One misconception about pregnancy is that it creates orthopedic problems. While there is some pain associated with carrying a baby, often the cause can be traced to underlying issues. Some examples include a history of back pain, pain during a previous pregnancy, and pelvic injury. The most common orthopedic complaints during pregnancy are lower back and pelvic girdle pain, as well as lower extremity pain
Finding the Source of the Pain
Two common causes of lower back and/or pelvic girdle pain and lower extremity pain are diastasis recti and separation of the pubic symphysis. Women who have had lower back pain in the past or pain during a previous pregnancy may want to get a physical therapy assessment done once they become pregnant, to assist in avoiding a reoccurrence.
Diastasis recti, a condition in which the rectus abdominis muscle separates, due to stretching of the mid line of the stomach where the muscles attach. Hormone changes during pregnancy can soften the connective tissue, and this along with the increased weight of a growing baby in the abdomen can create a separation. The separation itself is painless, which is why it if often over looked, but it does weaken your core muscles, which can then lead to back pain and overall instability. A physical therapist knowledgeable in pre-natal care can assess the presence of this condition for you.
Separation of the pubic symphysis
Your pubic symphysis is the joint that connects your right and left pubic bones. The separation of the pubic symphysis in most people is 1-5 mm, but during pregnancy this can increase by .5 to 7 mm. If this separation becomes greater than 10 mm, as assessed by a physician or physical therapist, it can create pain and instability
Pain Management Strategies
Daily Activities and Exercise
Maintaining a level/symmetrical pelvis during activities of daily living and exercise will help to limit/minimize pelvic girdle/low back and LE pain. Avoid crossing your legs, standing on one leg, or bending and twisting your body, and don’t carry anything too heavy on one side. Keep your pelvis in alignment as you move. You may want to adjust your exercise routine from anything that requires an asymmetrical stance such as running, elliptical, and lunges to more symmetrical activities like fast walking or doing squats.
When you’re pregnant, your center of gravity moves forward and your postural stability is decreased as your progress in your pregnancy. These changes can last 6-8 weeks after you give birth. Because of that, a lot of people compensate by increasing the arch in their lower back, moving their pelvis forward. This position can lead to an increase in low back pain and pelvic girdle pain. The good news is that there’s no reason that you can’t maintain optimal posture throughout and after your pregnancy once you know how. A physical therapist can give you a postural assessment and show you ways to maintain a neutral posture best fitted for you.
If you have swelling and/or pain in your lower extremities, be sure that you’re drinking enough water, and staying active. If your doctor says it’s okay to be active go ahead and do some light exercise to keep your body moving. I often suggest that my patients get a stability belt (which can be fitted for you by your physical therapist or at a maternity store), and if your doctor gives you clearance you can wear compression socks to help alleviate any lower extremity swelling especially if you spend a lot of time sitting or standing in one position for long periods of time throughout the day.
Prenatal massages are great! Not only do they relax you, but they stimulate blood flow throughout your body.
Finally, if you had physical therapy before becoming pregnant and find that you can no longer perform the exercises that were prescribed for you, be sure to go back to your therapist and get a re-assessment.
Anna Ribaudo is a doctor of physical therapy at the Integrative Care Center at Hospital for Special Surgery and a certified orthopedic specialist. She completed her doctorate degrees at New York Institute of Technology in 2003 and has completed an orthopedic residency at Hospital for Special Surgery.