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Pain

Back pain during pregnancy is a common and unpleasant symptom.  It is more likely to occur towards the end of the pregnancy but can occur at any stage.  The pain can be in the upper, mid or most commonly lower back.

Lower back pain is a very common problem for those who have given birth.

Possible Causes of Lower Back Pain

More Mobile Ligaments And Joints

Increases of Pregnancy related hormones can make your ligaments & joints more lax than they are normally making you more susceptible to sprains and strains.  You are more at risk at the lower back and pelvis as the baby becomes larger putting more strain through the joints.

Back Muscles Overloading

As your pregnancy develops your tummy muscles will naturally turn off, a common compensation for this is for the back muscles to work harder to make up for this.  This can make them ache and feel very fatigued and if pushed too far can lead to spasm and pain.

Abdominal Strains

The abdominal muscles are under a great amount of pressure just supporting your bump everyday especially in the final stages of the pregnancy so can strain.  Some people may even may experience an abdominal tear.

Diastasis Recti

This happens to everyone in pregnancy by the last trimester but it may start earlier with some especially if you have been pregnant before.  The abdominal separation affects how your core muscles work and how they work together.  Our Core Muscle Programs help you rectify this issue after birth.

Weakened Deep Core Muscles

If these deep core muscles are weak which is common then there is not a strong core centre meaning that joints, other soft tissues and muscles take the strain and this can lead to pain.

Treatments For Lower Back Pain

Heat

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Heat can be applied to the lower back and give relief.  You can use a hot water bottle or there are heat packs that are available to heat up in the microwave.  Pharmacys also offer a stick on heat patch which activates when you fold the patch before applying and the effect can last a couple of hours so can be worn while moving around.

Core Stability Exercises

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Our Pelvic Floor & Core Workouts will help you build strength in the Pelvic Floor & Deep Abs (Tranversus Abdominis) muscles which will help the muscles work as a powerhouse of your body centre helping your lower back not give in and strain.

Pain Relieving Patches And Pain Medication

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Pain relieving patches that you can apply to the lower back come in different types.  Some contain herbal relieving remedies or Tiger Balm and others contain medications that require prescription.  Always check the label to make sure safe to use in pregnancy.  Mild Oral Pain and Anti-Inflammatory medications are normally ok to take but need to be taken only with consent of your Doctor as some are not safe to use in Pregnancy.  Your Doctor can also advise on right dosages.

General Moving And Movement Exercises

Generally just moving helps lower back pain.  Often for those who sit around it makes the back pain worse and if you do not exercise and move your body becomes deconditioned and then if you start trying to move again the back pain will start. Try and walk more – gradually increasing each time how far you walk.  There are certain exercises that can help lower back pain. Have a go at our Lower Back Pain Relief Exercises Below and try these exercises once a day.

For the exercises involving one leg also repeat with the other leg.

Professional Help Options

Doctors

In Pregnancy it is best to seek advice from your Doctor or Obstetrician with regards to advising on any pain medication that you can take.  If you have Health Insurance usually a Doctor referral is required before you start a course of treatment with a Physiotherapist or other Health professional.

Physios And Osteopaths

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There are a number of treatments they can offer to help.  First they will take a thorough history of your complaint and medical history and then do a proper full physical assessment to diagnose what is causing your pain.  They will then be able to carry out the best treatments they feel fit for your condition which can include:

  • Manual Therapy where they work on the joints, soft tissues and muscles
  • Massage
  • Acupuncture (depends on if they are qualified to offer this)
  • Trigger Point Release (a trigger point is a specific painful point in a muscle and it can be released by certain techniques)
  • Teaching movement, stretching and core muscle exercises

Chiropractors

There are prenatal specialised chiropractors who are reported to help alleviate muscle & ligament pain as well as help with paving the way for a smoother labour.  Some are trained in the Webster technique which is a technique created for use during pregnancy that focuses on the sacrum and pelvis as well as the surrounding muscles and ligaments.

Acupuncturists

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Acupuncturists can help with low back pain in Pregnancy but be sure to choose one which is experienced with treating Pregnant women as there are certain Acupuncture points that should not be used in Pregnancy.

What is The Pubic Symphysis?

The pelvis is made up of three bones. This circle of bones is shaped like a bowl with a hole and it has three joints. The joint in the front, which joins the front pubic bones together is known as the pubic symphysis (PS). It is the most stable joint in the pelvis.

Where Do You Feel The Pain From Pubic Symphysis?

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Pain from the pubic symphysis is generally felt in the front part of the pelvis, right at the joint, just above the genitals.   It can radiate outwards into the hips (on one or both sides), into the groin and and/or genitals.

Why Does The Pain Happen?

Your hormones change a great deal throughout the course of your pregnancy, as well as after it. During pregnancy, the pubic symphysis joint softens. It needs to be more mobile to allow for the baby to pass through it during the birthing process. This increase in mobility can affect different women in different ways as it has an impact on the muscles, ligaments and nervous system.

Because the ligaments provide a passive form of support as they soften, some of the muscles and tendons will increase their workload to try and compensate for this. These muscles and tendons can then become fatigued and tired, resulting in spasm, which can cause pain.

As the hormones affect the whole nervous system, a sensitisation of the nervous system occurs, which can result in an increased pain response to normal movement.

What Can You Do About Managing The Pain?

Reduce Shearing Stresses Across the Pubic Symphysis Joint

The key to successfully managing Pubic Symphysis Pain is to try and avoid activities that make the pain worse and at the same time build strength around your pelvis.  Things that make pain worse are often causing a shearing like force over the joint.

Some good pointers to help stop this joint shearing stress therefore stop the pain from happening:

1) Reduce step size when walking
2) Go up and down stairs one step at a time
3) Try pillow between knees when sleeping
4) Keep Knees Together When:
      • Moving from one position to another
      • Getting out of a car
      • When having sexual intercourse
      • When getting out of bed or off the sofa – see video below

Rest and Offload With Crutches If Pain Very Severe On Walking

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If the pain is very severe on weight bearing and walking try to take some rest and put your feet up.  If need to walk then try using some crutches to help offload the area and relieve the pain hopefully helping it to settle down.

Learn to Activate Your Pelvic Floor & Core

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In the HUB there is the ‘Pregnancy Pelvic Floor & Core Workouts’  in the WORKOUTS Program which will help to engage your core pelvic floor and deep abs (tranversus abdominis) muscles.  These muscles will help provide support around your pelvis reducing the effect of stresses on your pubic joint area.   Learn easy ways of how to activate them now.

See a Physio, Osteo Or Chiro

First they will take a thorough history from you and do a full examination of your posture, strength, flexibility and pelvic floor core strength.  They will then be able to determine the issues that are causing the pain.  They will advise you on lifestyle modifications and then devise an individualised treatment plan which may include the following:

      • Hands on treatment which when done correctly can be highly effective at relieving pain
      • Custom designed exercise programme to be followed at home which will help address the issues relating to strength – some of the exercises that are commonly recommended are below
      • Different modalities like hot and cold treatments or sometimes electrical pain relieving devices may be prescribed
      • Various taping techniques or prescription of a bump belt support – which will be determined during your exam where the physio will take you through some specific functional stability tests.

Try These Strengthening And Movement Exercises At Home That Can Help

Exercise can be of great help as we try and strengthen up the muscles surrounding the pelvis as the pelvis is the attachment site for 35 different muscles.  Some of these important muscles that provide support are the gluteal buttock muscles and adductor inside thigh muscles.  Our Symphysis Pubis Pain Relieving Exercises are shown below.  Try practicing these exercises every day to help relieve your symptoms.  If you start feeling the pain on any of the exercises do not push further into the exercise but try to do in non pain producing range. Ie. if squeeze the pillow or ball between knees if you start feeling the pain stop there and release – do not continue the squeeze through the pain.  With time you should be able to squeeze more without the pain starting.  If you feel you need more supervision and help then seek the help of a physio.

Do the Leg Push exercise below both left and right sides

Do the Band Pull exercise below both left and right sides

Do the Clam exercise below for both left and right sides

What Is The Round Ligament And What Are the Symptoms of Round Ligament Pain?

A round ligament is fibrous connective tissue connecting bones to other bones or, in this instance, maintaining the position of internal organs.  The two round ligaments connect the front part of your uterus to your groin and they grow and stretch during pregnancy.

It can be quite common to feel Round Ligament Pain, especially during the second trimester of pregnancy.  It often is a deep, sharp or jabbing feeling in the lower belly or groin area.

The pain is usually brought on with movements such as sneezing, coughing, getting up, rolling over in bed, or taking a step.  The pain can either travel upwards, or downwards from the hips to the groin. It can also become a dull, lingering ache if it has been overworked.

Rule Out Any Possible Medical Causes That Could be Causing the Pain

Management of Round Ligament Pain

Simple Pain Relieving Tips To Try

      • holding or supporting your tummy if you cough or sneeze, and/or flex slightly at the hips and knees
      • a heating pad or warm bath might help – but not too hot! Extreme heat can be dangerous for the baby
      • self-massage or partner-assisted massage of the area
      • walking as it helps to offload the ligaments
      • bump-support belt
      • activity modification e.g. change positions slowly (such as rolling over before getting up – see video below)

Build Strength in Your Pelvic Floor And Deep Ab Core Muscles

By building core strength in the pelvic floor and deep abdominal (tranversus abdominis) muscles it helps to provide stability around the pelvis helping to reduce the strain on the ligaments.  See our ‘Pregnancy Pelvic Floor & Core Workouts’  in the WORKOUTS Section of the HUB.

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Try These Round Ligament Pain Relieving Exercises

These simple exercises will help to build strength in your bum and also stretch out and give movement over the painful area.  Try to do once a day.  For the clam exercise and quads stretch do the exercise with the painful side.  If you find that any of these exercises aggravates your pain then stop and seek the help of a physio.

Pain, numbness, tingling and weakness in one or both hands are all symptoms of a condition known as Carpal Tunnel Syndrome (CTS).  In the wrist there is a narrow passage way or tunnel created by the bones and ligaments on the palm side of the hand.  The median nerve, a nerve that supplies sensation and muscle activation to the hand passes through this tunnel.   When this nerve is compressed it can cause the above symptoms. 

In pregnancy this is more likely to occur than in the general population, in fact it was found that up to 62% of pregnant patients will experience CTS.  It is more likely to occur after the 30th week of pregnancy as this is where there is the greatest increase of weight and fluids.   During pregnancy your blood volume doubles, this can cause swelling in a number of different places including the hands and wrists. Combine that with associated soft tissue changes during pregnancy and certain repetitive actions such as typing or scrolling on your phone and the median nerve is quite likely to become compressed.

Treatment of The Symptoms

Splinting

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Your Workstation Set Up

You can either buy an over the counter brace that keeps your wrist in neutral or go and get a custom made one from a hand occupational therapist. Wearing it at night may be of significant help to prevent hands balling into fists. However sometimes the compression from the splint can aggravate it so try and see how it is goes

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Setting up how you work is critical. Ideally one could avoid any aggravating factors as much as possible, however this is not always feasible therefore it is important to optimise your environment.  

      • If you type a lot ensure you have an optimal keyboard – low in height and separate from the laptop if you work off one.  
      • Position the keyboard near the end of your desk to avoid resting your wrists on the desk.
      • If possible keep to a position where your elbows are above your wrists when typing.  
      • Avoid using wrist rests as they compress the carpal tunnel area.  
      • If you find that your mousing hand is the one most affected then try a vertical mouse.   
      • If you need to use equipment see if there are larger formats of the tools you use so that the grip component is reduced.
      • It is important to take frequent breaks.

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