Although pregnancy is a time of both excitement and anticipation, it can also be a time of discomfort. One of the more common discomforts experienced by expectant patients is low back pain. We would like to take a few moments to share some suggestions to help patients deal with back pain during pregnancy.
As a patient’s baby continues to grow and develop, the mother will carry greater weight. This added weight causes greater strain on a woman’s hips, knees and low back while the presence of pregnancy hormones such as relaxin and progesterone cause greater joint laxity. In addition, as a pregnant patient’s growing abdomen protrudes forward, her center of gravity will also change. To maintain her head over her body’s changing center of gravity, a third trimester patient will often compensate by leaning backward, causing a greater curvature in the lumbar spine. This combination of factors; increased weight, greater joint laxity and an accentuated lumbar spine curvature collectively contribute toward episodes of low back pain during pregnancy.
In addition to over-the-counter Tylenol and heat applied to the lower back, there are several things a patient can do to address back problems during pregnancy.
Wear comfortable shoes. During pregnancy, the use of flat shoes with well-padded arch support will reduce the incidence of low back strain. High-heeled shoes or shoes with poorly supportive arches can exacerbate a woman’s back discomfort.
Bend and lift with legs. Avoid bending at the waist when picking things up from the floor. It is safer to bend at the knee or squat when lifting things from floor level.
Avoid excessive weight gain. The more weight a patient has to carry during her pregnancy, the greater the likelihood she will experience back problems. To minimize excessive weight gain while pregnant, focus on eating whole grains, fresh fruits, vegetables and foods that are high in fiber while avoiding simple carbohydrates such as carbonated beverages, breads, and artificially sweetened foods. Sensible aerobic exercise is equally as important as a healthy diet in avoiding excessive weight gain during pregnancy.
Tips on sleeping. A comfortable mattress is perhaps the most important aspect of getting a good night sleep while pregnant and avoiding back pain the following day. Placing a pillow between the knees may also help reduce low back strain while sleeping. When arising in the morning, the patient should avoid swinging her legs out as she simultaneously sits up since this can sometimes strain the low back. The patient is encouraged to first sit up, then swing her legs over the side of the bed and then finally stand.
Supportive bra use. A patient’s breasts will become fuller and heavier as they develop and prepare for lactation after delivery. On occasion, especially with fuller busted patients, this can cause upper back discomfort between the shoulder blades. Wearing a supportive underwire bra and focusing on good posture can help with this discomfort.
Pregnancy support belts and harnesses. There are several commercially available abdominal support products that can help to support a pregnant woman’s torso, abdomen and back while also helping to improve her posture.
Massage. Since a significant component of back pain during pregnancy involves muscular strain, massage therapy can often help reduce such discomforts. When choosing a massage therapist, ask if they are comfortable caring for pregnant patients. Special equipment may sometimes be required to avoid placing excessive pressure on the uterus during the massage.
If a patient’s back pain fails to respond to conservative measures such as over-the-counter Tylenol, heat or the suggestions previously mentioned, she should be evaluated by her doctor.
Although back pain is common during late pregnancy, it is important to remember that back discomfort may also be associated with other medical conditions.
Kidneys. Back pain that occurs suddenly in the flank area, located left or right of the spine just below the rib cage, may be caused by the passage of a kidney stone. Pain associated with kidney stones often occurs every few minutes in waves and is frequently associated with bloody urine. If a patient’s flank pain has a more gradual onset and is associated with symptoms such as burning with urination, frequent urination, and/or fevers, it may represent an early kidney infection.
Gallbladder. Back pain located under the right shoulder blade occurring simultaneously with pain in the right upper abdomen may be related to gallbladder problems. Gallbladder pain is often worse after meals, especially after consuming fatty foods.
Labor pain. Cramping low back discomfort that occurs regularly every few minutes may represent early labor. If the patient is term, taking a warm bath or lying down will often help these contractions subside. However, if the patient is preterm and she experiences persistent intermittent low back pain, this may represent preterm labor and should be medically evaluated.
Herniated disk. Severe back pain that radiates down the back of the legs and is associated with difficulty walking may represent a herniated intervertebral disk and should be promptly evaluated by the patient’s doctor.
If a patient is concerned that her back pain may be attributed to another medical problem, she should promptly be evaluated by her doctor in order to minimize the chance of pregnancy complications.
For patients who have scoliosis and/or kyphosis, back pain is often a way of life. Scoliosis is the abnormal left or right curvature of a patient’s spine. Kyphosis is an abnormal front to back curvature of the spine. For these patients, it is particularly important that they minimize excessive weight gain during pregnancy and take care to lift with their legs rather than their back to avoid any low back strain or injury. While anti-inflammatory medication such as ibuprofen is discouraged during pregnancy, narcotic use is generally considered safe for pregnant patients and may sometimes be required to treat severe back pain if the scoliosis or kyphosis is prominent. Throughout pregnancy, it is wise to always discuss any medication a patient desires to take with her physician to ensure that it is an appropriate choice for her own individual medical needs and the needs of her baby.
Since patients who suffer from scoliosis and kyphosis have varying spinal anatomy, placement of an epidural or spinal for labor anesthesia may present the anesthesiologist or anesthetist with a challenge. Accordingly, it may prove beneficial to arrange a consultation with an anesthesiologist for patients with either scoliosis or kyphosis who anticipate requesting epidural or spinal anesthesia while in labor.
Low back discomfort during pregnancy can unfortunately be a common complaint. We hope that these tips will prove helpful to expectant mothers in successfully dealing with back discomfort during pregnancy and help them enjoy their pregnancies more fully.