Pregnancy is a time of tremendous changes in term of musculoskeletal, physical and emotional condition. It imposes a tremendous stress on the body and yet is a condition of great satisfaction and happiness. During this period, the incidence of back pain is quiet common.

The causes of the increased incidence of Low Back Ache are:

Changes in musculoskeletal system

Stretching of abdominal muscles : Due to the growing fetus as a result of which the muscles are quiet stretched as a result of which the muscle is unable to generate strong contractions and thus decreases the efficiency of contraction.

Hormonal Changes : Due to the increased level of progesterone and relaxin, the tensile strength of ligaments decreases. This also has an effect on the ligaments of low back and pelvis. The joints become hyper mobile due to ligament laxity. This may predispose the patient to joint and ligamentous injury, especially in the weight bearing joints of the back and pelvis.

Changes in posture and balance

POSTURE

It shifted upward and forward because of the enlargement of the uterus and breasts. As a result of the postural compensation occurs. One of the compensation is the increased lumbar lordosis. This can further become habitual, if proper guidance is not provided. This increased lumbar lordosis puts lots of stress on the anterior longitudinal ligament which may lead to pain.

Moreover, there is approximation of facet joints which may become weight bearing thus leads to synovial irritation and inflammation.

BALANCE

With change In Centre of Gravity and increased weight there are compensations to maintain it. The woman starts walking with wide Base of support and increased external rotation at hip. Some activities such as walking, stooping, stair climbing, lifting and reaching. If these activities are repeated then it can be a potential source of low back ache.

Types

LUMBAR PAIN

This is basically due to the altered posture and the additional bio-mechanical stresses that are discussed above.

Symptoms

Worsen with muscle fatigue after static posture or as the day progresses. These symptoms are usually relieved by change in posture and rest. Pregnant females that are usually fit of have lesser chances to develop this type of backache.

SACROILIAC (POSTERIOR PELVIC) BACK PAIN

This is due to the ligamentous laxity that leads to increased stresses on the SI joint. This leads to SI joint pain and sometimes inflammation of the joint. This is more common in females as compared to Low Back Pain, even if the female is fit.

Symptoms

Localized to the post aspect of the upper buttock ad is described as stabbing pain deep into the buttocks distal and lateral to lumboscral joint. Pain may radiate up to knee joint. It is aggravated by prolonged sitting, standing or walking; pain when climbing stairs, turning in bel etc. This kind of pain in not relieved by rest. This type of pain can develop even in females with active lifestyle.

MANAGEMENT

The back pain in pregnant females presents a completely different challenge for physiotherapy and thus requires great expertise on the part of the therapist. Thus, the exercises and postural corrections must be done under a proper guidance of a physiotherapist in a physiotherapy clinic.