Pain in Pregnancy

Most women experience some degree of pain during pregnancy leading up to the delivery itself. For most, this is manageable and entirely normal, but some women can experience significant pain in their pelvis, lower back and stomach muscles as their baby grows. The causes can vary but in many cases these conditions are treatable and a physiotherapist can help to manage the pain.


Pelvic Pain

Approximately 3% of women develop pelvic joint pain (symphysis pubis dysfunction or ‘SPD’) during pregnancy. This is caused by the hormone relaxin, which is released by the body to soften the joints in preparation for childbirth. Unfortunately in some cases, the hormone goes into overdrive and causes the ligaments to soften and stretch too much, which can result in pain and discomfort. This normally occurs from the second trimester onwards, but it can happen at any stage or even after childbirth.

SPD can produce the following symptoms:-
• pain in your pubic area and groin;
• pain in the inside of your thighs;
• lower back and hip pain;
• pain when you walk, move or go up stairs;
• a clicking sound that you can hear;
• a feeling that your bones are grinding together;
• difficulty and pain when you try and open your legs.
If you are experiencing any of these, then it’s worth contacting a physiotherapist for an assessment.

Lower Back Pain

It is estimated that over half of all women experience some degree of lower back pain during pregnancy, usually towards the latter stages, but as early as 3 months in some cases. Pregnancy results in weight gain of up to 25% of normal bodyweight, putting significant stresses on the body’s internal structures (spine, joints, ligaments and muscles). The change in your body’s centre of gravity as the baby grows causes certain muscle groups to work harder, leading to muscle imbalance and muscle fatigue. Once normal activities, such as rolling in bed, prolonged sitting, bending, twisting, lifting and navigating stairs can exacerbate lumbar pain, particularly if you are already predisposed to lumbar problems.

Treatment commonly involves exercise therapy to strengthen weak muscles and the use of proper body mechanics i.e. ensuring that you maintain correct posture and move appropriately for day to day tasks, such as lifting, sitting up/down etc. This may be accompanied by ‘gentle’ soft tissue work or mobilisations, along with stabilisation exercises. Gentle massage therapy may also be appropriate.

Diastasis Recti

Diastasis Recti is a naturally occurring condition in pregnant women and refers to the separation of the abdominal muscles. Your abdominal muscles are normally joined together down the middle of your abdomen by a fibrous strip. During pregnancy, hormones cause this fibrous strip to soften, and as the growing baby creates a strain on the join, the muscles may separate. This is usually quite painless and is simply nature’s way of ‘making room’ for your baby. In some cases, the muscles may separate during labour, whilst others do not experience any separation.

For those who have experienced a separation of the abdominal muscles, the gap between these muscles will close to some extent naturally over time (usually by about 6 months post partum). However, whilst this is happening, the muscles can be weak and vulnerable. Abdominal muscles play a major role in posture and support for the back and any weakness can contribute to back or pelvic pain. Patients with diastasis recti should take extra care with certain activities:-

• When getting in and out of bed, roll onto your side. Do not try to sit forwards.
• Try to avoid carrying your baby in a car seat. Where possible, lift the baby out of the seat to carry them.
• Take care lifting baby baths filled with water – ask someone else to do this if possible.
• Where possible, avoid heavy housework e.g. vacuuming, heavy baskets of wet washing.
• Try to carry everything close to your front, in the midline of your body, not to one side.
• Avoid lifting anything heavy.

A physiotherapist will be able to assess the severity of the muscle separation and offer advice on how to manage the condition, along with safe exercises to help strengthen the abdominal muscles without risk of making the condition worse. They may also be able to offer advice on supports to help safeguard the abdominal muscles during exercise or daily activities.