Low Back Pain During Pregnancy

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🎓 Detailed Explanation of Low Back Pain During Pregnancy

🔍 What is it?

  • Low back pain (LBP) during pregnancy is very common – affecting 50–70% of pregnant women.

  • It’s caused by a combination of:

    • Hormonal changes (e.g., relaxin hormone loosening ligaments).

    • Mechanical stress from the growing uterus and baby.

    • Postural changes due to shifting center of gravity.

    • Weight gain and muscle imbalance.

    • Pelvic girdle changes (e.g., sacroiliac joint stress).

⚠️ Why is it important?

  • If not managed, it can:

    • Affect daily activities (e.g., walking, standing, sleeping).

    • Reduce quality of life.

    • Increase the risk of chronic back pain after delivery.

📚 Management – Step by Step

🧠 1. Education & Reassurance

  • Explain that LBP is common during pregnancy.

  • Most cases are not dangerous and resolve postpartum.

  • Empower the patient to manage symptoms with safe strategies.

🏃‍♀️ 2. Exercise & Physical Therapy

  • The goal is to strengthen supportive muscles, improve flexibility, and maintain posture.

Examples:

  • Pelvic tilts: Strengthens abdominal muscles and reduces lumbar lordosis.

  • Knee-to-chest stretch: Relieves lower back tension.

  • Cat-cow stretch: Improves spinal mobility.

  • Strengthening: Focus on gluteal, pelvic floor, and core muscles.

  • Walking or aquatic therapy: Reduces joint stress and improves circulation.

  • Supervised prenatal physiotherapy: Ensures exercises are safe and effective.

🏠 3. Ergonomic & Lifestyle Advice

  • Correct posture: Avoid excessive lumbar lordosis, stand tall with shoulders back.

  • Use supportive chairs when sitting; place a small pillow behind the lower back.

  • Avoid prolonged standing or sitting; change positions frequently.

  • Use a pregnancy pillow while sleeping, lie on the side with a pillow between knees.

  • Wear supportive shoes with low heels to maintain balance.

  • Use a maternity support belt if needed.

💊 4. Pain Management

  • Paracetamol (Acetaminophen) is the safest first-line medication.

  • Avoid NSAIDs (e.g., ibuprofen) especially in the third trimester, as they can affect fetal circulation (e.g., premature closure of the ductus arteriosus).

  • Avoid opioids unless absolutely necessary and prescribed.

  • Heat therapy (warm compress) can relieve muscle tightness, but avoid very hot baths or saunas.

💆 5. Manual Therapy (if trained)

  • Chiropractic adjustments or osteopathic manipulations may be helpful for pelvic and lumbar alignment.

  • Acupuncture has shown benefit for pregnancy-related back pain.

  • Massage therapy can relax tense muscles but should avoid deep pressure on certain points (e.g., near the sacrum or inner thighs).

🧘‍♀️ 6. Stress & Relaxation

  • Stress and anxiety can worsen muscle tension and pain perception.

  • Encourage:

    • Breathing exercises.

    • Prenatal yoga for relaxation and stretching.

    • Mindfulness or meditation.

🚨 7. Referral & When to Worry

Refer the patient to an obstetrician or specialist if:

  • Severe or worsening pain.

  • Neurological symptoms: Weakness, numbness, foot drop.

  • Bladder or bowel dysfunction (e.g., incontinence – possible cauda equina syndrome).

  • Fever or night sweats with back pain (possible infection).

🚫 8. What Should Be Avoided?

  • Heavy lifting or strenuous activities.

  • High-impact exercises (e.g., running, jumping).

  • Deep tissue massage over certain points (risk of stimulating contractions).

  • Electrotherapy (TENS, ultrasound) unless approved by the doctor.

  • Hot tubs/saunas – excessive heat can be risky during pregnancy.

📝 Summary for a Student: Key Points

✅ LBP during pregnancy is common and usually benign.
✅ Management is conservative and non-invasive.
✅ Education, exercise, posture correction, pain relief, and emotional support are key.
✅ Always monitor for red flags (neurological signs, severe pain, fever).
✅ Be cautious with medications and manual therapies – safety first for mother and baby.


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