Low back pain is common during pregnancy. Researchers estimate that between 45-80% of pregnant women will experience low back pain at some stage of their pregnancy.1-8 The pain may be mild for some and not require treatment. For others, the low back pain can be so severe that it interferes with daily activities and work. Although pain is usually experienced sometime between the fifth and seventh month of pregnancy, it can begin as soon as eight to twelve weeks after becoming pregnant.9
Pregnancy-related back pain is usually due to a combination of functional stressors such as weight gain, postural changes, altered walking patterns, and hormone changes that cause ligamentous laxity. As the baby develops, a woman’s center of gravity changes. The abdomen and pelvis shift forward to accommodate for the growth of the baby. This causes the lumbar curve in the lower back to increase which puts increased strain on the joints of the low back and pelvis. This can also cause alterations to balance and walking patterns.10 These postural changes may lead to increased pain, muscle tightness, tenderness, and discomfort.9
Some women can experience low back and pelvic region pain the year after birth, and even up to three years after labor and delivery.11-12 Pregnancy-related low back and pelvic pain, as well as post-partum spinal disorders, are not only common, but they can impede recovery, nursing, and caregiving.5
Symptoms of pregnancy-related low back pain are usually located in the lower back, pelvis, or hips, but may radiate into the buttocks or back of the thigh. Symptoms are often aggravated by activity, including standing, sitting, coughing, sneezing, and straining during a bowel movement. Symptoms often increase throughout the day. Many women also have pain at night that disturbs sleep.
Pregnancy can be a challenging time to deal with pain as most women do not want to take pain medications for fear of harm to the baby. Pregnancy is a time when safe non-drug options are needed.
Chiropractic is a safe and effective non-drug option for the treatment of pregnancy-related low back pain. The goal of chiropractic care is to restore normal joint motion and reduce muscle tension. Spinal manipulation (adjustments) is an important component in the management of pregnancy-related low back pain. Almost 75% of women undergoing chiropractic manipulation report significant pain reduction and clinically significant improvements in disability.14-15 Postpartum low back pain also responds to spinal manipulation- approximately 10 times greater than watchful waiting.16 Treatment can improve functional activities such as standing, walking, sitting, and sleep.
Low force chiropractic adjustments work well for pregnant women. Hormone changes during pregnancy create a looseness in the ligaments so very little force is needed to adjust the pelvis and lower back. Tables with drop away abdominal pieces accommodate the growing abdomen so pregnant women can still lie down on the treatment tables.
Other common treatments for pregnancy-related low back pain include exercise, education, acupuncture, and pelvic belts. Maintaining optimal function and reducing pain levels are goals that should be discussed with a doctor of chiropractic as well as an OBGYN when it comes to pregnancy-related pain.9 A detailed history and clinical examination are essential for determining what biomechanical source is causing a pregnant woman’s low back or pelvic pain.13
Low back pain and pelvic pain do not have to be an inevitable part of pregnancy. If you are one of the 45-80% of pregnant women experiencing pain during your pregnancy, there are options for treatment available to help make your pregnancy more comfortable.
Sean Flynn, DC
Sioux City, IA Chiropractor
1.Wu WH, Meijer OG, Uegaki K, Mens JM, Van Dieen JH, Wuisman PI, Östgaard HC. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. European Spine Journal. 2004 Nov 1;13(7):575-89.
2.Pierce HM. Pregnancy-related low back and pelvic girdle pain: listening to Australian women (Doctoral dissertation).
3. Diakow P.R.P., Gadsby T.A., Gadsby J.B., Gleddie J.G., Leprich D.J., Scales A.M. Back pain during pregnancy and labor. J Manipulative Physiol Ther. 1991;14(2):116–118.
4. Berg GÖ, Hammar M, Möller-Nielsen JE, Lindén UL, Thorblad J. Low back pain during pregnancy. Obstetrics and gynecology. 1988 Jan;71(1):71-5.
5. Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine. 2005 Apr 15;30(8):983-91.6.
6. Weis CA, Barrett J, Tavares P, Draper C, Ngo K, Leung J, Huynh T, Landsman V. Prevalence of low Back pain, pelvic girdle pain, and combination pain in a pregnant Ontario population. Journal of Obstetrics and Gynaecology Canada. 2018 Aug 1;40(8):1038-43.7.
7. Saxena AK, Chilkoti GT, Singh A, Yadav G. Pregnancy-induced low back pain in Indian women: Prevalence, risk factors, and correlation with serum calcium levels. Anesthesia, essays and researches. 2019 Apr;13(2):395.
8. Weis CA, Barrett J, Tavares P, Draper C, Ngo K, Leung J, Huynh T, Landsman V. Prevalence of low Back pain, pelvic girdle pain, and combination pain in a pregnant Ontario population. Journal of Obstetrics and Gynaecology Canada. 2018 Aug 1;40(8):1038-43.
9. Montgomery, S.P. “Management of back pain during pregnancy.” (2009). Retrieved March 2020 from: https://www.spine-health.com/conditions/pregnancy-and-back-pain/management-back-pain-pregnancy
10. Verstraete, V.H., Vanderstraeten, G., and Parewijck, W. (2013). Pelvic Girdle Pain during or after pregnancy: a review of recent evidence and a clinical care path proposal. Facts Views Vis Obgyn. 2013; 5(1): 33–43.
11. Yoo, H., Shin, D., and Song, M. (2015). Changes in the spinal curvature, degree of pain, balance ability, and gait ability according to pregnancy period in pregnant and nonpregnant women. J Phys Ther Sci. 2015 Jan; 27(1): 279–284.
12. Maiers, M., et al. (2018). Chiropractic in Global Health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic. Chiropr Man Therap. 2018; 26: 26.
13. Katonis, P., et al. (2011). Pregnancy-related low back pain. Hippokratia. Jul-Sep; 15(3): 205–210.
14. Shaw G. When to adjust: chiropractic and pregnancy. J Am Chiropr Assoc. 2003;40(11):8-16.
15. Murphy DR, Hurwitz EL, McGovern EE. Outcome of pregnancy-related lumbopelvic pain treated according to a diagnosis-based decision rule: a prospective observational cohort study. Journal of Manipulative and Physiological Therapeutics. 2009 Oct 1;32(8):616-24.
16. Schwerla F, Rother K, Rother D, Ruetz M, Resch KL. Osteopathic manipulative therapy in women with postpartum low back pain and disability: a pragmatic randomized controlled trial. J Am Osteopath Assoc. 2015 Jul 1;115(7):416-25.
17. Chiroup
18. Chiropractic Success Academy