CAUSES

Hormone Changes
During pregnancy, significant shifts in hormone levels occur which are necessary for the growth and development of the baby (and its support system). Relaxin is a hormone which has the effect of the “relaxing” joints and ligaments to accommodate the fetus within the womb and eventually to allow for its passage down the birth canal at delivery. Unfortunately, increase joint mobility can allow for abnormal motion and function in joints, especially the sacroiliac, or “SI” joints (at the base of the spine, just above the buttocks).

Physical Changes
As a result of hormone changes which promote the baby’s growth and maturity, there are noticeable physical changes associated with pregnancy, including abdominal expansion and enlargement of the breasts, both of which may lead to undesirable postural changes. With abdominal expansion, there occurs stretching of the abdominal musculature and an increased tendency toward an exaggerated lumbar lordosis, or “sway back”. Muscles and joints of the low back may become cramped and compressed, while the abdominal muscles become stretched out and inefficient, and thus less capable of supporting the back. Enlargement of the breasts may result in rounding of the shoulders and an increased kyphotic curve or outward “hunching” of the upper back. Here again, there is imbalance: the front of the chest (i.e. pectoral muscles), may become tight when the muscles of the upper back are over stretched and weakened.

Late Pregnancy
As pregnancy progress, the increased girth of the abdomen often has the effect of throwing a woman off balance. Seemingly simple tasks such as getting in/out of bed, walking upstairs, picking up objects from the floor, carrying groceries, et. Become a challenge, and a woman is more vulnerable to strain her back in normal activities of daily living.

WHAT CAN BE DONE?
A physiatrist can help rule out serious causes of pain and establish the structural basis for the symptoms. A physical therapist can aid in establishing a safe and effective program for postural correction. He/she can further address specific problems associated with back pain due to joint laxity and dysfunction by utilizing specific muscle energy techniques to gently encourage realignment; soft tissue mobilization and/or a corset as needed.

Following are aspects of particular emphasis and helpful ideas:

Posture and Body Awareness
Because joints are more mobile during pregnancy and because of the new stresses placed on the body due to altered weight distribution, it becomes important that the body be maintained in good alignment during activities of daily living (ADLs), and while resting.

It is important to stand with weight evenly distributed to both feet to avoid overloading either side of the pelvis. In regard to ADLs, it is essential to maintain good posture and body mechanics with whatever task you may be involved. A “neutral spine” position refers to that position of the low back where the spine is neither fully extended (backward bent) or flexed (flattened), but in a position where muscles can optimally support the spine. Abdominal and gluteal muscles work as a “force couple” to unload the low back.

Neutral Spine
Specific exercises for abdominal and gluteal muscles are outlined more completely in the sections to follow, but here is a simple exercise for achieving a neutral spine.

• Stand with feet at shoulders' with apart.
• Roll from heel to toe and then center weight midfoot.
• “Unlock” knees (so that if you needed to move quickly, you could).
• Tighten belly (think of hugging baby toward spine while slightly squeezing buttocks together).
• The result is a “lengthened” spine.