“Just because it’s common to have pain in pregnancy, doesn’t mean it’s normal!”
This is often first thing I always say to women when they come to me pregnant and in pain. It is very common to welcome a very pregnant women into my clinic for the first time, limping due to the shooting pain into her right buttock. She will often concede that she has suffered with it progressively since 20 weeks of pregnancy but has just been dealing with it thinking it would go away eventually or because “low back pain is normal in pregnancy, isn’t it?”
Should we expect pain in pregnancy?
Well technically yes, we have come to expect pain during pregnancy because we hear it so often. Some “discomfort” CAN be normal. Your muscles are adapting to a greater load and can get tired towards the end of the day. Certain ligaments can pull or twinge with sudden movements as they too are adapting to your changing body. And blood vessels and other organs are under a lot more pressure toward the end of pregnancy.
BUT “pain” that is sharp, referring down your leg, asymmetrical (one sided), progressively getting worse, made worse with movement like walking or standing on one leg or rolling over in bed is NOT normal and can often be helped!
Pain is a WARNING SIGN!
There is a good reason for these types of pains. They are warning sings; your body telling you something isn’t quite right. Even the shooting ligament pain you have at the front when you stand up too quickly or stops you in your tracks while you’re walking. This is a stretch of the ligament that attaches your uterus to your pelvis – it has to stretch to accommodate the growing baby. Yes, that is a “normal” pain of pregnancy but not if it’s consistently only occurring on one side. That can be your body sending you a warning signal that perhaps your uterus isn’t sitting centrally within your pelvis and if you read my “Pelvic alignment” blog, you’ll find out just how imperative this is.
** if you experience pain with abnormal bleeding/spotting, abdominal pain or cramping, unusual headaches which are severe in nature, sudden swelling of your hands/face/legs, a fever or a decrease in your baby’s movements – you should call your midwife, doctor or OB immediately. 
Should I expect low back pain in pregnancy?
Pregnancy is a time of softening. This is essential for the widening and moulding that occurs to accommodate your growing baby and in the preparation to release him/her. This is thanks to the hormone “relaxin” that is produced and released during pregnancy AND breastfeeding. If you have suffered low back pain in the past, pregnancy and it’s relaxin hormone will only make it worse or help it to rear its ugly head once more. That’s why I always recommend being checked by a Chiropractor or physical therapist who specialises in women’s health before falling pregnant. This will help to ensure you’re in balance before the softening of pregnancy begins.
A little bit of a low back ache at the end of the day can be quite normal. Especially if you’ve been on your feet all day or equally, sitting at your desk all day. (Thank goodness for those frequent toilet breaks!) There are muscles on either side of your spine that help to keep you upright and are under particular load when you have a heavy belly pulling you forward and can no longer rely on the help of the ligaments which once helped keep everything taught and stabilised.
If your pelvis is pulling too far forward, or you have a weakness in some of the other muscles that are designed to assist in stabilising your pelvis, those back muscles can quickly become overloaded and lead general low back pain that becomes more and more consistent.
The GOOD NEWS for Low Back Pain!
This is easy to fix, through gentle muscle release and stretch. But the “fix” won’t last long unless you correct all the other things going on that caused the issue the first place. Things like:
Muscle imbalance and weakness;
Poor pelvic alignment;
Poor posture;
Core and pelvic floor weakness; and
Previous injuries.
How to manage SIJ pain.
Another cause of low back pain in pregnancy is called Sacroiliac joint (SIJ) sprain/strain. The SIJ are the large joints on either side of the back of your pelvis.
Symptoms may include:
Deep pain in the back of the pelvis. This can be in both sides or predominately one side;
Pain that radiates from the back to the front of your pelvis; and
Pain exacerbated by standing from sitting, standing for long periods, standing leaning to one side, walking up stairs and rolling over in bed.
Thanks to that relaxin hormone, the ligaments of your pelvis are softened to allow for expansion and greater movements of these joints. If the muscles overlying your SIJ are weak also, this can lead to excessive movement in one or both of these joints which can cause hypermobility > strain > debilitating pain.
It is so important that you have good tone in these muscles before and throughout your pregnancy to prevent this type of common injury...
IT’S NEVER TOO LATE TO START STRENGTHENING THE WEAK MUSCLES THAT ARE CONTRIBUTING TO YOUR PAIN.
...But if you don’t, that’s ok too because it’s never too late to start and your situation can improve dramatically, very quickly. This can be achieved through simple muscle and ligament releases. Combine treatment with easy rehabilitation exercises at home and avoiding habits that exacerbate it, you can be pain free.
Things to avoid:
Standing with one hip cocked – especially if there is a small child sitting on that hip!
Sitting for long periods - especially with one leg crossed over the other;
Standing with your knees locked back and your hands resting on the back of your hips;
Lifting something heavy without bracing your core first, especially if that heavy thing is a child going into their cot! and
Doing exercises that involve one leg standing or incorrect squats that use the front of your legs excessively.
Sciatica & Sciatica Pain
This is another very annoying pain that is common in pregnancy and largely avoidable. I call it “annoying” because it is a nerve type pain that can be constant and persistent even at rest!
Sciatica is pain that radiates into your buttocks predominately on one side and sometimes into the back of the upper thigh. If it is serious enough, it can go all the way down your calf and into your foot and can be associated with numbness or pins and needles and in worse cases – weakness.
True sciatica means there is pressure on the nerve root where it exits the spine. This alludes to spinal pathology like arthritis, inflammation of the spinal joints or disc pathology. Luckily, the majority of sciatica in pregnancy isn’t sciatica at all. It feels the same because there is pressure on that nerve but the pressure is due to something much less sinister.
As I mentioned above, the relaxin hormone released in pregnancy designed to make your pelvis more malleable for expansion means that there is more movement within the joints. And if the muscles that surround your pelvis are weak too due to lack of conditioning, there becomes excessive movement. Now your body is clever, it knows that excessive movement at these joints can lead to injury and chronic inflammation – look up Osteitis condensans ilii.
To reduce that risk of injury, your body will recruit a different muscle called the Pirifomris to lock down that joint. Unfortunately, this muscle sits right on top of your sciatic nerve (and for some people, the nerve runs THROUGH this muscle) and when it is overactive, will squash that nerve and give you, it’s owner sciatica pain.
The good news is, this is also really easy to fix. We release that muscle, mobilise the pelvis and surrounding joints while strengthening the appropriate muscles and the pain goes away!
See my blog on Symphysis pubis dysfunction for details on another common and potentially debilitating pain in pregnancy. (Blog coming soon.)Your Core.
Just because you’re pregnant doesn’t mean you can forget about your core, some of which directly impact your pelvic floor. Doing the appropriate core exercises during pregnancy can help to minimise a myriad of issues that crop up in pregnancy and postpartum. They’re important for:
Protecting your spine as the pressure of the belly grows;
Reduces the risk of abdominal separation;
Secures your SIJ’s to avoid excess movement and pain;
Create a strong foundation of muscle for the uterus to work with in birth; and
Aid in a speedy postpartum recovery.
However, this does not automatically apply to everyone. Some women have issues with overactive pelvic floor and core muscles which can be just as problematic and require the opposite type of treatment and care. So it is imperative to seek professional guidance before undergoing any new exercise regime!
Thanks to @duvet_days for image two and four, @eugeniedbart for image five and @tinamariaelena for image six.