Human Performance and Rehabilitation Centers, Inc.

Pregnant with Back Pain? Physical Therapy Can Help!

I recently had the opportunity to work with a woman in her 34th week of pregnancy, with a diagnosis of low back pain (LBP).   She was experiencing right sided buttock pain (pelvic girdle pain or PGP), with mild intermittent mid posterior thigh pain.  Her pain was made worse with attempting to stand on one leg as in dressing or washing her feet.   Her treatment included manual therapy, postural education and awareness to decrease the strain on her joints, and appropriate exercise.  As you can see in the photo to the right, with therapy she was able to adjust her posture so that she was carrying her baby instead of her baby carrying her.

When I encounter pregnant women with low back pain I expand my normal evaluation to focus on the unique physiological and musculoskeletal changes that occur during that exciting nine month period.   Pregnancy is a common time for back pain to begin, with over 50% of pregnant women reporting back and or pelvic girdle pain.   20-25% continue to experience LBP and PGP postpartum.  Think about the changes that occur in a woman’s body throughout pregnancy and it is no wonder women are three times more likely to develop low back pain than men. Physiological changes, alterations in hormone levels and necessary weight gain during pregnancy contribute to the increased postural demands on the musculoskeletal system.  How often do we gain an average 25 pounds in nine months? The growing baby places significant demands on the mothers’ core!

The mother’s spine adapts to the baby’s growth.  The natural spinal curvatures increase from the lumbar (low back) to the cervical (neck) spine.  The typical pregnancy sway back posture increases the load on the spinal joints.  The pelvis takes on an anteriorly rotated position, which places excessive stress on the SI joints, not to mention making it harder for the muscles around the joint to function accordingly and affects the stability of the pelvic ring.  Hence low back and pelvic girdle pain, (pain between the top of the pelvis and the fold of the buttock including the sacro- iliac joints and the joint of the anterior pelvis the pubic symphysis).  Hormonal changes produce laxity in the joints of the body, which is most recognized in the pelvis.  The joint at the front of the pelvis begins to widen in the 10th to 12th week, and averages a 6 millimeter separation which is considered normal.   The increase in laxity places a greater demand on the muscle system and it is theorized that it is the asymmetrical laxity and increased demand on the joints and muscle that lead to pregnancy related back pain.

Looking at the diagram above it is obvious that the abdominal muscles stretch in all pregnant women.   The rectus muscle, the most superficial of the abdominal group is stretched at its midline attachment to the underlying tissue called the linea alba. (Stay tuned for another blog about caring for abdominals before and after pregnancy)   Some women will have spontaneous return of their abdominal muscles postpartum and some will not. Weak and stretched abdominals limit the function of the core to assist in support of the spine.  Bending forward becomes impossible through the later stages of pregnancy, and alternative strategies for bending become the norm.

The bottom or basement of the pelvis is supported by 3 layers of very important pelvic floor muscle.  This group of muscles attaches from the pubic bone in the front to the tail bone in the back and along the sides of the pelvis.  These are muscles that we generally do not think about, but they are muscles that are under voluntary control. They function to support the contents of the pelvis, which in the last few months of pregnancy can be a considerable number of pounds.  PFM assist the back and pelvic joints with stability for increased loads, such as carrying and lifting.  They also function to keep us dry or continent, which is a demanding job considering the extra weight they are already supporting.  So, it is not uncommon for women to experience bladder leakage in the latter part of pregnancy.   Women with PGP are more susceptible to bladder leakage.  More argument to get help for your back pain!  No bladder leakage is ever considered normal !  The good news is, UI can be prevented with the use of Kegel exercises.

Since physical exam is the primary means of diagnosing back pain in pregnancy, a physical therapist with pregnancy postpartum specialization is one of the best options to help reduce or even eliminate your back or pelvic girdle pain, help you protect your abdominals, teach proper Kegel ex through pregnancy, and advise on regular exercise.  The mechanical dysfunctions of pregnancy related back pain  are helped by restoring and supporting  joint function, participating in regular and  appropriate  exercise (www.acog.org) and adapting posture and regular everyday day tasks to accommodate the growing baby.

Most patients believe that pain will be eliminated once they give birth but, up to 1/3 of women continue to experience pain 1 year or more after their pregnancy. Back pain during pregnancy does not have to be “normal”.   If you are experiencing back and or pelvic girdle pain with your pregnancy that is limiting your regular activities talk to your doctor, and request a visit to either one of our 2 women’s health physical therapists that specialize in pregnancy postpartum back and pelvic girdle  pain.

Managing Workplace Injuries

Following up on our previous blog post, we also received some great tips from Birmingham clinician Morgan Jackson, PT, DPT on managing workplace injuries.

  1. Know Your Body: It’s important to monitor any aches and pains that begin to appear. The earlier you catch the injury the better – if injuries last more than 2-3 weeks, it’s time to see someone. Recovery can be much quicker, and you can avoid more serious issues that could require surgery and/or physical therapy.
  2. Know Your Symptoms: Dull aches that go away may be normal, but a persistent burning sensation or sharp pain may indicate that it’s time to see someone.
  3. Know Your Situation: If your activity level has changed, pains may be expected, but if your activity level hasn’t changed and you aren’t doing a new job with different movements – it may be time to see a therapist.

Most small strains or overuse injuries go away after two weeks, if the proper adjustments and rest are performed.  It’s important to see a doctor if the pain persists to avoid a more serious injury, for example, carpal tunnel syndrome, that could require surgery and/or physical therapy.

This is also an important time to talk to your employer’s HR team (or the person in charge of injury prevention, such as a safety manager) about your pain.  They can review the setup of your work area, chair and look at your posture to help you get into a more comfortable position.

Be sure to ask questions about the changes they suggest so you have a full understanding of the reasons for the changes.  And finally, if you don’t already have it, now would be a good time ask for any materials they have on injury prevention.

Preventing Workplace Injuries

We recently spoke with Birmingham clinician, Morgan Jackson, PT, DPT, about preventing workplace injuries. She shared great tips on how employees and employers can work together to prevent injuries and build a workplace where employees thrive.

Employees:

  1. Know your policies: Many workplaces have injury prevention plans in place. Reach out to the HR team or safety manager at your company to see if they have a program.  The tips they provide can be as simple as proper posture, setting up your chair properly and the correct placement of your monitor and keyboard.
  2. Take breaks: Take micro break every 20 minutes to stand up and stretch or move a bit. Then, most importantly, follow their guidelines and if you start to feel pain such as a sore back, wrist or shoulder ask them to come back for a tune-up.
  3. Escalate when appropriate: If pain persists more than 2-3 weeks, it may be time to see someone before it gets worse.

Employers:

  1. Have a policy and follow up: The most important thing the employer can do is have an injury prevention plan in place that can be tailored to each employee. But as important is the follow up and reinforcement.  Have a plan that starts on day one, but continues to educate and remind employees.
  2. Set up employee work stations: If in an office environment, help employees set up their work area in the proper way, including desk, chair, monitor, keyboard and mouse and explaining proper sitting posture to the employee.
  3. Don’t just tell the what, explain the why: Explain what things SHOULD feel like, but more importantly, explain why it’s important and what can happen if they don’t take direction properly.