Postural Changes During Pregnancy
Common Trunk and Spine
Complaints
Postural Changes
Contributing Factors
Examination
Pre-Partum Back Pain Prevalence
Causes of Low Back Pain
Low Back Pain and Pelvic Pain
References
- Headache
- Neck pain
- Jaw pain
- Diastasis Recti
- Sacroiliac pain
- Rib pain
- Symphasis pubis dysfunction
- Back pain
- Coccyx pain
- Pelvic ring dysfunction
Postural Changes
- Cervical spine- Increased lordosis
- Thoracic spine- Increased kyphosis, protracted scapulae
- Lumbar spine- Increased lordosis
- Pelvis- Possible increased anterior tilt
- Base of support- Widens
- Lower extremity position- Increased external rotation, possible increased genu recurvatum, possible increased foot pronation
- Feet- Lower forefoot, higher hindfoot pressures
Contributing Factors
- Ligamentous and soft tissue laxity
- Increased breast weight and size
- Increased uterine size
- Shifting of position of uterus/fetus
- Change in center of gravity position
Examination
- Previous history of back pain
- Pain aggravated by weight-bearing positions and relieved in recumbent, resting positions
- Pain increases throughout the day
- Standard neurological exam if signs and symptoms suggest neuropathy
- PROM, AROM, over-pressure, compression/distraction, postural assessment, muscle imbalances, palpation
- Clear the sacroiliac joint, pubic symphasis joint, hip joint, and lumbar spine
- True nerve root pain is uncommon
Pre-Partum Back Pain Prevalence
- Common during pregnancy beginning most often during the second trimester between the fifth and seventh months of gestation
- 45- 60% of pregnant women have LBP
- Multiple pregnancies or births may have LBP associated with poor abdominal or pelvic floor tone and ligamentous laxity
- Women who have experienced one or more abortions may seek health care months to years later with a variety of physical and psychological symptoms referred to as postabortion syndrome
Causes of Low Back Pain
- Factors contributing to postural changes
- Mechanical strain, pelvic ligamentous laxity, sacroiliac pain, vascular compression, spondylolisthesis, discogenic pain, peripheral circulatory disorders, and hip pathology
Low Back Pain and Pelvic Pain
- Location of symptoms may present in low back as well as the pelvic area
- Most frequently irritated ligaments in the lumbar region during pregnancy are interspinous, iliolumbar, and sacroiliac
- Increased lumbar hyperlordosis, pelvic anteversion, and widening of the pubic symphasis leads to increased mechanical tension of the pelvic ligaments resulting in low back pain
- Pelvic pain often radiates to the low back
References
- Requejo SM, Barnes R, Kulig K, Landel R, Gonzalez DS. The use of a modified classification system in the treatment of low back pain during pregnancy: a case report. J Orthop Sports Phys Ther. Jul 2002;32(7):318-326.
- Goodman, Catherine Cavallaro, and Teresa E. Kelly Snyder. Differential diagnosis for physical therapists: screening for referral. 5th ed. St. Louis: Elsevier Saunders, 2013. Print.
- Borg-Stein J, Dugan SA, Gruber J. Musculoskeletal aspects of pregnancy. Am J Phys Med Rehabil. Mar 2005;84(3):180-192.
- Malmqvist S, Kjaermann I, Andersen K, Okland I, Bronnick K, Larsen JP. Prevalence of low back and pelvic pain during pregnancy in a Norwegian population. J Manipulative Physiol Ther. May 2012;35(4):272-278.
- Ostgaard HC, Andersson GB, Schultz AB, Miller JA. Influence of some biomechanical factors on low-back pain in pregnancy. Spine (Phila Pa 1976). Jan 1993;18(1):61-65.
- Sipko T, Grygier D, Barczyk K, Eliasz G. The occurrence of strain symptoms in the lumbosacral region and pelvis during pregnancy and after childbirth. J Manipulative Physiol Ther. Jun 2010;33(5):370-377.