Most of the women you will treat during their pregnancies will be complaining of back pain. However, it is not uncommon for RMT’s to ignore the origins of pain and therefore do not note the relationship between back pain and the posterior pelvis. With the extreme changes a women’s body undergoes during pregnancy the effects it can have on her pelvis can often be at the root of overall complaints of back pain.
Pregnancy and Gravity
The effects gravity has on a pregnant woman can be quite amazing. The enlargement of the uterus forces a women’s centre of gravity forward. This in turn places strain on her rib cage and the resulting shift of weight ultimately affects her sacroiliac pelvic joints as well as her lumbosacral joint. Studies indicate that upwards of 50 percent of pregnant women suffer from back pain, 10 percent of those cases being extreme. 30 percent of women who suffer from back pain during pregnancy have never suffered from back pain before.
Working and Pain
As more women continue to work during their pregnancies, more women are seeing back pain in pregnancy. Challenges such as standing and/or sitting all day put enormous stress on the bodies of pregnant women. A study in Sweden showed that 70 percent of the pregnant women who required sick leave during their pregnancies were off due to back related issues.
Drawing from Pain
When women are asked to draw out the line of their pain 50 percent indicated their pain was radiating from the crest of the ilium and lateral to the sacrum. 25 percent indicated their pain was in the lumbar area. The description of pain is often associated with sciatica as it exists in the gluteal area and down the thigh. However, only a very small percentage of women (1 in 10,000) are actually suffering from disc related disease. All of these women do however share one thing in common: They all had a pre-existing disc problem prior to pregnancy.
Identifying Pelvic Symptoms
The complaints of back pain related to pelvic issues can present around the 18th week of pregnancy. Symptoms will include:
- Pain in one or both sides of the gluteal region
- She will have free range of motion in her back and hips
- Her pain will come with movements and not be constant
The best way to determine if the pain is related to the pelvis is to conduct a Posterior Pelvic Pain Provocation Test lying with her painful side up. If the test reproduces her pain in the sacroiliac area or symphysis pubis then the pain is more than likely pelvic.
Relief of Pelvic Pain
A pelvic belt is often a good idea for pregnant women suffering from pelvic pain. Treatments that work well include neuromuscular therapy and positional release techniques. You can also assist her by showing her side-lying positions to use while resting or sleeping. She should also avoid the following movements:
- Using the stairs
- Standing, especially on one leg
- Prolonged walks
- Extreme back and pelvic ranges of motion
- Heavy lifting
- Sitting for extended periods of time
It is important for patients to know that without treatment during pregnancy she is likely to continue to have pelvic pain following the birth of her child. 35 percent of women who did not receive supportive body work during pregnancy continued to suffer from pelvic pain beyond pregnancy.