Back Pain During Pregnancy: Do You Have to Live with It?
Back pain is a common ailment that affects 50% of pregnant women. The severity can range from mere nuisance level to being a major disability. There are a number of potential causes of back pain during pregnancy that range from loosening of the joints due to the action of certain hormones to the relatively quick increase in weight that accompanies a developing baby.
Back pain during pregnancy can be associated with pain radiating down the leg, commonly referred to as "sciatica", and in most cases it can be dealt with effectively, if the right approach is taken.
At the Rhode Island Spine Center, we establish a treatment strategy that is personalized to each patient. This is because there are a wide variety of factors that can conspire to create pain in the lower back that are unique to pregnancy. These factors must be detected and treated as they affect each individual.
What Are the Factors That Contribute to Most Back Pain?
We believe that most cases of back pain can be attributed to what is called dysfunction. This simply means that the joints and muscles, and central nervous system are not performing their job at optimum efficiency.
Joint Dysfunction Joint Dysfunction occurs when one of the joints in the spine or limbs loses its normal resiliency and shock absorption capacity. When a joint develops joint dysfunction, its normal range of movement is affected and the joint can become painful. In addition, because the joint contains receptors, the dysfunction can cause abnormal signals to be sent to the central nervous system that can cause the muscles related to that joint to either become tense or, conversely, to become limp.
Muscle Dysfunction
Some muscles respond to joint dysfunction by becoming tense and overactive, while others respond by becoming limp and underactive. In either case, one thing that can happen in these muscles is the development of trigger points, areas of congestion within the muscle where toxins accumulate. These toxins can irritate the nerve endings within the muscle and produce pain.
Because the joints and muscles contain a great number of nerve receptors, joint and muscle dysfunction can cause abnormal neurological signals to be sent into the central nervous system. This can then disrupt the ability of the central nervous system to properly regulate muscles in other parts of the body, leading to the development of instability.
Instability
Instability occurs when the muscles whose job it is to support the spine and protect the discs and joints fail to function properly. These muscles must work cooperatively and harmoniously to guard against strain to the back. But injury, disuse or joint and muscle dysfunction can cause these muscles to stop working at optimum, rendering the spine susceptible to injury.
Disc Derangement
Sometimes these joint and muscle dysfunctions and faulty movement patterns put strain on the discs that are positioned between the vertebrae and small tears in the disc can develop. These small tears can allow the gel that is held in the middle of the disc to seep out into the tears and irritate the nerve endings in the outer portion of the disc. This is known as disc derangement. Occasionally, but uncommonly, this gel can seep all the way out and press on one of the nerve roots that exit the spinal cord in front of the disc. This is known as disc herniation. When this happens, pain in the back as well as in the leg can develop, along with neurological symptoms such as numbness, tingling and muscle weakness.
How Does the Doctor Detect the Cause of My Back Pain?
At the Rhode Island Spine Center, the staff Chiropractic Physicians are trained in the differential diagnosis of pregnancy-related back pain. This includes the identification of significant joint and muscle dysfunction, faulty movement patterns and disc derangement or herniation discussed above, as well as the more uncommon but potentially serious disorders that can produce back pain.
History Taking
The process starts with history taking. By obtaining the required detailed information, the doctor is able to establish clues as to where to look in the physical examination for the processes that are causing your pain.
Physical Examination
This is followed by the physical examination, which involves motion palpation, muscle examination, assessment of mobility and stability as well as neurological examination and general physical tests.
Testing
Occasionally, it is necessary to obtain advanced testing such as x-ray, CT Scan, MRI, blood tests, or other physical tests to further investigate the problem. During pregnancy, however, these tests are rarely ordered, and only in coordination with your obstetrician.
In most cases, after history taking, examination, and further testing are complete, a diagnosis can be established. If the problem is determined to be one that is treatable at the Rhode Island Spine Center, and your case is accepted, a treatment strategy is formulated and recommended to you. This strategy will be discussed with you prior to the institution of any treatment.
What Will the Treatment Consist of?
The staff Chiropractic Physicians and Physical Therapists work as a team to provide the best care for you. The most common treatments are:
Spinal Manipulation
Spinal Manipulation consists of gently moving the involved joint into the direction in which it is restricted and may involve the application of a short, quick movement in that direction. In many cases, no quick movement is applied but, rather, a slow mobilizing movement is utilized. There are certain techniques that we utilize that are specific to the pregnant woman for maximum comfort. "Cracking" type manipulation is often useful but, in most cases, non-"cracking" techniques are just as effective. If you are nervous about "cracking" techniques, please speak to your treating chiropractic physician.
Muscle Relaxation / Stimulation
Muscle Relaxation or Stimulation Procedures consist of gentle stretches to the involved muscle that has excessive tension or repeated contractions of the muscle that is weak. Gentle finger pressure techniques may be applied to trigger points to relieve the pain associated with these points.
Stabilization / Sensorimotor Exercises
Stabilization or Sensorimotor Exercise are designed to train your central nervous system to improve stability so that your back is maximally protected. This is especially important during pregnancy when the pelvic joints become unstable do to the release of the hormone relaxin.
Ergonomic and Lifestyle Advice
Ergonomic and Lifestyle Advice: there often are factors in an individual’s work, home or recreational activities that perpetuate the dysfunctions that lead to back pain. In these situations we teach people better "use of self". This consists of better ways in which they can perform these activities with minimal strain to the body.
The treatment plan developed for your specific problem may include one or more of these approaches, and may involve others as well. This will include working with your OB or midwife (or other medical specialists), if it is deemed appropriate.
Back Pain During Pregnancy:
Back pain during pregnancy can be associated with pain radiating down the leg, commonly referred to as "sciatica", and in most cases it can be dealt with effectively, if the right approach is taken.
Spinal Manipulation consists of gently moving the involved joint into the direction in which it is restricted and may involve the application of a short, quick movement in that direction. In many cases, no quick movement is applied but, rather, a slow mobilizing movement is utilized. There are certain techniques that we utilize that are specific to the pregnant woman for maximum comfort. "Cracking" type manipulation is often useful but, in most cases, non-"cracking" techniques are just as effective. If you are nervous about "cracking" techniques, please speak to your treating chiropractic physician.
