Back pain is more prevalent among women than men. This association has only been partially evaluated, but it could be related to the unique female conditions of pregnancy and childbirth. Unfortunately, some individuals develop back pain during pregnancy that lingers and becomes a chronic condition.
Lower back pain may manifest itself as pain around the lumbar spine or as pelvic girdle pain. It is critical for the source of the pain to be diagnosed and differentiated early on 1. A diagnosis of back pain during pregnancy is made based on a physical examination, a review of the patient’s medical history, and, possibly, a magnetic resonance imaging (MRI) scan to rule out the presence of a herniated disk. No X-ray or computed tomography (CT) scan should be performed given that these produce radiation that is risky for the developing fetus 2.
Research shows that a history of pregnancy and childbirth is a risk factor for chronic functionally significant back pain in women.3 In other words, among the patients in the study, those who gave birth previously were more likely to experience chronic back pain that affects their daily life.
Multiple factors can result in chronic back pain during pregnancy. First, pregnancy-related hormones affect muscles and joints. Relaxin and progesterone relax muscles and loosen joints and ligaments, in particular in the pelvic area. This helps prepare the body for labor. However, this can place a strain on the joints of the pelvis and lower back and pelvis, resulting in back pain 4. In addition, as the uterus develops, a woman’s center of gravity shifts. The weight of the fetus and concurrent weakening of stomach muscles can result in the lower spine being pulled forward, placing additional strain on the back muscles. Many women lean back in response, further straining the back 5. In addition, these weight shifts can result in falls.
Back pain may persist after giving birth. Severe acute postpartum pain is a risk factor for future disability, suggesting that the peripartum period is an important time to intervene preventatively. Early recognition and management of chronic back pain related to pregnancy may help mitigate future disability. In addition, individuals can also take certain steps to minimize pregnancy-related back pain.
First, it is key to use proper body mechanics. To pick an item up, it is best to squat, bending at the knees while keeping the back straight, avoiding bending over from the waist. Second, it is important to use good posture when sitting or standing, while wearing shoes that provide good arch support. While sleeping, it is best to sleep on one’s side with a pillow between the knees for support. It may also be helpful to strengthen the stomach muscles by doing pelvic tilts or by sitting on an exercise ball while rocking back and forth 2. As necessary, heat, cold, or a massage can be applied to the painful area as well 5.
Finally, additional treatment options include exercising, physiotherapy, stabilization belts, nerve stimulation, pharmacological treatment, acupuncture, and yoga, depending on an individual’s case 1.
Additional research in the form of large studies is warranted in order to develop the best prevention and treatment options for acute and chronic back pain during pregnancy.
References
1. Katonis, P. et al. Pregnancy-related low back pain. Hippokratia (2011).
2. Back Pain During Pregnancy | Cedars-Sinai. Available at: https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/back-pain-during-pregnancy.html. (Accessed: 9th January 2023)
3. Zhang, M., Cooley, C., Ziadni, M. S., Mackey, I. & Flood, P. Association between history of childbirth and chronic, functionally significant back pain in later life. BMC Womens. Health 23, 4 (2023). doi: 10.1186/s12905-022-02023-2.
4. Back pain in pregnancy – NHS. Available at: https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/back-pain/. (Accessed: 9th January 2023)
5. Back Pain in Pregnancy | Johns Hopkins Medicine. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/staying-healthy-during-pregnancy/back-pain-in-pregnancy. (Accessed: 9th January 2023)