So you’re pregnant. Congratulations! In 9 months or less you will get to meet the very small person who will change your life forever!
If you are like about 3/4 of all pregnant women, you will also have discovered the joys of pregnancy-related lower back pain, pelvic pain, or the winning combination of both at the same time!
Lower back pain is pretty much what it sounds like. By comparison, pelvic pain is any pain located around the pelvis, either at the back where your sacroiliac joints are (the dimples at the top of your buttocks), around your hips, and/or in the join between your pubic bones at the front of your pelvis. As I said, about 75% of pregnant women will experience some kind of pain in one or more of these areas. About half of all pregnant women will experience pain bad enough to have a significant impact - preventing or limiting normal daily activities, requiring time off work, and in extreme cases becoming debilitating! If this is not your first pregnancy and you’ve experienced pain in other pregnancies then you are almost definitely going to get it again.1,2
Suddenly normal tasks like sitting in meetings, picking up the kids, doing the shopping, walking up stairs, can become extremely painful and challenging.
In addition to this, there is a link between high levels of lower back or pelvic pain in the third trimester and a higher incidence of caesarian section, assisted delivery, and a longer labour.3
If this is you, don’t worry, there are things you can do!
Stay appropriately active. Modify physical activities as necessary.
A pelvic stability belt can sometimes help.
Consider a qualified manual therapist such as a chiropractor with experience in pregnancy-related issues.
First, in the case of low back pain, stay active. Often the pain you’re feeling can make you worry that if you keep exercising you will do further damage. In the majority of cases this is not true. In fact regular exercise, particularly activities aimed at working on your core, pelvic floor and hip stability, can contribute to better outcomes.4 And regular exercise is linked to a range of other beneficial health outcomes during pregnancy. In contrast, standing still and sitting for long periods is often a bad idea. Keeping on your feet but moving around is better, and when you want to rest lie down instead of sitting.
Pelvic pain can be a little different. Sometimes pelvic pain is due to instability in some or all joints in the pelvis. Because of this, normal daily activities like pushing a stroller or shopping trolley, walking up stairs, getting in and out of cars, and lifting and carrying become extremely difficult. It is a good idea to limit or avoid these activities where possible, until you can get some resolution to the pain.4 Engaging in these activities still won’t cause any permanent damage, but it may flare up the condition, sometimes considerably. Further, any exercise needs to be aimed at reducing the stress on the unstable joints of the pelvis, and improving the stability of the entire pelvic girdle.
Of course, it can still be a good idea to get you back or pelvic pain checked out by a professional just to be sure. This is particularly true if you are experiencing severe pain, or if you are getting numbness or shooting pains down your legs as well.
Second, sometimes using an aid to give stability to the pelvis and lower back can help. The easiest and most cost effective is a length of tubigrip. This is a tubular elastic bandage that you can wear around your waist. Some health professionals may be able to provide you with a length, otherwise you can often buy some from your local pharmacy. If you need more support than the tubigrip offers there are a range of pelvic support belts that can help with pelvic instability. You can’t necessarily wear them in all circumstances - they’re often good when standing and walking, not so good when sitting as they can cut in to your lower belly - but if they help they can be gold!
Third, see a good manual therapist who is experienced in treating pregnancy-related issues. There is good evidence that you will get a better outcome in terms of managing lower back and pelvic pain if you look after it with the help of a chiropractor in addition to your obstetrician or midwife.5, 6 The care should consist of joint manipulation or mobilisation, soft tissue work, exercise prescription and education about how best to manage it. A physiotherapist or osteopath with a similar approach can also be an excellent choice. Acupuncture has some promising evidence that it can help with lower back pain too.4
Malmqvist S, Kjaermann I, Andersen K, Okland I, Bronnick K, Larsen JP, Prevalence of Low Back and Pelvic Pain During Pregnancy in a Norwegian Population. J Manipulative Physiol Ther 2012;35:272-8
Mohseni-Bandpei MA, Fakhri M, Ahmad-Shirvani M, Bagheri-Nessami M, Khalilian AR, Shayesteh-Azar M, Mohseni-Bandpei H, Low back pain in 1,100 Iranian pregnant women: prevalence and risk factors. Spine 2009;9:795-801
Brown A, Johnston R, Maternal experience of musculoskeletal pain during pregnancy and birth outcomes: Significance of lower back and pelvic pain. Midwifery2013;9:1346-1351
Katonis P, Kampouroglou A, Aggelopoulos A, Kakvelakis K, Lykoudis S, Makrigiannakis A, Alpantaki K, Pregnancy-related low back pain. Kippokratia 2011;15:205-210
George JW, Skaggs CD, Thompson PA, et al. A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy. Am J Obstet Gynecol 2013;208:295.e1-7
Peterson CK, Muhlemann D, Humphreys BK, Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1 year follow-up. Chiropractic & Manual Therapies 2014;22:15