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Pregnancy-related back pain
Seventy percent of back pain during pregnancy is related to musculoskeletal changes
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Seventy percent of back pain during pregnancy is related to musculoskeletal changes. During pregnancy, the uterus grows larger with the weight of the fetus and amniotic fluid. This mechanical weight can shift the mother's center of gravity, causing increasing strain on her back muscles and ligaments.
As this happens over nine months, most mothers have time to adapt to the change. Those who cannot adapt will get the resultant back pain - muscle sprain or ligamental injuries.
Try holding a box weighing between 3 and 10 kilograms in front of you for an hour. Your back will start to protest; it needs support to reduce the strain and discomfort. All this is without considering that any pregnant woman will gain between 10 and 20 kilograms body weight.
Hormonal changes also can increase the risk of ligamental injuries. Progestrone makes ligaments more lax and flexible to allow the changes to take place within the uterus and the pelvic bone - so that the fetus can pass through the vagina for a normal delivery.
Those ligaments in the spine will be subject to increased laxity, increasing the risk of the back overcompensating for the weight being carried in front. Without strong back muscles, this can lead to increased ligamental injuries and poor posture.
The other 30 percent of back pain during pregnancy may be due to previous underlying spine conditions. All the hormonal changes and mechanical/structural changes can make underlying spine conditions such as disc herniation or nerve compressions manifest, and this may be worsen with successive pregnancies. With more episodes of prolonged back strain (during pregnancy), the spine will suffer more stress.
Prevention is the best treatment. Develop good core muscles before pregnancy. It is not too late to start during the early months of pregnancy. All low-impact exercises: step-aerobics, aqua-aerobics, brisk walks and back strengthening exercises, are good for keeping core muscles toned and ready to take on the increased load of the fetus.
Although calcium is important for the normal functioning of the muscles, most pregnant women do not reach a stage where blood calcium levels are so low they lose muscle strength, even though women do lose more calcium during fetal development because of the fetus' needs. This loss in calcium will not result in osteoporosis, and is not in itself a reason for back pain. Hence, calcium supplements are not needed to prevent back pain, although they may be needed for the growth of the fetus.
Women who do suffer back pain during pregnancy should consult a doctor to determine the cause. If it is a muscle sprain or ligamental injury, generally a short course of anti-inflammatories will deal with the pain.
However, in certain groups of muscle injuries, this can start to become persistent. Any back pain continuing for more than one month will require specialist attention. If it is not resolved, it can result in chronic back pain, which will be more difficult to treat or to cure. In these conditions, treatments may involve injections with anesthetics or steroids to resolve the problem.
Physical therapy can help with nonspecific back pain, where the cause is nonspinal (i.e., musculoskeletal). During physiotherapy, manipulation of the muscles to deactivate the muscles can be effective. Low-intensity laser treatment is also useful for those patients at advanced stages of pregnancy (too-heavy uterus), who cannot lie on their front.
Chiropractic manipulation is the same as manipulating the muscles. Chiropractors "crack" the bones in the spine to stretch the capsule of the joints, which may release the tension within the joints and muscles. However, exercising one's self is better treatment than external manipulation.
Back pain is also a part of labor, and most parturients have back pain with or without an epidural injection: Clinical research does not show any increased risk of back pain relating to epidural analgesia during labor. Ligamental and muscle strain during and after pregnancy, together with hormonal changes, are the most likely causes of back pain after delivery.
In addition to all this, there is a condition known as piriformis syndrome, which can start in pregnancy and continue afterward. This condition involves pain in the buttocks and is a functional problem.
A specialist will need to exclude any mechanical causes (such as disc compression on the nerve). The piriformis muscle can spasm either from stretching during labor or from hormonal changes resulting in overstretching of that muscle during pregnancy. Intensive physical therapy is needed to treat this painful condition, which can prevent the mother from standing or walking. Occasionally, we use a muscle relaxant injection such as Botox.
Postpartum back pain is frequently due to intensive nursing of the baby. Many positions adopted when caring for a baby - nursing the baby under the arms, leaning forward to place the breast in the baby's mouth, washing the baby, cleaning the baby on the cot bed - are ergonomically unfriendly to the mother and are potential causes of back injuries. Always bring the baby to the breast. Always clean the baby at waist level rather than in the cot or on the bed. As the ligaments in the back and neck are still lax after delivery, good posture is advised and should be maintained throughout.
cFlyFreeForHealth2009
Articles in this column, which will appear every two weeks, are provided by a panel of doctors from www.flyfreeforhealth.com, a leading multimedia medical tourism platform dedicated to providing adopters of healthy lifestyle with travel and lifestyle incentives. The doctors include: Dr. Bernard Lee, one of the pioneer interventional pain specialists in Singapore and Director for Interventional Pain Management Services at Singapore Pain Care Center; Dr. Suresh Nair, a pioneer in gynecological "Robotic Surgery", Vice President of the Obstetrics & Gynecologic Society of Singapore; Dr Keith Goh, Consultant Neurosurgeon in the International Neuro Associates, with specialty training also in Pediatric Neurosurgery, at Novena Medical Centre, Singapore. Email us at info@flyfreeforhealth.com.
