Acute or Chronic Pain in the Lumbar or Sacral Region During Pregnancy

Back pain, especially in the lumbar or sacral regions, is a common condition experienced during pregnancy. In fact, nearly 1 out of every 2 pregnant women can expect to experience acute or chronic pain the in lumbar or sacral regions of the spine. The pain in these areas is typically temporary and a direct result of pregnancy-induced weight gain and hormonal changes, and often contributes to pain, sleep-disturbances, and other discomforts experienced during the course of the pregnancy.

Lower Back Pain During Pregnancy (Lumbar Pain)

Lumbar pain during pregnancy is generally located at and above the waist in the center of the back. For all intensive purposes, low back pain experienced during pregnancy is very similar to lumbar pain experienced by women who are not expecting, and includes:

• Increased pain accompanying prolonged periods of sitting and/or standing;
• Aching and stiffness resulting from sleeping on stomach and/or back
• Discomfort and pain associated with movements, including walking, twisting, bending and lifting.

It is important to note that the lumbar pain defined above is not sciatica, another condition that can occur during pregnancy. While the two conditions can occur concurrently, symptoms of sciatica also include low back pain and pain that radiates into the buttocks, legs, and feet.

Sacral Back Pain During Pregnancy

Sacral back pain occurring during pregnancy is known as pregnancy pelvic pain, or PPP. PPP is the result of pain or discomfort occurring near the sacroiliac (SI) joints of the pelvis (the joints located at the 2 “dimples” of the lower back), and as a result of SI joint dysfunction.

Women are four times more likely to experience posterior pelvic pain than lumbar pain during their pregnancy. PPP typically begins in the 18th week of pregnancy, becomes progressively more intense as the pregnancy progresses, and goes away 10 to 12 weeks after delivery. In rare cases, PPP can be chronic and cause debilitating pain.

Diagnosis of Pregnancy-Related Back Pain

Most cases of lumbar back pain and pregnancy pelvic pain will be diagnosed by your doctor after conducting a complete physical exam and health history. During this assessment, your doctor will look for a complete and detailed description of symptoms causing pain and discomfort. Your doctor may also elect to conduct a series of physical tests designed to recreate and pinpoint the exact cause and location of the back pain.

While assessing for PPP, doctors will often inject a numbing agent into the SI joint to further identify the exact source of pain.

To further assist with diagnosing the condition, your doctor might also order a series of imaging test, such a CT scan, MRI, or X-ray to further assist with identification of a cause (It is important to note that any imaging exam or medical procedure using radiation is generally avoided during pregnancy, unless its use is absolutely necessary and unavoidable).

Causes of Back Pain During Pregnancy

Back pain experienced during pregnancy can be caused by several different conditions and factors that are associated with natural changes that occur during pregnancy, including:

• Weight gain and a changing center of gravity. Women can gain as much as 25% of their body weight during pregnancy, this increased weight adds tremendous stress to the lower back and other weight bearing joints. In addition, and since weight is typically added in the front, women tend to compensate for this shifting center of gravity by leaning backwards, which increases the stress placed on the lower back.
• Muscle fatigue. As a result of the added weight, shifting center of gravity, and increased stress on the structures of the back and other weight-bearing joints, the muscles in and around the associated areas tend to become weak and less flexible - increasing the likelihood of experiencing low back pain.

In addition, and as a result of the growing uterus, the muscles in and around the pelvis also become stretched and weak.

• Increased production of the hormones estrogen and relaxin. The increased production and release of estrogen and relaxin occurs in preparation for birth. However, the increased production of these hormones can also contribute to back pain by contributing to laxity of the joints in the pelvis and surrounding areas.

Treatment of Lumbar Pain and Sacral During Pregnancy

Recommended treatment of lumbar back pain and PPP during pregnancy typically involves conservative (non-surgical) treatments, including exercises and stretching designed to improve posture and increase strength and flexibility of the supporting muscles and joints in and around the lower back and pelvis.

Your doctor will often recommend a few visits to a physical therapist who specializes in treatment of pre and postpartum lower back pain for further recommendations for a non-invasive treatment program designed to treat or prevent lower back pain during pregnancy. This program is designed to maintain optimal function during pregnancy and will often include treatment instructions and exercises for improved posture while sleeping, walking, and conducting regular movements during each stage of your pregnancy.

Lower Back Pain Relief After Pregnancy

Back pain in the lumbar region and pregnancy pelvic pain typically subside right after your baby is born. Roughly six weeks to eight weeks after deliver, the ligaments of the pelvic return to a normal state of rigidity and are able to resume the role of supporting normal motion and daily weight bearing activities.

Pain or discomfort in the lumbar or sacral regions lasting longer than this should be evaluated by your physician.

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