Pregnancy Series, Part I: Aches, Pains & Much-needed Relief

What’s going on?

Your body changes significantly during pregnancy to accommodate your growing baby. Your body starts to look and feel different from early in your first trimester when fatigue and morning sickness may begin to the last trimester when your pelvic organ shifts upward to become an abdominal organ. These body changes are necessary for the growing baby but can really limit even simple movements such as tying your own shoes let alone exercise. Many women are able to stay active during pregnancy, although the intensity and type of exercise varies according to pre-pregnancy fitness level, physician recommendations related to each woman’s specific pregnancy and risks (click here for the American College of Obstetrics and Gynecology guidelines for exercise during pregnancy) , and comfort. It’s not uncommon for women to experience aches and pains during pregnancy regardless of activity level, but what you may not know is that there is treatment that can help reduce your pain and keep you moving!

Buttock & leg pain

Many of our patients reports sharp pain in the buttock, sometimes with numbness and/ or tingling into the thigh, calf, and foot. These symptoms are often called sciatica and typically occur on one side and is worse with sitting and prolonged standing. The sciatic nerve is a large nerve that develops from your spine and travels through your buttock, down your thigh and into the calf. It is a big nerve, thicker than your thumb, so it’s no surprise that your bum hurts when the sciatic nerve is involved. These types of symptoms may come from the back, or more commonly during pregnancy may come from direct compression of the sciatic nerve by the piriformis muscle, sometimes called piriformis syndrome.

The good newsusually there are some simple things you can do to improve your symptoms, including some basic exercises, activity modification and attention to how you move. Exercises may involve stretching, strengthening and coordination to retrain how your body moves. Here’s the rub: a short and tight piriformis can compress the nerve and lead to symptoms, but bear in mind that aggressive stretching to an already lengthened muscle can result in the same. Bottom line: your pregnancy doesn’t have to be a pain in the butt. Before you start madly strengthening your hips and stretching your piriformis, see a PT who can determine the source of your pain and prescribe the right program for you.

Oh my aching back

How often does a pregnant women see her obstetrician and report low or upper back pain, only to be told that it is a normal part of pregnancy and to just ride it out until delivery? We are fortunate to work in an area where many of the OB-GYNs listen to their patients and refer to physical therapy when it appears there is a muscular problem contributing to the pain. Upper and mid back pain may be a result of increased demand on the muscles to support the trunk in light of growing breasts and changes in breathing patterns later in pregnancy. Likewise, lower back pain in pregnancy may result from altered mechanics, increased loading due to weight and body changes, weakness, and muscle imbalance.

The good news being pregnant doesn’t automatically result in back pain. And having back pain during pregnancy doesn’t mean you are resigned to having it for your ENTIRE pregnancy or after delivery. Most women will report some level of low back pain at some point during pregnancy, which is typically minor and may go away on its own without treatment. If it persists or is more intense, you may benefit from physical therapy.

Pelvic Girdle Pain- Sacroiliac Joint (SIJ), Pubic Symphysis and Sacrum

SIJ pain is often described as a ‘catch’ or a lock upon rising from a seated position and may be aggravated by going up steps or shifting weight to one leg while standing. It may last awhile or gradually improves over time. Pain may be at the top or bottom of the sacrum, the triangular shaped bone at the base of the spine. It may also increase after sitting for prolonged periods or while rising from a seated position. Pubic symphysis pain, pain at the front of the pelvis, can be accompanied by clicking or popping and is often worse when standing, walking, or going up steps. Regardless of the location of pelvic pain, looking closely at aggravating factors and comfortable positions can help in restoring pain-free movement. Activity modification and exercises can improve mobility and reduce pain. Women with pelvic girdle pain are often most concerned with the labor and delivery due to limitations in positioning based on pain. We educate our patients and their partners about positions of comfort during pregnancy, labor, and delivery to give them confidence throughout this exciting time in a woman’s life.

The good news a few sessions of physical therapy may be all you need to learn a few exercises or positions to make your pregnancy and/ or delivery comfortable and keep you moving to maintain your active lifestyle.

Pain & the brain

Any talk about pain would be remiss if it didn’t discuss the nervous system too. Yes, often simple exercises and adjustments to daily activities can make a positive impact during your pregnancy. However, it’s not always just about the muscles, bones and tissue. Pain, whether in the back, the butt or anywhere in the body, is your brain’s way of protecting you. In simple terms, your brain interprets all sorts of information, present and past and attempts to determine the threat level of a given experience. If the threat level is deemed high, the output may be pain to ‘warn’ you from the potential danger of the situation. Funny thing- sometimes our brain is sleeping on the job and minimizes the potential for danger, and others it is like the little chicken chirping about the end of days. It’s not such a stretch that pregnancy- whether your first or fifth- brings its shares of stressors and worries that factor in to your symptoms. Have you had this pain before, and it went away? Did your mom or friend have similar symptoms and had a difficult delivery? Are you concerned about how you will care for your baby if the pain persists?

The good newsresearch suggests that just learning about your pain may help to decrease it.  Part of your physical therapy program includes education about your pain, as well as recommendations and referral if needed regarding additional support to help you adapt to all of the changes you are experiencing.

There’s hope!

Pregnancy is one of life’s most exciting and anxiety provoking times in a woman’s life. Pain should not be one more thing to stress about during pregnancy. Carolina Pelvic Health Center, Inc. physical therapists have specialized training and experience treating women with pregnancy-related back, hip and pelvic pain. Call us today for a consultation or to schedule an appointment.