Low Back and Pelvic Girdle Pain during pregnancy

During pregnancy the female body undergoes several changes.  Some of these effects include the release of a hormone called 'relaxin' which as the name implies causes relaxation of soft tissue such as ligaments in preparation for childbirth.  Such changes are in most circumstances beneficial.  However, in some instances women can develop low back and pelvic girdle pain. Exercises involving hip-back strength and co-ordination are frequently employed to maintain the optimal functioning of the legs and back.

The pelvic girdle is supported by ligaments and muscles.  Additionally, the low back also has an intervertebral discs which act as semi-flexible spacing structures for the back. These structures undergo increased loading as a result of increasing weight of the expectant mother, as well as altered posture as the foetus grows.  The pelvic girdle tends to tilt forward placing extra strain on the low back curvature.  Moreover, the pelvic ligaments holding the sacrum to the ilium and binding the pubic bones at the front can be strained resulting in the ilium shifting on the sacrum which can cause significant pain.  Women can experience difficulty in bearing weight through one leg.  Such pain can be associated with altered muscle tension as well as weakness creating inco-ordination around the hip-pelvis-back regions.

Physiotherapy addresses such problems by undertaking a comprehensive assessment to ascertain the mechanisms of pain ane movement impairment.  The articular structures of the back, pelvis and hip are assessed for their ability to rotate and glide.  The muscles are assessed to evaluate whether they are excessively tight due to spasms or excessively weak due to reflexogenic pain mechanisms.  Muscles of most importance are the pelvic floor, the deep low abdominal muscles, the deep hip flexors and the hip rotators.  Additionally, the back extensors and side benders are also assessed for their postural reflex integrity.  The knees and feet are also assessed for their alignment and occasionally orthotics are prescribed.

Treatment usually involves a Canadian approach, using muscle energy techniques, soft tissue massage, joint mobilisation as well as exercises for low back-pelvic synergy and postural stability. Frequently, the thorax is quite stiff and may need soft tissue work and joint mobilisation as well as breathing exercises. Once, sacro-iliac (pelvic joint) positioning is attained, it should be maintained through a home exercise programme. Sometimes, a pelvic belt is used to maintain stability.

Lateral breathing, along with thoracic mobility exercises and venous stockings may aid in leg circulation. As the foetus becomes larger, lying on the back should be avoided as it may reduce blood flow in the aorta and vena cava.

- only works if your not too pregnant yet!! Modifications may be made using a towel or using the sidelying position. Sidelying also reduces the risk of compromising the aorta and vena cava

Please consult us or your local physiotherapist as the treatment regime should be tailor made for your precise condition.

Last update : 10 October 2007