During pregnancy a woman’s body experiences a multitude of changes, both physical and hormonal. For a large proportion of women, these changes result in low back pain, culminating in the third trimester.
There is currently no consensus as to the most effective form of physiotherapy treatment in pregnant women suffering low back pain, so this article aims to outline the most commonly used methods for treating to condition and their benefits.
The data is based on a recent study in the UK whereby over 1000 physiotherapists, working in both the public and private sector, answered a questionnaire regarding the methods they use to treat such patients. It is worth noting that physiotherapists that worked exclusively in the private sector were more inclined to have a more “hands-on” approach in treating patients, with a higher incidence of manual therapy, massage and acupuncture being used in comparison to public sector employees.
The top physiotherapy interventions used to treat low back pain in pregnancy from the study are as follows:
1). Home Exercise Program/Postural Control/Stabilising Exercises
During pregnancy the hormone relaxin is released in order to for the joints to become more flexible and allow the baby to pass through the birthing canal easier. This increased flexibility however creates instability and postural changes throughout the body. Coupled with increased weight gain, particularly around the abdomen, the change in the body’s centre of gravity applies a large amount of pressure on the low back, leading to pain and discomfort. A program consisting of cardiovascular, strength and stability training has been shown to improve low back pain immensely.
Whether walking, swimming or biking, all considered safe during pregnancy, aim to perform the activity for 20-30minutes with a light to moderate intensity. At this level of activity, you should be able to hold a conversation with only a small amount of breathlessness.
Two examples of strength and stability exercises to perform during pregnancy include pelvic tilts and quadruped/superman exercises. Aim to hold each position for 3-5 seconds and repeat 10-20 times for 3 sets, or as many as is comfortably possible.
2). Pelvic Floor Exercises
Also known as Kegel exercises, these types of exercise target the deepest layer of the abdominal muscles whilst also activating the intrinsic back muscles. Activating these muscles leads to increased stability around the lumbar spine, decreasing pain.
In order to perform these exercises, lie flat on your back with your knees bent and resting on the floor. Gently draw your stomach inwards and upwards, aiming to hold the contraction for 10 seconds. You should not feel your buttocks, thighs and outer stomach muscles tightening when done correctly.
3). Supportive Pillows/Belts/Taping
Support pillows, particularly whilst sleeping have been shown to have a positive effect on low back pain during pregnancy by keeping the spine and pelvis neutral, thus decreasing the pressure placed on the lumbar region. It is an adjunct to postural corrective exercises and can make the difference between waking up tired and waking up feeling refreshed after a good nights sleep.
In women with very large postural changes, wearing a belt or using kinesiology tape has shown to reduce low back pain by correcting those postural changes and de-load the lumbar spine.
4). Manual Therapy
A very effective alternative to analgesics, which many pregnant women are reluctant to take, is manual therapy. Consisting of spinal manipulation, soft tissue release and massage, manual therapy has been shown to relieve symptoms very quickly. Coupled with patient education and an exercise program in order to prolong the effects of the treatment, manual therapy is a safe and effective way to treat low back pain in pregnancy. Be sure to speak with your therapist who can create a tailor made treatment program for you.