Hoag Orthopedic Institute’s Dr. Michael Gordon gives an inside look into why lower back pain is so prevalent among women who are pregnant.
Back pain during pregnancy is an extremely common complaint. More than 80% of women complain of some degree of back pain, usually at the end of the second trimester and into the third. It is thought to be related to the loosening of the pelvic ligaments that occur with the elevation in estrogen and progesterone towards the end-of-term of pregnancy. Other times, it can be due to the positioning of a growing fetus on the muscles, ligaments and nerves of the pelvic floor. This contributes to complaints of axial lower back pain with standing and walking, and in addition, radiating pain to the anterior thigh. This can be mistaken for the sciatica of lumbar disc herniation. Approximately 20% of women will have disabling lower back pain during a portion of their pregnancy that results in bed-rest for two weeks.
Occasionally, women can suffer true lumbar disc herniations that usually occur as a coincidence to their pregnancy, not as a result of it. These are often treated as any other disk herniation – with epidural Cortisone injections that have been shown to be safe to the fetus. Non-operative treatment is the rule during pregnancy and sometimes, within two or three weeks of delivery, the definitive operation will be performed.
Most lower back pain due to pregnancy is self-limiting and resolves after pregnancy spontaneously. I do have a small number of patients whose symptoms persisted after pregnancy and an even smaller number who have required surgery.
As a rule, diagnostic imaging is avoided during pregnancy, except in the case of emergencies, and I can remember one or two cases where an MRI scan of the lumbar spine has been performed and emergency surgery has been done safely in the end of the second trimester. Such a scenario is extremely rare and involves major life-threatening problems, such as paralysis.
Any surgery or other intervention requires careful consultation with anesthesiologists and obstetrics to avoid any precipitation of early labor and is never undertaken without very careful consideration of all of the risks and benefits.
Aside from the surgical management or extreme management paths of this common problem, as a routine, it is recommended that pregnant women stay within their ideal body weight. We recommend regular, gentle stretching and gentle aerobic programs. Modalities such as heat and ice are well tolerated. We do not recommend the use of a hot tub, particularly in the second trimester and third trimester, as core body temperatures can become too high.
Oral agents such as anti-inflammatories and narcotics are to be avoided. Topical agents may help, but be sure to have it cleared with your obstetrician. Physical therapy and acupuncture are also well tolerated.
During pregnancy, it is not recommended for patients to receive any electromagnetic radiation sources such as H-wave or ultrasound. These modalities are frequently administered by physical therapists in only non-pregnant patients. Electrical stimulation is also not recommended during pregnancy.
Much like everyday lower back pain in the non-pregnant population, this is generally a benign and self-limited type of complaint. Occasionally a patient can be pretty miserable but the best news is that soon it will be over.
In closing, the best treatment is prevention. Stay healthy, follow the advice of your obstetrician and good luck.
Dr. Michael L. Gordon
Dr. Michael Gordon trained at Johns Hopkins University and USC Spinal Cord Injury Center, and has been at the leading edge in spinal surgical technology since he began practice in Newport Beach in 1987. He specializes in a range of spinal surgeries from minimally invasive to complex deformities of the cervical and lumbar spine.
Having performed more than 8000 spinal surgeries, Dr. Gordon has extensive experience in complex reconstructive spinal instrumentation surgery of the cervical and lumbar spine, disk replacement, adult deformity and degenerative scoliosis.