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Lower back pain during pregnancy: Advice and exercises for women
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L
to facilitate delivery of the fetus. The average
ower back pain during pregnancy is widely symphysis pubis gap during the last 2 months of
accepted as a consequence of pregnancy, by pregnancy is 7.7 mm with a range of 3–20 mm
women, midwives and doctors. By under- (Philipp and Setchell, 1991).
standing the main reasons why back pain occurs It is therefore important that midwives are
during pregnancy, women can usually be reas- aware of the possible causes of back pain so that
sured and are able to help themselves. It is also they are able to advise women appropriately and
important that back pain during pregnancy is not refer those women who require further treatment
wrongly diagnosed and/or confused with pelvic to the correct health professional. This article
girdle pain (PGP), a term which includes symphisis focuses on lower back pain during pregnancy
pubis dysfunction (SPD) and diastasis symph- and not PGP. If a midwife suspects that a woman
ysis pubis (DSP), a condition which can only be has PGP, the woman should be referred to an
confirmed by diagnostic imaging. obstetric physiotherapist for diagnosis and appro-
This may cause confusion for midwives as priate treatment. The European guidelines for the
European back care guidelines (Vleeming et al, management and treatment of PGP have made
2007: 20) define PGP thus: a list of recommendations for the diagnosis and
imaging of PGP (Box 1).
‘Pelvic girdle pain (PGP) is a specific The guideline highlights that the risk factors for
Yana Richens, form of low back pain (LBP), that can developing PGP during pregnancy are most prob-
Consultant Midwife, occur separately or in conjunction ably: a history of previous LBP, and/or previous
University College with LBP.’ trauma to the pelvis. There is slight conflicting
London Hospitals NHS evidence (one study) against the following risk
Foundation Trust Pelvic girdle pain factors; pluripara and high work load. There is
Pain at the back of the pelvis is known as pelvic agreement that non risk factors are: contraceptive
Karen Smith, Sports girdle pain. It is sometimes also called sacro-iliac pills, time interval since last pregnancy, height,
Lecturer, Warwickshire joint (SIJ) pain, because that is the name of the weight, smoking and age (one study reports that
College, Pre/Postnatal joint where problems arise. PGP is often misdiag- young age is a risk factor).
personal trainer nosed as sciatica but only a few women, just 1%,
have sciatica during pregnancy. The prevalence of Low back pain during pregnancy
Shelia Leddington back pain was studied in 855 pregnant women who As highlighted in the antenatal care guide-
Wright, Senior Lecturer were followed from the 12th week of pregnancy, line (National Institute for Health and Clinical
Sports Therapy, every 2nd week, until childbirth. True sciatica Excellence (NICE), 2008), obtaining a clear picture
Coventry University, with a dermatomal distribution occurred in only of low back pain in pregnancy is difficult. This
Physiotherapist 10 women (1%). Back problems before pregnancy is mainly a result of the wide variations of low
and member of increased the risk of back pain, as did young age, back pain reported in the literature and low
the Association multiparity, and several physical and psychological back pain and pelvic pain are often reported
for Chartered work factors (Ostgaard et al, 1991). together. Furthermore, back pain or back discom-
Physiotherapists in Symphysis pubis dysfunction occurs where the fort during pregnancy is very subjective. The
Women’s Health joint becomes sufficiently relaxed to allow insta- estimated prevalence of backache during preg-
www.acpwh.org.uk bility in the pelvic girdle. In severe cases of SPD, nancy ranges between 35% and 61%. Among these
the symphysis pubis may partially or completely women, 47–60% reported backache first devel-
British Journal of Midwifery. Downloaded from magonlinelibrary.com by Yana Richens on October 20, 2015. For personal use only. No other uses without permission. . All rights reserved.
Clinical practice
Figure 1. Pregnancy can put a strain on the abdominal muscles as well as the lower back
British Journal of Midwifery. Downloaded from magonlinelibrary.com by Yana Richens on October 20, 2015. For personal use only. No other uses without permission. . All rights reserved.
Clinical practice
British Journal of Midwifery. Downloaded from magonlinelibrary.com by Yana Richens on October 20, 2015. For personal use only. No other uses without permission. . All rights reserved.
Clinical practice
British Journal of Midwifery. Downloaded from magonlinelibrary.com by Yana Richens on October 20, 2015. For personal use only. No other uses without permission. . All rights reserved.
Clinical practice
Antenatal pilates and yoga are both good forms Ansari NN, Hasson S, Naghdi S, Keyhani S, Jalaie S (2010)
of exercise during pregnancy. Women should be Low back pain during pregnancy in Iranian women:
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Women must be informed that if they have ment of pelvic girdle pain. www.backpaineurope.org/
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they should speak to their midwife or GP, as August 2010)