Pregnancy and Back Pain: A Tale of Two Cities Pregnancy, without question has to be one of the most beautiful chapters in the circle of life. The joy and happiness of bringing a new baby into the world is indescribable. However, with the excitement and preparation for the new arrival comes a physical price tag. Unfortunately, mom will be a host to many physical changes that will sometimes make pregnancy a tough cross to bear. When I think of pregnancy I can't help but remember Charles Dickens' opening words in A Tale of Two Cities, “It was the best of times, it was the worse of times”. Although a wonderful time of life, it is impossible to ignore the impact of the physical side effects. The road to motherhood is far from paved and promises to be a very bumpy ride. It is estimated that between 50 and 80 % of all expectant mothers will suffer from some type of back pain throughout their pregnancy.1 To further complicate things, a good portion of women will suffer with pain for up to 6 months after delivery. How and why does this occur? Pregnancy induced back pain stems from several sources that all contribute to the painful condition. The first contributing factor is due to the hormonal changes that occur in preparation for delivery. The body starts releasing huge amounts of estrogen and relaxin to allow the pelvis to accommodate childbirth. Relaxin, true to its name, causes muscles and more importantly, ligaments to relax and expand.2 Although necessary, the hormonal changes alter the normal body biomechanics. The stability the pelvis and low back normally provide are changed tremendously. Ligaments that were once taut are now loose and that changes the role of all the surrounding soft tissue. Muscles have to work twice as hard to compensate for the lack of support from the ligaments. An overworked muscle quickly fatigues and becomes sore and achy. When this occurs over time, the condition can be very difficult to control and pain can become quite debilitating. Back pain also occurs in pregnancy due to the change in weight. As mentioned earlier, the muscles are already having a difficult time coping with the lack of participation from the ligaments, never mind having to carry the excess weight put on with pregnancy. Imagine walking around with a dumbbell strapped to your belt all day long. The dumbbell could weigh on average 20-30 pounds and sometimes over 50 pounds in some cases. The stress on the muscles alone can cause the back muscles to feel stained and weak. In addition, the center of gravity changes. The pelvis rocks forward to accommodate the growth of the baby and the uterus. Changing the center of gravity places a great deal of stress on the body. To help put this into perspective, try this exercise. Walk on your toes with your knees bent slightly forward and your shoulders back. As you can see, changing the center of gravity has an impact on the muscles and joints that are involved in actions we take for granted like walking. Another contributing factor to back pain is the change of blood flow throughout the body. Blood carries oxygen, which nourish the muscles and allow for normal function. Mom's blood has to share oxygen with the baby, so muscles don't get the same oxygen they once received. This not only fatigues the muscles, but also can contribute to trigger point formation. Trigger points are extremely tender tangles of muscle fiber that can cause extreme local and referred pain. Taking a look at the changes that occur during pregnancy, it is not difficult to comprehend that the mother-to-be is undergoing a great deal of distress. This article is only looking at the low back and not taking into account the mental stress, morning sickness, headaches, neck and shoulder pain that also accompany the price of motherhood. Now that we have taken a peek at ‘the worse of times”, what can be done? Pain relief is difficult goal for many pregnant women to achieve. In most cases, with the exception of acetaminophen, pain relievers and drugs are contraindicated during pregnancy. Treatment options not only have to bring relief to the mother, but be safe for the baby as well. One suggestion is the use of a baby sling. A baby sling is a specialized back support used to help reduce the stress on the back muscles. Manual therapies such as massage, trigger point therapy and deep tissue work can reduce spasm and associated muscle pain. Spinal manipulation and joint mobilization performed by a chiropractor, osteopathic physician or physical therapist can reduce pain by restoring normal movement and alignment to the joints that are affected by the muscle and ligament changes. Many therapy tables are adjustable to accommodate the mother-to-be and her growing belly to ensure safety and comfort during treatment. Therapeutic exercises to strengthen weakened muscles and compensate for the postural changes that occur during pregnancy can reduce a great deal of back pain. Finally, acupuncture is a safe natural treatment option to reduce pain and decrease muscle tension that occurs throughout pregnancy. 3 Despite the inevitable changes that occur and the loss of the medicine cabinet as a savior, there are safe and natural forms of relief available for pregnancy induced back pain and muscle discomfort. Although some things can't be avoided, a great deal of the pain throughout pregnancy is treatable. Taking care of the mother-to-be is essential and sometimes forgotten with everything surrounding the arrival of the newest family member. Reducing stress and pain is one of the first steps to get through the bumps in the road and welcome “the best of times”. References
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