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Richard N. Norris: Back pain - a common side-effect of pregnancy

The sacroiliac joints are a common cause of pain during and after pregnancy. However, it’s possible to prevent sacroiliac, also called SI, pain and, if it does occur, to treat it.

The SI are two large joints in the pelvis, one on either side of the triangular sacrum that ends in the tailbone. These are critical eight-bearing joints that absorb shock while walking and provide stability as we transition between steps. Pain coming from these joints can be in the sacrum/low back, groin, front of the thigh to the knee, or down the back of the legs. This pain is sometimes imitates a condition called sciatica, which is pain, weakness, numbness or tingling in the leg.

As a pregnant woman enters the third trimester, her low back is increasingly pulled into an exaggerated, arched position called lordosis. This is due to the increased weight in the front, which stresses the joints.

In addition, during this period the placenta secretes certain hormones, including “relaxin,” which softens the ligaments in the pelvis to allow it to stretch out to allow passage of the baby during labor. This normal stretching response can be painfully exaggerated with a relatively large baby or in women who have a small pelvis, and in those with a preexisting tendency to loose joints (known as joint laxity), or in women with previous sprain injuries to the SI joints.

In fact, it’s estimated that 20 percent of all pregnant women suffer from back pain due to hormonal changes in their SI joints. An SI support belt, designed to hold the pelvis tightly together, can be worn for extra support as the mother enters the third trimester, especially if she has a history of joint laxity or a previous injury to these joints.

The SI joints have rough surfaces and normally have minimal motion. These joints can not only become painful during the third trimester and during labor from becoming loose and overstretched, but during the postpartum period as well. Here’s why: once baby is born, the new mother is carrying the baby outside of her body (and baby is getting heavier by the day!). She lugs items such as a diaper bag and a car seat. The new mom may also be holding the baby on a hip during daily activities. 

What to do

If that low back pain that occurred late in pregnancy continues, what can be done? Preventively, specific exercises can strengthen the core muscles, which surround the spine. Additionally, lumbar stabilization exercises, such as learning new ways to move using the strengthened core muscles, serve to protect the spine and the SI joints.

In addition, consider these self-care lifestyle modifications:

■ To avoid shocks to the SI joints, wear good sneakers or shoes with shock-absorbing insoles.
■ Observe how you sit. Sitting with the thighs parallel puts the center of gravity of the torso behind the SI joints and tends to lead to “sacral sitting,” which can stress the joints. A forward-sloping seat, such as a wedge cushion or kneeling chair or exercise ball, puts balance over the sit bones and thus unloads the SI joints.
■ Don’t step into the car with one leg and swing the other in after it; sit down with both legs out of the car, then swing them both in together.
■ Sleep on one side with a pillow between the knees.
■ Never bend and twist at the same time.
■ Lower slowly to sitting rather than “plopping” or “falling” into a chair.
If SI pain persists, treatment can include physical therapy for body mechanics and therapeutic exercise, gentle joint mobilization, medications and X-ray guided anti-inflammatory injections.

Richard N. Norris, M.D., is board certified in Physical Medicine and Rehabilitation and completed post graduate/fellowship training in both Orthopedics and Non-surgical Spine Medicine. Board certification demonstrates a physician’s expertise in his chosen specialty.

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