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Physiotherapy for Pregnancy-related Back and Pelvic Girdle Pain

During pregnancy, it is not uncommon for women to be troubled by back and/or pelvic pain. Whilst the cause and severity of pain often varies from woman to woman. The most common locations of pain include pain in the low back and posterior pelvis (back of pelvis); pain at the pubic symphysis (front of pelvis); pain in the thoracic spine (upper back pain); and pain in the cervical spine (neck pain) leading to headaches.
Regardless of the location of the pain, your Alana Physiotherapist is here to help.

Low Back and Posterior Pelvic Pain

Whilst ‘Low Back Pain’ and ‘Posterior Pelvic Pain’ both result in pain being felt in the lower half of the spine, they are actually quite different conditions.  Low back pain refers to pain felt in the arch of the lower spine, whilst posterior pelvic pain is usually felt in one or both sides of the sacroiliac joints (the joints underneath the buttock muscles).

Both low back and posterior pelvic pain can occur in pregnancy due to:

  • Pregnancy hormones softening ligaments in preparation for birth;
  • The increasing  weight of the uterus (womb) altering the normal posture, leading to an increase in curvature of the lower back (called a lordosis);
  • Alterations in the usual muscle activation around the back and pelvis to cope with the change in centre of gravity associated with pregnancy.

To achieve an improvement in symptoms of low back and posterior pelvic pain, it is important to first distinguish the exact location that the pain and the underlying cause specific to each individual woman.

How will I know if my pain is from my lower back or posterior pelvis?

The Alana Physiotherapists are trained to perform an accurate assessment of your condition and determine the true location and cause of your pain.  However, a useful first step can be to consider the types of activities that most commonly cause your pain.

The sacro-iliac joints (SIJs) in the posterior pelvis have an important role in walking, shock-absorption, and transmission of force from the upper body to the lower limbs.  As a result, women with posterior pelvic pain usually experience a worsening of their symptoms with activities such as rolling over in bed, getting in and out of cars and walking.  In contrast, women with low back pain more commonly report pain or difficulty with activities such as bending forward to pick up an object from the floor or turning to look over their shoulder in the car.

What should I do if I am suffering from posterior pelvic  or lower back pain?

If you think you are suffering from posterior pelvic pain or lower back pain, it is useful for you to seek advice from a health professional.  The Alana Physiotherapists are trained to identify the underlying cause of pregnancy related pain, and assist you in reducing these discomforts.  Correct diagnosis will enable specific treatment, allowing you to maintain comfort throughout your pregnancy, and assist in the prevention of long-term lower back problems.  Possible techniques include soft tissue release, myofascial release, joint mobilisations, prescription of a pelvic support belt/garment and taping.

Pubic Symphysis Pain (pain in the front of the pelvis)

The pubic symphysis is usually a firm cartilage structure, located centrally between the pubic bones at the front of the pelvis.  During pregnancy, hormones are released to cause a softening of the pubic symphysis and a widening of the joint by up to 9 mm to prepare for birth.  In some women however, this softening of the symphysis combined with a change in weight distribution through the pelvis can result in significant dysfunction and pain at this joint.  Severity can vary, and occasionally symptoms may radiate above the pubic bone and/or into the inner thigh area.

What activities will aggravate my symptoms?

If you are suffering from pubic symphysis dysfunction, you may find your symptoms are aggravated by activities such as:

  • Unilateral (one sided) weight bearing
  • Getting in and out of cars
  • Rolling over in bed
  • Putting clothes on
  • Walking

If this pain is severe, you may also develop a shuffling gait pattern when you walk as a result of a decreased step length in an attempt to manage your pain.

Are there treatments available to assist in the management of pubic symphysis pain?

Physiotherapy is the primary and most useful option in managing the pain associated with pubic symphysis dysfunction.  The use of prescriptive supportive garments/belts, soft tissue release and advice regarding modification of activity are particularly effective.  If your pain is particularly severe, the use of functional or assistive aides for walking may also be necessary.

Thoracic Spine Pain (Upper Back Pain)

Upper back pain may occur during pregnancy or after birth when caring for your baby.  During pregnancy, upper back pain commonly occurs due to the need for your ribcage to lift and expand as your baby grows.  This expansion can lead to pain in the upper back muscles, or the joints between the ribs and spine.  These pains may also radiate to other areas of your body such as the upper limbs, chest or lower back.

Whilst upper back pain can therefore occur during pregnancy, for many women this type of pain is more bothersome in the post-partum period.

Why am I more at risk of developing upper back pain post-partum?

Upper back pain in the post-partum period is often caused by new sustained postures during breastfeeding, repetitive lifting of your baby, lifting of your stroller or capsule, and an overall increased strain in the upper back muscles.

Will physiotherapy help in reducing my upper back pain?

The Alana Physiotherapists are trained to identify the underlying cause of your upper back pain, provide an accurate diagnosis, and assist in choosing the most appropriate intervention for your specific circumstance.  If you are suffering from upper back pain there are many simple treatments that are very effective.  Physiotherapy will aim to not only reduce your symptoms, but also assist you to find ways of caring for your baby that will not exacerbate your pain in the future.

Cervical Spine Pain (neck pain often leading to headache)

Some women suffer from neck pain and/or headaches throughout their pregnancy, which can severely impact on their ability to concentrate and function.  This pain is often caused by a combination of:

  • Increased fatigue and stress related to the increased demands placed on the body as it supports the growing baby;
  • Adjustments in positioning and development of poor postures relating to the pregnant belly (especially during sleep and work);
  • Increased concentration of circulating hormones;
  • Alterations in fluid intake requirements leading to dehydration.

Are there treatments available?

For several decades, research has shown that physiotherapy is effective in reducing muscle related neck pain, assisting in the management of ongoing headache, and managing future exacerbations.  Many women find advice regarding posture and positioning also helpful throughout the postnatal period.

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