Lumbopelvic Pain and Pregnancy
“Oh the joy of having a baby” is priceless, however it can take two years to recover from the stress and strain it puts on a woman’s body. During pregnancy the additional weight in the abdomen from the growing baby increases intraabdominal pressure and intradiscal pressure. This increased pressure paired with ligamentous laxity can trigger low back pain, hip pain, sacroiliac pain, sciatica and other lumbopelvic issues.
Physical therapists have the skills necessary to create an all-inclusive recovery program during pregnancy and/or injury sustained during delivery. Pain or limited function typically brings a patient to a physical therapy office. Physical therapy is an all natural approach to find a self healing solution to your pain and dysfunction. A physical therapy evaluation and program treating lumbopelvic issues will include correcting: movement dysfunctions, pelvic asymmetry, core weakness, and faulty body mechanics. Using this information an individualized treatment strategy is created.
A movement dysfunction in the sacroiliac joint can be present and asymptomatic prior to pregnancy. The ligamentous laxity caused by the hormone relaxin and rapid abdominal weight gain during pregnancy can shift the bony pelvis out of alignment straining muscles, spraining ligaments, tractioning nerves and aggravating lumbar disc problems. During vaginal delivery the pubic bones separate to allow safe passage for the baby through the birth canal. In some cases the pubic bones do not return to their anatomical position leading to weakening of the pelvic floor musculature. If not properly treated, this misalignment can cause chronic low back and pelvic pain. Muscle energy techniques are utilized by Physical Therapists to direct the pelvis back into alignment through a guided isometric contraction at a specific angle and a specific effort. Once the proper alignment is restored a muscle balancing exercise program is prescribed to increase core strength and stability while returning a patient back to normal daily activities.
Attention to your core strength is critical in the early stages of your exercise program. “Physical Therapists are qualified to increase core stability through exercises such as Pilates in a safe and properly prescribed manner”, states James J. Modera, P.T. Sometimes it is necessary to have more specific training of the pelvic floor. “Physical Therapists who have received specialist training in Women’s Health and Pelvic Therapy will instruct a core stability program for the pelvic floor using the principles of the Kegel exercise and stability training”, states Kathryn Scibona, D.P.T.
Even though a woman has gone through the challenge of delivery there is still a small child who needs mom’s care. The postures required by childcare can cause back, neck, and leg pain and symptoms. Using proper body mechanics to perform these tasks reduces the risk of further injury and creation of chronic pain. Physical therapists may receive additional training in ergonomics to teach patients strategies for all childcare while protecting the potential hip, pelvic or low back injury. For example, when picking up your infant and/or car seat bend at the knees and look up keeping your spine straight to avoid neck and back strain. This is especially important when lifting your child in and out of a car seat or crib. Low back support, proper support under your child and avoidance of excessive forward bending of the head when breast feeding will save you from a “pain in the neck,” as well as low back pain.
An exercise program post pregnancy is necessary to regain your prior physical condition. Exercise classes for the general public may be too much at first. Once released to begin an exercise program by your obstetrician, a stationary bike with a comfortable seat may be a safe place to start. A walking program should be implemented first before returning to running. Running too soon can make you susceptible to ligamentous strains in the lumbopelvic region. A Physical Therapist will prescribe a program based upon your current and prior level of activity taking into account current medical conditions to help achieve post pregnancy weight loss, muscle strength improvements, and prevention and abolishment of lumbopelvic pain.
In conclusion, your care plan should entail education on exercise and hands on treatment based on a thorough physical examination by a qualified Physical Therapist with experience working with women’s health issues.
Sacroiliac joint– the joints on either side of the low back which connects the two sides of the pelvis located just above the buttocks
Movement dysfunction– increased or decreased movement in a joint which causes strained muscles and tendons, sprained ligaments, and irritated nerves triggering pain.
Body mechanics– Movement patterns during work or daily activities which minimize excessive stain on particular muscles and or joints
Relaxin- A hormone produced by the placenta during pregnancy which increases flexibility in the uterine ligaments as well as ligaments throughout the rest of the body.
Pelvic floor– The muscles supporting the inferior portion of the spine keeping abdominal contents in place as well as supporting the spine and pelvis.
Core- Any muscle which has an attachment to the spine or pelvis.
Kegel exercise– An exercise which is aimed at strengthening the pelvic floor.