Management of Pregnancy Related Back Pain
By Rod Lefler, DC, CSCS
Neuroscience Group Physical Medicine & Pain Management Division
      Low back pain (LBP) is a leading cause for all physician visits in the United States, and is a common complaint during pregnancy.  68.6% of pregnant patients experience LBP and 41.4% report this as their first episode.  The negative impact of pregnancy related LBP extends across many areas of women’s daily lives, work, household, leisure activities, and sleep.  Traditional medical management of this patient population is limited and in fact only 32% of patients reveal the existence of low back pain to their prenatal care providers.   Pregnant women have a 19% higher rate of low back pain compared to non-pregnant women of the same age, and those with severe pain are at extremely high risk of future episodes. 
      There are many potential cause of pregnancy related LBP: facet joints, pelvic girdle pain (PGP) or sacroiliac joints (SI), disc herniation, discogenic and myofascial pain. Pelvic girdle or sacroiliac pain is four times more common than low back pain during pregnancy and is associated with a higher rate of chronicity.  SI pain is often localized to a small gluteal area, however can create groin as well as leg pain.  Patients with facet joint pain will often have localized low back symptoms and have greater pain standing than sitting. Facet joint pain during pregnancy is often elevated by an increased in lumbar lordosis creating greater sheer forces on those joints. 
Diagnostic procedures for facet & SI joint or Pelvic girdle pain include orthopedic testing and local anesthetic blocks. In pregnant patient we must rely on subjective and orthopedic information exclusively.  For obvious reasons radiographs will not be performed and a heel lift prescription for a leg length discrepancy should wait until an accurate radiographic analysis can be performed. 
      Treatment of low back pain in pregnant patients can be more challenging.  Not only is the clinician limited in diagnostic interventions they are also limited in traditional therapeutic approaches.  Pharmacologic as well as complementary and alternative medicine (CAM) interventions have been suggested as treatments for LBP in the general population.  A recent Cross-Sectional Survey reported that 61% of pregnant women would accept CAM therapy as treatment for low back pain and 36.6% of providers recommended chiropractic.  The American College of Physicians and the American Pain Society recently released A Joint Clinical Practice Guideline for the Diagnosis and Treatment of Low Back Pain. Recommendations “for patients who do not improve with self care options” are spinal manipulation for acute low back pain as well as chronic or subacute low back pain. Acetaminophen is the most commonly recommended medication for the treatment of LBP during pregnancy, however, has been shown to have a limited level of evidence and only a small net benefit in non-pregnant subacute or chronic low back pain sufferers.
      Data clearly indicate that LBP during pregnancy is a common problem and many women suffer significant pain that is left untreated.  Therapeutic approaches should be multi-modal and include proven modalities.  Chiropractic traditional spinal manipulation in combination with patient education, flexibility & strength training, self mobilization techniques, external supports and Acetaminophen are proven therapeutic interventions.   Patients that do not achieve postpartum resolution of back pain should have special studies and a comprehensive musculoskeletal evaluation.  The Neuroscience Groups Physical Medicine and Pain Management Division can provide the multi-disciplinary approach needed in the management of acute and chronic back pain.  Chiropractic and Physical Medicine Physician services are available for same day appointment.  Our team of Physical and Occupation Therapist aid patient management with manual therapy techniques and therapeutic rehabilitation.  Our diversity provides each clinician the opportunity for collaborative case reviews, enhancing patient care and the ideal patient experience.