I’m currently treating an array of pregnant patients, from the start of the second trimester to a few weeks before the due date. The interesting thing is that they all present with a variation of the same thing: lower back and pelvis area pain. For some it is relentless, and may even need crutches. For others it only comes on after an hour or so of dancing or standing. Whatever it is, if it’s bothering you then don’t put up with it!
Whereas some patients expect pain in pregnancy, others are surprised or even worried to have it. The explanation of what’s going on makes them feel more at ease. During pregnancy, the body prepares the pelvis to move in new ways and allow the baby through the birth canal. This requires a lot of the aptly named hormone “relaxin”. This hormone increases the laxity of ligaments, especially around the pelvis. By allowing more movement through the pelvis, the muscles around it have to work harder to keep it stable. This, combined with a growing weight on the front of the abdomen, leads to achey buttocks and lower back muscles. Sometimes it can also lead to piriformis syndrome too. Jarring movements like stepping off a kerb tend to bother the joint itself, which might feel like a deep ache. It’s not unusual for pain to flip from side to side, or even manifest in the front of the pelvis. The pelvis is like a ring when viewed from above, so it makes sense that if forces change through one part of it, that another part will adapt.
It might sound like an uphill struggle, but the benefit of relaxin is that everything is a bit more responsive. I tend to be able to get a lot more done in half an hour with a pregnant patient, because I don’t need to spend as long on the sacroiliac joint or buttock muscles before they react.
More good news is that current research supports osteopathy for lower back pain in pregnancy. A 2017 study said that:
Osteopathy provides significant reduction of pain, and improvement in function, for lower back and pelvic pain associated with pregnancy. (Franke et al, 2017)
Problems tend to arise more in the third trimester as the relaxin and weight of the bump increase. The weeks just before maternity leave tend to be the most common time for a pregnant lady to come and see me. Combine all the changes in the body with difficult postures at work, lifting, commuting; something’s got to give.
It’s not unusual to be particularly cautious during pregnancy, especially in the first trimester. As with any other patient, nothing will be done that you are uncomfortable with. Some pregnant ladies feel like their backs really need clicking, and others are reluctant to do anything stronger than massage. It’s also absolutely fine if you change your mind during the session or further down the line. Consent is always ongoing, and feedback is valuable.
As the pain subsides and we start to spread treatment sessions further apart, don’t feel like we’re leaving you on your own! Chances are that the pelvic pain will resolve once baby’s out, but the lifestyle changes are just beginning! Breastfeeding, co-sleeping, pushing a pram, or carrying baby in a sling have all been blamed for pain by my new-mum patients. You’re still producing relaxin months after giving birth, so get those aches and pains addressed while responsiveness is at its height! Your osteopath can also give advice about how to avoid the pain in the first place. Carrying baby on the other side and using breastfeeding pillows can be a good start.
Franke, H., Franke, J., Belz, S. and Fryer, G. (2017). Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: A systematic review and meta-analysis. Journal of Bodywork and Movement Therapies, 21(4), pp.752-762.