Lower Back Pain in Pregnancy: How to Avoid a Pelvic Support Brace (Part 1) by Sally Harrison, Physiotherapist. Director of Pro-Align Pilates and Exercise
Back ache, from niggling discomfort to severe pain, is one of those aspects of pregnancy that many women simply expect to have to put up with. But exactly why does it occur? Is it inevitable? And what can you do to both prevent and relieve it? Physiotherapist Sally Harrison, Director of Pro-align Pilates and Exercise rehab, explains:
Unfortunately, it is not uncommon to experience pain and discomfort in the low back and pelvic region during pregnancy. There are so many changes happening throughout the body but particularly in the abdomen and trunk as they expand to accommodate the growing foetus. In the majority of cases, back pain is linked to postural changes from this ever changing shape, especially during the second and third trimester. This is due to a forward tilt of the pelvis and an increase in low back curve leading to tight and fatigued low back muscles, a lengthened and weaker abdominal sheet (flat muscle layers of the stomach) and tightness in the hip flexors and external rotators (back of hips). Some expectant mothers, however, suffer from a more specific and sometimes quite debilitating pain around the pelvis. This is known as SIJ (sacroiliac joint) and pubic symphysis dysfunction and needs a physiotherapist’s attention before it becomes a major problem.
|Picture the pelvis as basically a bony basin/bowl shape formed from the connection of 3 bones; the sacrum and left and right inominates (hip bones). They connect at the back with two joints and at the front with the pubic symphysis. Under normal conditions there is very little movement at these joints but with pregnancy and a subsequent change in hormone levels, (especially relaxin), the supporting ligaments can become softer and these joints less stable. This can be felt as pain in the pelvic region both in the joints and from associated spasm in surrounding muscles such as Piriformis (back of hip) and the adductors (inner thighs) as they try to stabilise the pelvis.|
So how can you prevent and/or relieve this? Firstly, correcting your posture as well as activating and training the core muscles (‘inner unit’) are of paramount importance in stabilising the pelvis/SIJ region. The combined connection of the pelvic floor, transversus abdominus (innermost layer of abdominal muscle) and surrounding fascia (supportive tissue) is vital in supporting the growing uterus and providing strength in an ever-weakening abdominal region. The Pilates method of training is unbeatable in these circumstances as it focuses precisely on isolating these core muscles of the trunk and pelvis as well. If started early, then Pilates can certainly reduce and even prevent this type of pain.
|As the core is not strong enough to work alone, however, it is also vital to work on the ‘outer unit’ of muscles that work as teams to produce a strong connection that holds the pelvis together. These teams of muscle cross over the pelvis in spirals and diagonal lines thus supporting it from all angles. They are known as ‘functional slings’ and comprise bigger, stronger muscles such as the gluteals, lats, obliques and inner thighs. It is important to train these muscles together as ‘teams’ to provide support over the top of the inner core. Again, Pilates is ideal for working these muscles in the correct, safe way as well as generally lengthening the spine, releasing compressed joints in the low back and stretching out the hips and chest.|
It is the action of these two units, the outer and inner, working together simultaneously that provides ‘nature’s pregnancy support belt’. Through training from early on in pregnancy (or before!) with a specialist prenatal Pilates instructor, preferably a physiotherapist, these muscles can be primed and at their peak. In this way pregnancy-related joint laxity is often coped with well, meaning low back pain is definitely not an inevitable part of being pregnant!
In Part 2 we will look at some exercises for the outer slings and some tips on how to avoid pelvic stress and asymmetry in your everyday activities.