals, pelvic tilt, cat stretches, back stretches and breathing exercises should done.
*Learn to do light weight lifting without stressing the back.
*Have a back rest on the bed, know about the proper technique of getting in and out of bed to maintain proper position of the spine.
For managing pain around the pelvic region, minimise activities like climbing, and running that increase the pain, support legs while lying by using a pillow under the feet, and avoid too much bending of the hips and spine.
Use belts after consulting the doctor for managing lumbar or pelvic pain. In case of acute back pain, just rest and do not exercise at all.
What not to do
Do not stand straight with the lower tummy muscles tightened. The weight has to be equally distributed on both feet. Avoid leaning on one side. Avoid using big cushions while sitting as it can cause arching of the back. Do not slouch or cross your legs. Avoid heels. One can buy larger shoes with low heals. Do not buy totally flat shoes. Avoid sudden movements. Avoid lifting heavy weights or moving furniture. Do not bend forward from the hips.
Try to follow these sleeping positions
– Either sleep on one side with a pillow between the legs and a pillow behind the back.
– Three quarter position wherein the woman lies on the side and puts the leg on top of the pillow and arm behind.
– Lying down straight is not recommended in pregnancy.
– Massage, stretching, hot water compression, and acupuncture can also be helpful in reducing the pain.
– The right amount of weight gain under expert’s guidance will prevent LBP during pregnancy.
– Take the medication prescribed by gynaecologist.
– If severe, consult a physiotherapist and orthopedician.
Few “red-flags” such as radiating leg pain, neurological deficits (numbness or weakness), bladder and/or bowel symptoms, or fever should be excluded and explained in all women. While the evaluation of LBP is mostly clinical, MRI is the diagnostic investigation of choice during pregnancy, Dr Sabharwal said.
