VOLUME 28 - 8 Low Back Pain in Pregnancy

New Doctor on Staff
Dr. Robert E. Morrow, one on the area's leading orthopedic surgeons has joined the staff of The Personal Injury Clinic. He is avilable for orthopedic consultations as well as many other procedures regarding cardiovascular and orthopedic health. Click on his name to review his credentials. Call the office if you would like to meet him.

Health Tips

Chiropractic Advice for Moms-to-Be

As many new mothers can attest, the muscle strains of pregnancy are very real and can be more than just a nuisance. The average weight gain of 25 to 35 pounds, combined with the increased stress placed on the body by the baby, may result in severe discomfort. Studies have found that about half of all expectant mothers will develop low-back pain at some point during their pregnancies.1-3 This is especially true during late pregnancy, when the baby's head presses down on a woman's back, legs, and buttocks, irritating her sciatic nerve. And for those who already suffer from low-back pain, the problem can become even worse.

During pregnancy, a woman's center of gravity almost immediately begins to shift forward to the front of her pelvis. Although a woman's sacrum-or posterior section of the pelvis-has enough depth to enable her to carry a baby, the displaced weight still increases the stress on her joints. As the baby grows in size, the woman's weight is projected even farther forward, and the curvature of her lower back is increased, placing extra stress on the spinal disks. In compensation, the normal curvature of the upper spine increases, as well.

While these changes sound dramatic, pregnancy hormones help loosen the ligaments attached to the pelvic bones. But even these natural changes designed to accommodate the growing baby can result in postural imbalances, making pregnant women prone to having awkward trips and falls.

What Can You Do?

We recommend the following tips for pregnant women:

Exercise

• Safe exercise during pregnancy can help strengthen your muscles and prevent discomfort. Try exercising at least three times a week, gently stretching before and after exercise. If you weren't active before your pregnancy, check with your doctor before starting or continuing any exercise.
• Walking, swimming, and stationary cycling are relatively safe cardiovascular exercises for pregnant women because they do not require jerking or bouncing movements.
• Jogging can be safe for women who were avid runners before becoming pregnant-if done carefully and under a doctor's supervision.
• Be sure to exercise in an area with secure footing to minimize the likelihood of falls. Your heart rate should not exceed 140 beats per minute during exercise. Strenuous activity should last no more than 15 minutes at a time.
• Stop your exercise routine immediately if you notice any unusual symptoms, such as vaginal bleeding, dizziness, nausea, weakness, blurred vision, increased swelling, or heart palpitations.

Health and Safety

• Wear flat, sensible shoes. High or chunky heels can exacerbate postural imbalances and make you less steady on your feet, especially as your pregnancy progresses.
• When picking up children, bend from the knees, not the waist. And never turn your head when you lift. Avoid picking up heavy objects, if possible.
• Get plenty of rest. Pamper yourself and ask for help if you need it. Take a nap if you're tired, or lie down and elevate your feet for a few moments when you need a break.

Pregnancy Ergonomics: Your Bed and Desk

• Sleep on your side with a pillow between your knees to take pressure off your lower back. Full-length "body pillows" or "pregnancy wedges" may be helpful. Lying on your left side allows unobstructed blood flow and helps your kidneys flush waste from your body.
• If you have to sit at a computer for long hours, make your workstation ergonomically correct. Position the computer monitor so the top of the screen is at or below your eye level, and place your feet on a small footrest to take pressure off your legs and feet. Take periodic breaks every 30 minutes with a quick walk around the office.

Nutrition

• Eat small meals or snacks every four to five hours-rather than the usual three large meals-to help keep nausea or extreme hunger at bay. Snack on crackers or yogurt-bland foods high in carbohydrates and protein. Keep saltines in your desk drawer or purse to help stave off waves of "morning sickness."
• Supplementing with at least 400 micrograms of folic acid a day before and during pregnancy has been shown to decrease the risk of neural tube birth defects, such as spina bifida. Check with your doctor before taking any vitamin or herbal supplement to make sure it's safety for you and the baby.

How Can Your Doctor of Chiropractic Help?

• Before you become pregnant, your doctor of chiropractic can detect any imbalances in the pelvis or elsewhere in your body that could contribute to pregnancy discomfort or possible neuromusculoskeletal problems after childbirth.
• Many pregnant women have found that chiropractic adjustments provide relief from the increased low-back pain brought on by pregnancy.
• Chiropractic manipulation is safe for the pregnant woman and her baby and can be especially attractive to those who are trying to avoid medications in treating their back pain.
• Doctors of chiropractic can also offer nutrition, ergonomic, and exercise advice to help a woman enjoy a healthy pregnancy. Chiropractic care can also help after childbirth. In the eight weeks following labor and delivery, the ligaments that loosened during pregnancy begin to tighten up again.
• Ideally, joint problems brought on during pregnancy from improper lifting or reaching should be treated before the ligaments return to their pre-pregnancy state-to prevent muscle tension, headaches, rib discomfort, and shoulder problems.

Chiropractic Care Can Help... Talk to your doctor of chiropractic about ways to improve the health of your bones. Doctors of chiropractic are licensed and trained to treat patients of all ages and can help people suffering from osteoporosis lead healthier lives.

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Related Research

Patient-oriented assessment of back pain in pregnancy
Eur Spine J 2002 Jun;11(3):272-5 Padua L; Padua R;
Bondi R; Ceccarelli E; Caliandro P; D'Amico P; Mazza O; Tonali P Institute of Neurology, Catholic University, Rome, Italy

Abstract

Aim: Back pain is a common symptom in women during the last trimester of pregnancy. Only a few studies using validated patient-oriented tools have been undertaken on this topic. The authors report on a multicenter study on back pain in women during this last period of pregnancy, which involved seven Italian institutions.

Methodology:

Seventy-six women in their 8th and 9th months were studied using the Italian validated version of the Roland Questionnaire. Sixty-two percent of the women had gone through at least one previous pregnancy, and clinical data concerning both the period before all pregnancies and the period before the current pregnancy were acquired.

Results:

The study found that 31% of the women had no back pain symptoms (Roland score 0); 40% scored from 1to 4; 21% scored from 5 to 10; and 8% scored more than 10. With regard to the predictive factor, history of back pain and sciatica before the pregnancy were found to be associated with occurrence of back pain symptoms during pregnancy. However, back pain was not associated with having gone through previous pregnancies, nor was the Roland score related to the weight before pregnancy or to increment of weight during pregnancy.

Unexpectedly, the authors results showed that male sex of the fetus seems to be related to occurrence of back pain during the last trimester of pregnancy.

Conclusions:

Evaluation of the patient's perspective made it possible to identify predictive factors for occurrence of back pain.

Commentary

There are two generally accepted questionnaires which relate to activities of daily living (ADL) and low back pain (LBP). These are the the Roland-Morris Low Back Pain and Disability Questionnaire and the Oswestry Low Back Pain Questionnaire. The Roland-Morris form is considered a more sensitive reporting mechanism in acute and subacute patients, whereas the Oswestry Low Back Pain Questionnaire is felt to be more sensitive for identifying activity intolerances in chronic patients.

There have been copious research articles written over the past few years whose point was to provide predictive values for low back pain. Every article I have reviewed has always had one overall finding - prior history of back pain and sciatic neuritis was the single strongest predictive indicator for future episodes of LBP. Even though this Italian study was oriented to females in their last trimester of pregnancy, the discoveries were essentially the same as with all other predictive research trials. Prior incidence of low back pain was the greatest single predictive factor despite being currently pregnant or multi-parous, and weight gain was not considered etiological in any fashion. The surprising finding in this European article was that LBP was statistically significantly higher when the fetus was a male. Do you feel like being an uncannily accurate crystal ball in predicting your pregnant patient's baby's sex if she has not had an ultrasound providing this information? If she has had no history of any low back pain prior to pregnancy, but the patient is experiencing significant enough LBP to bring her into your office, then there is a good chance she is going to have a boy.

In The News

Eat This and You'll Never Get Arthritis?

A diet rich in vitamin C when you're young could protect you from the ravages of arthritis when you're old. Foods that are high in vitamin C appear to protect people against inflammatory polyarthritis, a form of rheumatoid arthritis that involves two or more joints, Reuters reports of new research from the University of Manchester in the United Kingdom. The opposite also holds true. Those whose diets have the least amount of vitamin C are three times more likely to develop the condition than their peers who consumed the highest amounts.

The study: More than 20,000 participants, all of whom were free from arthritis when the study began, kept detailed diaries of the foods and drinks they consumed. The analysis focused on 73 subjects who developed inflammatory polyarthritis during the follow-up period between 1993 and 2001, as well as 146 similar subjects who remained arthritis-free, reports Reuters.

The results: People who had a low intake of fruits, vegetables, and vitamin C also had a higher risk of inflammatory polyarthritis, specifically three times the risk compared with those who consumed the highest amounts of foods with vitamin C, reports lead study author Dr. Dorothy J. Pattison. Low intake of vitamin E and beta-carotene were only weakly linked with an increased risk of inflammatory polyarthritis, notes Reuters.

The contradiction: Previous studies have shown that high doses of vitamin C worsens osteoarthritis in guinea pigs who already have the disease. Osteoarthritis, which is more common than rheumatoid arthritis, is seen more frequently in older people. Pattison explained the seeming contradiction by noting that the two types of arthritis are caused by different physiologic problems. Rheumatoid arthritis is an autoimmune disease in which the body attacks itself, while osteoarthritis is a degenerative process that worsens over time.

The top 10 foods richest in vitamin C are: Papaya, Broccoli, Orange juice from frozen concentrate, Strawberries, Oranges, Kiwi, Cantaloupe, Grapefruit juice, Raw mango, Raw peppers

The study findings were reported in the Annals of the Rheumatic Diseases.

The Rear End Collision

These are becoming more frequent now and you need to know what to do if you are hit from behind or slip into someonw else. Follow these simple rules if you are involved in a car accident and are not hospitalized:

• Stay calm and reduce movements of the spine
• Ice packs on the spine and neck for 5 minutes per hour will help for the first few days
• See your chiropractic physiciain right away - He is the only provider trained to evlauate spinal subluxations

For more information, click here!

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