Back pain is undoubtedly one of the most common ailments in pregnancy. It occurs more frequently from the end of the second trimester, but there are women who report it as early as the first weeks of gestation. But is this a normal condition? And what can be done to relieve the pain? Can it be prevented in any way? The physiatrist Mark of Jesus gives us some interesting answers.
Dr. Marco Di Gesù
Doctor Di Gesù, back pain in pregnancy is often considered "physiological". But it is so? Do all women suffer from it?
“No pain can be defined as 'normal' even when, as in the case of back pain during pregnancy, it is a very frequent phenomenon. About 50-80% of pregnant women suffer from back pain and the greatest prevalence occurs between the fifth and seventh month. (Mogren IM, 2005) It is essential, before addressing the topic, that attention is paid to the diagnosis: 'back pain' can be the common ailment we will talk about in this interview, but it can also be kidney pain , a urinary disorder or, much more serious, fetal suffering or cancer. This is why, in the first instance, in case of pain in the lumbar area, it is necessary to consult a doctor ".
What are the causes of back pain?
“Generally back pain derives from the normal postural changes that affect the pregnant woman. Schematic: - the center of gravity is moved forward and the lumbar muscles are called to a greater effort (for which they are often not prepared!). - The lumbar curve (lordosis) is accentuated. - The abdominal muscles are gradually stretched and have less ability to 'balance' the action of the lumbar muscles in keeping the back 'steady'. - The intervertebral discs are subjected to a greater load and are more likely to come out of their natural location forming a hernia. - The sacroiliac joints are subjected to gradual and increasing stress. However, there are also hormonal factors that can lead to back pain (which would explain back pain that occurs as early as the second month of pregnancy, when postural changes have just begun) or vascular factors (often the cause of back pain. which gets worse at night). Excessive inactivity is associated with a greater risk of back pain. As well as carrying out 'heavy' work tasks for the back. This means that both extremes are inadvisable in pregnancy. (Mogren IM, 2005). Although you might imagine the risk of developing back pain is not directly related to weight gain! Not all studies, in fact, agree on the fact that excessive weight gain during pregnancy is related to back pain ".
Back pain and sciatica: are they the same thing?
"No. We can say that 'back pain' is pain limited to the lumbar region that can radiate to the buttocks (normally described as 'a nail' or 'a bite') and to the back of the thighs. The pain never goes beyond the knee 'Sciatica' is a pain that follows the course of the ischial nerve (from the lumbar region it radiates to the buttock, thigh, lateral region of the leg and reaches the big toe). Sciatica is a 'string that pulls' the entire leg associated with falling asleep and tingling. Calf cramps can also occur. It is often present in only one leg, but in pregnancy it is not uncommon to involve both legs ".
How can this ailment be prevented? Can physical activity help or does it make the situation worse? Which one to choose?
“Back pain in pregnancy can, often but not always, be prevented. In this sense, it is essential to evaluate what are the factors that predispose to back pain, lifestyle habits and physical activity. Numerous studies, for several years already, have underlined the importance of exercises in controlling and preventing back pain in pregnancy. (Dumas GA, 1995) A good exercise program before pregnancy and in the first weeks of gestation can lead to strengthening the lower back, abdominal and pelvic floor muscles. This allows an improvement in the postures maintained and the ability to bear the physiological load of the unborn child. Over the last few years, various training strategies related to fitness have been developed for pregnant women and for the postpartum period. Which one to choose? The one led by experienced and up-to-date professionals! ".
What should I do with drugs during pregnancy?
“With absolute moderation and always and only under medical advice! Only some drugs can be used during pregnancy and they are used only in case of need. Self-medication is absolutely inadvisable. Often 'natural' substances are used which, especially if applied locally, can soothe ailments. Therefore, it is necessary to focus attention on other remedies that are not pharmacological ".
What are the solutions for back pain?
“The remedies available obviously derive from the definition of back pain that is carried out during the visit. In general, among the therapeutic options we have available, the following should be mentioned: - Physiotherapeutic treatments: some manual techniques, heat and TENS (transcutaneous electrical nerve stimulation) can give good or excellent results in pain management. - Pharmacological treatments (see above). - Education in maintaining 'correct postures'. - Adoption of lumbar belts (only in some cases). - Exercises! - A course of low-intensity exercises that stimulate the movements of the pelvis and leg muscles can lead to a reduction in pain. (Garshasbi A, 2005) - Some activities carried out in heated water (hydrokinesitherapy) can be, as well as pleasant, of great relief for back pain. - Acupuncture has also been shown to be useful in the management of back pain without involving any patient and unborn risk ".
When is a visit with the physiatrist useful?
“Normally we are called into question in the period of maximum pain, but the greatest benefit is obtained by contacting the physiatrist in a preventive way. Interestingly, women who have reported back pain in pregnancy have a high likelihood of experiencing it again in subsequent pregnancies. (Mens JMA, 1996) Prevention, in this case, plays a fundamental role. The physiatrist can diagnose, indicate the right treatments, perform some (manual therapy) and, last but not least, give valuable advice! ".