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Integrated Physical Medicine

Why didn’t my doctor recommend physical therapy for my back pain after pregnancy?

Why didn’t my doctor recommend physical therapy for my back pain after pregnancy?

Are you among the millions of new mothers each year that experience chronic back or pelvic pain for months or years following pregnancy?  You may be one of a growing number of people that have asked yourself or your doctor this very question at some point.  I can tell you from experience that most of the time the excuses given for not making this recommendation are pretty lame.  From what my patients have relayed to me, their physician will shrug their shoulders, or worse, will advise them to “wait it out” or direct them towards an over-the-counter pain medication. 

I can speak from 15 years of experience having treated all manner of musculoskeletal pain conditions that the incidence of chronic back or pelvic pain following childbirth is high.  Don’t take my word for it, a study done in 1994 found that almost half (45%) of the 1,042 women that participated in the study had continued low back pain at 1-2 month following giving birth (1).

I have helped many new moms through this very difficult situation.  Honestly, just having a new baby in the house is tough enough, now add back or pelvic pain and you have the makings of a nightmare!   I have three small children myself, so I truly understand the need to be able to pick up your child when the situation calls for that.    


What causes the pain?

It doesn’t take a medical degree to understand that a woman’s body undergoes a big change during pregnancy.   From the moment a woman’s egg is fertilized the body releases a series of hormones that are going to begin to prepare her body to be able to successfully carry and deliver a baby.  The most well-known hormones that are at work during pregnancy are relaxin, estrogen and prolactin (2).  Some but not all of the actions of these hormones are well known.  One quick example, it is widely believed that relaxin is responsible for relaxing ligaments and joints in and around the pelvis to allow more freedom of movement during pregnancy. “Its main mechanism of action appears to be the facilitation of remodeling of connective tissue in target tissues to allow the necessary changes in organ structure during pregnancy and parturition.” (8) Many believe that this alone causes pretty drastic changes in pelvic girdle biomechanics and in some, increased pain. 

In my opinion, the weight gain and structural changes associated with the increased size of the uterus, baby and amniotic fluid is the most significant driver of back and pelvic pain in these women.  On average, a woman will gain approximately 11 kg during pregnancy (3).  A woman’s center of gravity moves forward, this greatly increases the stress on the low back and abdominal muscles (4).   A majority of pregnant women experience “Diastasis Recti”, which is a separation of the abdominal muscles due to the stress on the abdominal muscles.   This condition must be addressed if a woman’s core is going to be strong and stable moving forward.

Look at it this way, any non-pregnant patient that walked into a doctor’s office complaining of new or worsening low back or pelvis pain, following a drastic weight gain, would immediately be instructed to lose the weight and report to therapy.  I argue that the same approach should be recommended to new moms as soon as it is safe to do so.


BEFORE- Be prepared!  Unless you are a physical healthcare professional, the first thing you probably want to do is find one that you know and trust to help you customize a routine that best addresses your individual needs.  This is a proactive way to prepare your body for the rigors of pregnancy.           

I get it, the thought of preparing one’s body for pregnancy is not the first thing on most young woman’s minds.   I will always take the time to educate a patient who is actively trying to get pregnant to make sure they keep themselves strong, stable and balanced in the pelvis, core and low back.  Studies have shown that a history of low back pain, low back pain during a previous pregnancy, obesity and pre-existing conditions increase the likelihood of low back pain during and after pregnancy (1).

DURING- Many pregnant women will be able to do gentle exercise throughout their pregnancy under physician supervision.   Exercises programs should primarily focus on posture correction, abdominal and lumbar spinal muscle strengthening, pelvic tilt, and proper rest (6,7).  Chiropractic joint manipulative therapy can be a valuable tool for pain reduction in many cases as well.

Some women also benefit from pelvic bracing.  This is not my favorite practice as it can lead to increased reliance on external support.   Usage of any external support should always be monitored by a physician.

AFTER- Congratulations!! Now the real work begins!  It can be very easy to completely neglect yourself because all eyes are on the beautiful new baby.  Please DO NOT do that to yourself.   The longer you wait to piece yourself back together the harder it gets to dig yourself out of that hole!  In my opinion, most if not ALL females need some amount of rehabilitation following a pregnancy. 

Common deficits that need to be addressed following a pregnancy include; core instability, gluteal muscle inactivation, pelvic floor instability, increased lumbar lordosis (low back curvature), facet irritation, diastasis recti and hyperactive mid and low back paraspinal musculature. 

Once again, the process of getting your body back to what it was nine months ago should be supervised by your physician and therapist.  Click HERE if you want to send a question directly to Dr. Polcyn.

Many couples plan to have multiple children that are close in age.   Obviously, there is nothing wrong with this practice from a practicality perspective.   However, from my experience, the fallout on a woman’s body from multiple pregnancies in a short amount of time with no attempt at repairing the body is devastating.   It’s these women in particular that tend to have chronic pain that can prove to be very difficult to reduce and subsequently keep under control. 

I believe, and so do all of the healthcare professionals at Integrated Physical Medicine that women should take a more active role in preparing for pregnancy, managing their body during pregnancy and restoring the body following pregnancy.   DO NOT be afraid to inquire about and, if deemed safe by the physician, insisting upon a referral for physical therapy.   Your body will thank you down the road! 


About the Author

Dr. Polcyn is a board-certified chiropractor with a bachelor’s of science in human biology.   He is the co-owner of four physical therapy and chiropractic clinics in northern Illinois that specialize in treating musculoskeletal issues that plague young, active and otherwise healthy people.  Marathon runners, high school/college athletes, CrossFit athletes, cyclists, migraine sufferers, physical laborers and postpartum women make up the majority of his patient base. 


Citations:

(1) Breen TW, Ransil BJ, Groves PA, Oriol NE. Factors associated with back pain after childbirth. Anesthesiology. 1994 Jul;81(1):29-34. doi: 10.1097/00000542-199407000-00006. PMID: 8042807.

(2) Ireland, Mary Lloyd, MD; Ott, Susan M., DO The Effects of Pregnancy on the Musculoskeletal System, Clinical Orthopaedics and Related Research®: March 2000 - Volume 372 - Issue - p 169-179

(3) 15. Cunningham FG, MacDonald PC, Levano KJ, Gant NF, Gilstrap LC: Maternal Adaptations to Pregnancy. In Cunningham FG, MacDonald PC, Levano KJ, Gant NF, Gilstrap LC (eds). William's Obstetrics. Ed 19. Norwalk, CT, Appleton & Lange 209-246, 1993.

(4) Yamaga A, Taga M, Minaguchi H, Sato K. Changes in bone mass as determined by ultrasound and biochemical markers of bone turnover during pregnancy and puerperium: a longitudinal

(6) 33. Heckman JD, Sassard R: Musculoskeletal considerations in pregnancy. J Bone Joint Surg 76A:1720-1730, 1994.

(7) Ostgaard HC, Zetherstrom G, Roos-Hansson E, Svanberg B: Reduction of back and posterior pelvic pain in pregnancy. Spine 19:894-900, 1994.

(8) MacLennan AH. The role of relaxin in human reproduction. Clin Reprod Fertil. 1983 Jun;2(2):77-95. PMID: 6322955.