Low Back Pain & Sciatica During Pregnancy.

One of the unfortunate consequences of pregnancy can be Low Back Pain & Sciatica. It is a very common consequence as well, with it being said that 50%-80% of pregnant women will suffer with such pain at some stage of their pregnancy.

One thing I must really stress here though, is that although it is a relatively common occurrence, it is definitely not something you should accept and put up with. Due to the physical changes taking place, Low Back Pain & Sciatica can be difficult to treat during pregnancy, but it is cetainly not impossible.

The Causes

There are three main causes of Low Back Pain & Sciatica during pregnancy, they are as follows:

1) Increased Curvature of the Spine.

2) Muscle Imbalance.

3) Hormonal Changes.

Increased Curvature of the Spine

With pregnancy, an increase in weight is obviously inevitable. Consequently, this cause of pain typically becomes more of a problem as each trimester passes. As the increase in weight occurs your abdominal region becomes larger. This results in your centre of gravity moving forward i.e. you stomach being positioned further out in front of. This posture increases the natural forward curve of your lower back even more.

These postural changes taking place increase the strain upon the facet joints of the lower back as these joint surfaces are forced against one another more. This pressure upon the facet joints can lead to low back ache / pain. Continued pressure may also result in an inflammatory response taking place. This will mean your low back pain will become more intense and sensitive, with the potential for the pain to radiate into the buttock region and down the leg (Sciatica) should the sciatic nerve roots become involved.

Muscle Imbalance

Associated with 'Increased Curvature of the Spine' discussed above is muscle imbalance. Due to the changes in posture, the abdominal muscles at the front become stretched and weak while the muscles of your lower back become tight and taut. The former issue here is inevitable to a certain degree, simply because as your baby grows, your abdominal muscles are going to be stretched. However, that does not mean they cannot be exercised to increase their strength, therefore keeping this influence to an absolute minimum... and I am not talking about sit-ups either! Likewise, the tight muscles in the lower back can also be stretched in order for them to maintain as much suppleness as possible.

Hormonal Changes

This will occur in particular towards the end of your pregnancy. During this stage, the body will be producing hormones in preparation for child birth which will relax the ligaments of the pelvis. However, the implications of this are that the joints at the back of the pelvis i.e. the Sacro-Iliac Joints (SIJ) will not be as stable as they should be, leading to increased movement and stress across these joints and therefore potentially pain.

It is crucial I add again here that just because Low Back Pain & Sciatica are unfortunate common consequences of pregnancy, it does not mean it is something you just have to put up with. It is imperative you do all you can to resolve this problem.

Nearly all low back pain & sciatica which is encountered during pregnancy will resolve itself in a fairly short period of time following the birth of your child. The more you do to address the pain during your pregnancy, the quicker it will resolve afterwards. In addition to this, for a small percentage of women, the pain does not resolve itself quickly after child birth. Doing the correct things for the pain as soon as possible will minimise the risk of you suffering long term afterwards.

The Treatment

In order to treat those suffering with Low Back Pain or Sciatica during pregnancy, we obviously need to address the first two causes above, as there is nothing we can do about hormonal changes, and we wouldn’t want to change this even if we could! 

Exercises  

The aim of the following exercises are three fold: 

• “Reverse the Curve” At the moment the tendency is for your lower back to arch forward and increase the natural forward curve present. This places increased stresses across the surfaces of the facet joints. The following exercises will encourage your lower back & pelvis to move in the opposite direction. This will take the pressure away from the sensitive structures and encourage the pain to settle.

• Strengthening. In order to 'reverse the curve' as described above, you will need to work your abdominal muscles. This will therefore help strengthen them. Increasing the strength of your abdominal muscles will help to prevent your back from over arching, therefore taking pressure away from the facet joints.

• Stretching. Once again, by moving your lower back & pelvis in order to ‘reverse the curve’ the structures in the lower back which will be tightening due to the increased arch, will now be stretched out. This will further decrease the stresses being placed across the sensitive structures responsible for your pain. 

NB All of the exercises given on this page should be performed without increasing your pain at all. If at any stage you feel your pain is being aggravated, it is important to stop performing that particular exercise.

Posterior Pelvic Tilt 

A good exercise for this is to lay on the floor with your knees bent and hands resting upon the sides of your hips as shown below. The aim is then to flatten your back into the floor, using your hands to encourage the ‘back & downwards’ rotation of your pelvis. 

When you have flattened your back towards the floor and are still comfortable, hold this position for a count of 5-10 seconds and relax. Repeat this 3-5 times in one go, approximately 2-3 times per day.

If you find this exercise difficult, you can try using your heels and bottom muscles to help out. As you attempt to flatten your lower back into the floor gently tighten your buttock / gluteal muscles while very gently pushing through your heels.

Four Point Kneeling Stretch 

Placing yourself on all fours, with your hands approximately below your shoulders and you knees below your hips, gently arch your back up towards the ceiling. Having done this, gently lean backwards as if to sit on your heels as shown below. While doing this, you may feel a stretch in your lower back area, further up your back towards your shoulders or down towards your buttocks and even upper leg. As long as it is only a stretch you are feeling and not pain, this is no problem.

When in this position, hold it there for a count of 5-10 seconds and then return to the starting position. Repeat this 3-5 times approximately 2-3 times per day.

General Advice 

As I have alluded to above, the main problem with Low Back Pain and Sciatica during pregnancy is typically the increased arch in the lower back. Therefore, other advice which may help is as follows.

Walking

Abdominals: Little and often while walking gently tighten your stomach muscles for a few seconds (5-10) and relax. The abdominal muscles are vitally important when it comes to providing stability of the lower back and pelvis region. Therefore if you tighten them little and often, it can help to prevent the forward tilting of the pelvis. 

Footwear: Not that I can imagine many pregnant ladies walking around in high heels, but nevertheless, as a rule of thumb the smaller the heel the better. This is because a high heel will encourage your whole body to lean forward, which in turn you will compensate for by leaning backwards from your lower back. This movement places increased pressure upon the facet joints which are a potential sauce of your pain.

Sleeping Position

You may well find that sleeping becomes difficult when pregnant, especially towards the last trimester when you are becoming significantly larger. It is likely that the best position for you to sleep in is side lying, with either a pillow between your knees or the position I feel is better, with your bottom leg straight and top leg supported by pillows (as shown below).

NB As always be guided by what your body tells you. Although this may sound a little flippant, the best position for you to sleep in is the one which gives you the best nights sleep and where you wake feeling most comfortable in the morning.

Support Belt

My personal experience given by feedback from patients is that these are a little ‘hit & miss’. The aim is to support both the back and your ‘baby bump’ therefore taking pressure from your lower back. They have worked well for some and yet others have gained no benefit. 

I hope the above helps you in your quest to resolve the current pain you are suffering. As I mentioned at the top of the page, Low Back Pain & Sciatica are an unfortunate consequence of pregnancy for many women. However, that does not mean nothing can be done for it. 

Regards,

Paul.