The body endures extensive changes through pregnancy. As a result of these changes women commonly experience pregnancy pains including low back pain (LBP) and pelvic girdle pain (PGP). (1,2) Over 30% of pregnant women report their first episodes of LBP during pregnancy and up to 90% of pregnant women will experience LBP and/or PGP. (1) Pregnancy-related pains place an added burden on women’s wellbeing and can impact their physical, social, mental, and emotional health. However, many women choose not to seek any form of treatment for their pregnancy-related pains which may result in the development of chronic pain persisting long after the postpartum period. (1,2,3)
What Causes Pregnancy-Related Pains?
Changes to the body during pregnancy such as maternal weight gain, an expanding belly, muscle dysfunction, and hormonal changes including relaxin – which allows the body to become laxer in preparation for birth – may all contribute to the development of pregnancy-related LBP and PGP. (1,4) However, pain is complicated. Many factors may influence pain generation in pregnancy. These include but are not limited to;
A history of low back pain
Low levels of physical activity
High levels of sedentary behaviours, and
We can begin to understand from this list that there is much more to pregnancy-related LBP and PGP than just bodily changes. (1,3)
To address how physical changes to the body may contribute to the development of pregnancy pains, we can use the example of changes to the pelvis. Think of the pelvis as a bowl that holds and protects our organs, transfers weight from our upper body to our lower body – allowing us to perform actions such as sitting, standing, and walking -, and in females, supports the growth of a baby. During pregnancy, the expansion of the belly and widening of the pelvis may lead to pelvic asymmetry (a variation in the structure or function between the left and right sides of the pelvis). Pelvic asymmetry changes how the body moves and functions. Differences between sides of the pelvis alter loading through the body which can lead to postural adaptations, dysfunction, and pain. (5,6) It has been reported that women who suffer from PGP are less likely to exercise regularly during pregnancy. (2) This is problematic as exercise during pregnancy may reduce the severity of LBP and PGP during and after pregnancy. (1)
How Can A Chiropractor Help?
A multimodal approach to care including manual therapies, exercise, and self-management strategies/advice are shown to be effective in the treatment and management of pregnancy-related LBP and PGP. (7) A chiropractor or your chosen musculoskeletal health care professional has extensive knowledge of how the body moves and functions. This knowledge paired with your personal preferences and capabilities will create the basis for an individualised treatment plan/strategy focused on allowing you to continue to move and exercise throughout your pregnancy in a way that is safe, appropriate, and invigorating for your body. Treatment modalities will be used to reduce pain, alter loading patterns, and improve your functional capabilities. Some of these modalities may include traditional chiropractic manual therapies, low force techniques, soft tissue therapies, exercise programs, and self-management strategies.
Pregnancy-related LBP and/or PGP does not have to be something tha you just have to deal with. There are many options out there that may enable you to find relief from your pregnancy-related LBP/PGP and reduce the risk of developing chronic pain. (1,3,) So, if you are finding it difficult to find relief, please book in with your chiropractor or chosen musculoskeletal health care professional to see how you may be supported through your pregnancy.
Dr. Naomi Erickson
Weis C, Pohlman K, Draper C, daSilva-Oolup S, Stuber K, Hawk C. Chiropractic Care for Adults With Pregnancy- Related Low Back, Pelvic Girdle Pain, or Combination Pain: A Systematic Review. Journal of Manipulative and Physiological Therapeutics. 2020;.
Davenport MH, Marchand A, Mottola M, Poitras V, Gray C, Garcia A et al. Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta- analysis. Br J Sports Med 2019;53:90–98. doi:10.1136/bjsports-2018-099400
Kinser P, Pauli J, Jallo N, Shall M, Karst K, Hoekstra M et al. Physical Activity and Yoga-Based Approaches for Pregnancy-Related Low Back and Pelvic Pain. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2017;46(3):334-346.
Malmqvist S, Kjaermann I, Andersen K, Økland I, Brønnick K, Larsen J. Prevalence of Low Back and Pelvic Pain During Pregnancy in a Norwegian Population. Journal of Manipulative and Physiological Therapeutics. 2012;35(4):272-278.
Opala-Berdzik A, Bacik B, Cieślińska-Świder J, Plewa M, Gajewska M. The Influence of Pregnancy on the Location of the Center of Gravity in Standing Position. Journal of Human Kinetics. 2010;26(1).
Morino S, Ishihara M, Umezaki F, Hatanaka H, Yamashita M Kawabe R et al. The effects of pelvic belt use on pelvic alignment during and after pregnancy: a prospective longitudinal cohort study. BMC Pregnancy and Childbirth. 2019;19(1).
George J, Skaggs C, Thompson P, Nelson D, Gavard J, Gross G. A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy. American Journal of Obstetrics and Gynecology. 2013;208(4):295.e1-295.e7.