19 Aug Aches and Pains in Pregnancy
The stereotypical picture of a pregnant woman grimacing with discomfort while clutching her low back is well known, but why? And does this have to be the expectation in pregnancy? For many women, pregnancy is a time of excitement, planning, but also of physical discomfort. In fact, it is estimated that virtually ALL women experience musculoskeletal discomfort during pregnancy, with 25% of these women experiencing at least temporarily disabling symptoms.
Three of the most common musculoskeletal disorders of pregnancy include:
1. Low Back Pain
Studies estimate that approximately 50% of pregnant women experience low back pain, with only 32% of these women reporting these symptoms to their prenatal care provider. Lumbar spine pain is typically felt above the belt line and is thought to be due to altered biomechanics and joint relaxation due to the hormone relaxin. Notably, disc herniations can also occur during pregnancy, although they are relatively uncommon. If the pain is severe and radiates into the leg, it is imperative for the patient to have a complete neurological exam; if there are any findings of a severe radiculopathy (pinched nerve), an MRI may additionally be ordered for evaluation. In most cases, after appropriate diagnosis, a customized treatment plan can be designed to treat low back pain and may include core and pelvic stabilization exercises, manipulative treatments, use of a lumbar support binder, medications, and/or acupuncture.
2. Pelvic Girdle Pain
Pelvic girdle pain refers to persistent musculoskeletal pain at the anterior and/or posterior pelvic ring, including the pubic symphysis (in the front) and the sacroiliac (SI) joints (in the low back/buttock region). Pubic symphysis pain is felt at the front of the pelvic girdle and can be aching, burning, or stinging and can radiate down into the thighs. This is commonly due to symphysis widening mechanical strain due to pelvic instability. SI joint pain is typically felt below the belt line and can also refer down the leg. Pelvic girdle pain is often exacerbated by weight bearing, transitional movements (i.e. sit to stand), and predominantly single-legged movements like stairs or lunges. When correctly diagnosed with a detailed musculoskeletal exam, many patients see relief with a tailored program of pelvic stabilizing exercises, heat and ice, and use of an appropriately fitted pelvic support belt. Injections are rarely needed but can be helpful in the most severe cases.
3. Carpal Tunnel Syndrome
The symptoms of carpal tunnel syndrome occur far away from the back and pelvis – all the way out in the hands – but this diagnosis is also associated with pregnancy. Peripheral edema, or swelling, during pregnancy can cause compression of the peripheral nerves, including the median nerve at the wrist, causing pain, numbness and/or tingling, and sometimes weakness involving the first three fingers of the hand. After accurate diagnosis with history and exam and in some cases with electrodiagnostics, many women see relief with thermoplastic night splints, stretching, and biomechanical re-education with injections available in refractory cases.
Many women have been told by friends, family, and even healthcare providers that aches and pains are just a part of pregnancy, and there’s nothing to do but wait it out. But more and more we are learning that that is not the case. The providers at Desert Spine and Sports Physicians are all board-certified physiatrists (PM&R specialists) who take the time to evaluate each patient with a comprehensive history and a complete musculoskeletal and neurological exam to determine the correct diagnosis, screen for any potentially dangerous conditions, and create a comprehensive treatment plan to help relieve pain and improve function. Our goal is to help our pregnant patients enter motherhood feeling fit, healthy, and strong!
1. Borg-Stein J, Dugan SA. Musculoskeletal disorders of pregnancy, delivery and postpartum. Phys Med Rehabil Clin N Am. 2007;18(3):459-ix.
2. H.L. Carlson, N.L. Carlson, B.A. Pasternak, et al. Understanding and managing the back pain of pregnancy. Curr Womens Health Rep, 3 (2003), pp. 65-71
3. S.M. Wang, P. Dezinno, I. Maranets, et al. Low back pain during pregnancy: prevalence, risk factors, and outcomes. Obstet Gynecol, 104 (2004), pp. 65-70
4. M.M. LaBan, S. Viola, D.A. Williams, et al. Magnetic resonance imaging of the lumbar herniated disc in pregnancy. Am J Phys Med Rehabil, 74 (1995), pp. 59-61
5. Kanakaris, N.K., Roberts, C.S. & Giannoudis, P.V. Pregnancy-related pelvic girdle pain: an update. BMC Med 9, 15 (2011).
6. Stuge, B., Lærum, E., Kirkesola, G., Vøllestad, N. The Efficacy of a Treatment Program Focusing on Specific Stabilizing Exercises for Pelvic Girdle Pain After Pregnancy: A Randomized Controlled Trial, Spine: 2004; 29 (4), pp. 351-359
7. G. Ekman-Ordeberg, S. Salgeback, G. Ordeberg. Carpal tunnel syndrome in pregnancy: a prospective study. Acta Obstet Gynecol Scand, 66 (1987), pp. 233-235