Low Back Pain and Pregnancy: Difference between revisions
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== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
The most common onset tends to be during the 5th and 6th month of gestation, and the pain is usually worse later on in the day. 67% of women suffer from pain at night. Factors that aggravate the pain include: standing, sitting, coughing or sneezing, walking, and straining during a bowel movement. During the physical exam, the paravertebral muscles are tender to palpation, the muscles of the back are weak during testing, and there is possible decreased ROM in flexion. The description of the pain is not localized at times, and may be intermittent. It is possible for the pain to radiate down as far as the calf. (4)<br><br> | |||
== Differential Diagnosis == | == Differential Diagnosis == | ||
Revision as of 06:59, 30 April 2011
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Search Strategy[edit | edit source]
Key words: Pregnancy, Manual Therapy, Physical Therapy, Low Back Pain
Definition/Description
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Low back pain is a common complaint that occurs in 60-70% of pregnancies. (1) It can begin at any point during pregnancy, and approximately one third of these women suffer from severe pain. (2) This is know as either Low Back Pain (LBP) or Peripartum Posterior Pelvic Pain (PPPP). There is limited research available regarding Physical Therapy intervention for pregnant women suffering from Low Back Pain, and for this reason, a homogenous approach tends to be used. As we know, Low Back Pain is not homogenous, and special considerations and precautions should be taken when treating this population. Pregnancy-related Low Back Pain can be defined as pain that is anywhere between the 12th rib and the gluteal folds/pubic symphysis during the course of pregnancy that is not the result of a known pathology such as disc herniation. (3) (4)
Epidemiology /Etiology[edit | edit source]
The exact etiology of LBP during pregnancy is unknown, but there are known factors that are believed to be contributers. During pregnancy, hormonal changes occur, specifically the release of the hormone Relaxin, which is thought to contribute to ligament laxity, softening of cartilage, and the proliferation of synovium. (2) This specifically causes ligament laxity in the Sacro-Iliac Joint, and the Pubic Symphysis.
Another contributer is the average of 25-35 pounds of weight that women gain while pregnant, which increases the forces across joints, changes the center of gravity, and forces the patient into an anterior pelvic tilt. The anterior displacement of the center of gravity will cause women to shift their heads and upper body posteriorly over the pelvis, causing hyperlordosis of the lumbar spine, which will place additional stress on the intervertebral discs, ligaments, and facet joints that can lead to joint inflammation. In addition, abdominal muscles are stretched and weakened, and the weight can compress on the lumbosacral plexus. There are additional theories that vascular changes that occur during pregnancy, including pressure changes in the vena cava and aorta that lead to water retention, cause hypervolemia, decreased cardiac output, lowers the blood pressure and raises heart rate, which can lead to ischemia, metabolic changes, which can induce Low Back Pain.
Risk factors for Low Back Pain during pregnancy include a history of LBP during pregnancy, multiple abortions, and smoking. (4)
A condition called Diastasis Rectus Abominis, which is the separation of the Rectus Abdominis at the Linea Alba, can lead to poor posture and LBP. (5)
Characteristics/Clinical Presentation[edit | edit source]
The most common onset tends to be during the 5th and 6th month of gestation, and the pain is usually worse later on in the day. 67% of women suffer from pain at night. Factors that aggravate the pain include: standing, sitting, coughing or sneezing, walking, and straining during a bowel movement. During the physical exam, the paravertebral muscles are tender to palpation, the muscles of the back are weak during testing, and there is possible decreased ROM in flexion. The description of the pain is not localized at times, and may be intermittent. It is possible for the pain to radiate down as far as the calf. (4)
Differential Diagnosis[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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