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Q: Pregnancy and back pain ( Answered,   0 Comments )
Subject: Pregnancy and back pain
Category: Health > Women's Health
Asked by: andyskelton-ga
List Price: $50.00
Posted: 19 Oct 2005 23:08 PDT
Expires: 18 Nov 2005 22:08 PST
Question ID: 582459
Does pregnancy affect back pain from a bulging disc at L5-S1 ?
Subject: Re: Pregnancy and back pain
Answered By: crabcakes-ga on 20 Oct 2005 15:30 PDT
Hello Andyskelton,

    Back pain during pregnancy is fairly common, without the added
effects of a herniated disc, but yes, the pain can become worse during
the last few months of pregnancy!  The good news is that If a
herniated disc is causing sciatica, it should disappear after
pregnancy. You don?t say if you are already pregnant, but if you are
not, have you considered getting treatment for the bulging/herniated
disc before pregnancy?

   ?In a pregnant woman it sometimes happens that the position of the
fetus puts pressure on the sciatic nerve, especially during the last
few months of pregnancy. In all age groups, sciatica may occur as the
result of muscle spasm or of sitting for long periods in a cramped or
awkward position, such as during a long airplane flight.? (More on
sciatice near the end of the answer)

   ?Pregnancy and labor. Some women, when they begin labor, will have
a nagging lower backache that comes and goes with regularity. If a
woman is expecting a baby in a posterior position (baby is head down,
facing toward mother's pubic bone instead of her backbone), back labor
is a frequent occurrence. It can be very intense back pain due to the
pressure of the baby's skull pressing against the tailbone.?

Pregnancy and Herniated Discs

   Before seeking any kind of chiropractic/physical therapy/massage
therapy or undergoing an exercise program, please check with your
obstetrician first.

?Certain situations increase the risk of straining the sacroiliac
joints. During pregnancy, the ligaments in the sacroiliac area soften
and lengthen. This may also occur with prolonged bending or lifting
and with degenerative arthritis. In dancers, potential for sacroiliac
injury is significant due to the extreme ranges of motion and artistic
demands placed on dancers. Dancers with sacroiliac pain may or may not
recall a method of injury. Symptoms may present over the sacroiliac
joint, or it may be referred, usually to the groin and the posterior
thigh, and less often to the leg. Pain may become worse when they lie
on the affected side?

?Between each vertebrae are discs, made up of a combination of strong
connective tissues which hold one vertebra to the next. These discs
act as a cushion between the vertebrae. As individuals age, the center
portion of the disc (nucleus pulposus) may start to lose water
content, making the disc less effective as a cushion. This may cause a
displacement of the disc?s center through a crack in the outer layer
(known as a herniated or ruptured disc). A herniated lumbar disc can
ultimately press on the nerves in the spine and may cause pain,
numbness, tingling or weakness of the leg called "sciatica".?

?Often just one or two visits to a physical therapist experienced in
pre/post partum treatment can be very helpful to help minimize or
alleviate unwanted back pain during pregnancy. If more extensive
treatment is required, a physical therapist should perform an
individual evaluation and recommend a treatment program for you.
The main goal of treatment is for you to maintain an optimal level of
function throughout your pregnancy and to have the least amount of

?Typically, conservative therapy is the first line of treatment to
manage lumbar disc disease. This may include a combination of the
?bed rest
?patient education on proper body mechanics (to help decrease the
chance of worsening pain or damage to the disc)
?physical therapy, which may include ultrasound, massage,
conditioning, and exercise programs
?weight control
?use of a lumbosacral back support
?medications (to control pain and/or to relax muscles)?

?In a study of the epidemiology of acute herniated lumbar
intervertebral discs in the New Haven, Connecticut, area, it was found
that the female cases had had more pregnancies resulting in live
births than women of similar age without known herniated discs.
However, cases had not had more pregnancies resulting in miscarriages
than other women of their age. Among women who underwent surgery for
their herniated discs, the association between number of live births
and herniated discs was found for women with herniations at the L5
level but not for women with herniations at the L3 level.?

?Generally, women who have had previous spinal surgery can go on to
have children. What they will note in the course of their pregnancy is
that as they may have more back pain than most of their friends.
Often, people who have spinal problems will find that as they gain
weight during a pregnancy, the pain in their back increases. In most
cases, that pain will subside after delivery. If you do decide to have
children, you should talk to your gynecologist. Depending upon what
kind of surgery you have had, your doctor may want to discuss with you
the option of having a cesarean section rather than a normal

?Pregnancy - A woman's body undergoes significant hormonal and
physical changes during the nine months of pregnancy. For most women,
this can lead to back pain as an unavoidable side effect during this
time. Early in pregnancy, certain hormonal changes result in increased
joint laxity. As a result, the spine, abdominal and back muscles, and
posture of the lower back change and become more relaxed. Poor posture
and poor muscle tone prior to pregnancy can affect how the back
adjusts. The lumbar (lower back) curve begins to increase slightly as
the pelvis tilts backward. This posture begins to influence the
weakened and now fatigued lower back muscles. A woman may experience
mildly painful spasms, which can be the first sign of a persistent
backache in early pregnancy.?

?Chiropractic care during pregnancy can make labor and delivery
easier. A chiropractor working with pregnant women can help correct
problems with fetal positioning, allowing a breech baby to turn
head-down or a posterior baby to turn anterior, preventing back labor.
Improper fetal position causes discomfort during pregnancy and can
lead to unnecessary interventions during birth. Michelle W. of Hudson
visited Parnell Chiropractic for sciatic pain during pregnancy. ?Not
only did my sciatic pain go away, but my energy level increased

? I'm pregnant and experiencing back and leg pain. What can be done to
help alleviate this discomfort during my pregnancy?

A. With most women, pregnancy comes with some back pain. The most
common cause of back pain in pregnancy is your sacral iliac joint.
Your obstetrician should be alerted to your low-back discomfort and
may recommend prenatal-safe medication, exercises and support belts.
Only in cases of severe neurological impairment is spinal surgery
remotely considered.?

?Tips for easing back pain during pregnancy:
?Consult with your doctor, especially if back pain is accompanied by
fever, burning during urination, or vaginal bleeding.
?Exercise for a healthy back. Consult with your doctor, and see the
following website, Easing Back Pain During Pregnancy, for exercises
ideas [

?Wear low-healed (but not flat) shoes with good arch support.
?Ask for help when lifting heavy objects.
?If your bed is too soft, have someone help you place a board between
the mattress and box spring.
?Don't bend over from the waist to pick something or someone up --
squat down, bend your knees, keep your back straight, and use your
legs to lift.
?Sit in chairs with good back support, or use a pillow behind the
lower part of your back.
?Try to sleep on your side with one or two pillows between your legs for support.
?Apply cold, followed by heat (if needed) to the painful area or massage it.
If back pain continues, your doctor may suggest you wear a maternity
girdle, special elastic sling, or back brace (American College of
Obstetricians and Gynecologist, 1997).

This page had many good tips for alleviating some of this discomfort:
?Low back pain is very common among pregnant women. Back pain during pregnancy
may occur due to hormones and/or weight gain. The increased weight may
change the center of gravity, placing a significant amount of stress
on the musculoskeletal
system, especially the spinal column. Utilizing proper posture and
body mechanics throughout the day and night will help to alleviate
some of the stress and pain
felt during pregnancy.?

?I am experiencing a lot of back pain in my pregnancy, what natural
strategies can I try to alleviate the pain?

   The first strategy would be to ensure that you are getting
sufficient rest. You may find heat very effective at reducing the
discomfort caused by back pain. Apply a hot pack or hot water bottle
to the area ? careful not to burn yourself. You could also try a nice
warm bath or shower. There are various support gadgets available to
help support your growing tummy. The most common gadget is a maternity
support belt, which provides additional support for your back.
Physiotherapists often recommend and fit maternity support belts.
Another strategy is to do some strengthening exercises. The
pelvic-tilt exercise is the most common exercise recommended. Ask your
midwife or doctor how do this exercise correctly. You may find
spending some time on your hands and knees will provide some welcome
relief from the back pain. In this position you take the baby?s weight
of your back. If pain becomes worse, be sure to consult your midwife
or doctor.?

?The incidence of some degree of back pain during pregnancy is
relatively high. Researchers worldwide have suggested it may be
between 30 - 70%. The cause of back pain during pregnancy remains
debateable and often there are several structures involved. An
increase in body weight, hormonal changes, postural changes, a past
history of back pain, repetitive bending and lifting are all thought
to contribute. The most common sites of pregnancy related back pain
are the lower back and the posterior pelvis (back of the pelvis),
although other sites may also exist.?

Caude Equina can occur, secondary to herniated discs.
?Although extremely rare, cauda equina syndrome and severe and/or
progressive neurologic deficit caused by lumbar disc displacement can
occur during pregnancy. The prevalence of symptomatic lumbar disc
herniation during pregnancy may be on the increase because of the
increasing age of patients who are becoming pregnant. These cases
showed, and the literature confirms, that pregnancy at any stage is no
contraindication to magnetic resonance imaging scan, epidural and/or
general anesthesia, and surgical disc excision.?;jsessionid=DYVFlXKjg7RgAO52tNJsXrSfAKcEfKCmBXaVhygkZ4jW27B8CBjY!-352798717!-949856145!9001!-1

?Although lumbar disc herniation is reported in only one in
approximately 10,000 pregnancies,3 and fewer than 2% of lumbar disc
herniations are estimated to result in cauda equina syndrome with
severe and/or progressive neurologic deficits, physicians should be
aware that these conditions can in fact occur during pregnancy. They
constitute an emergency and should be diagnosed and treated prompty
without considering the stage of gestation. A poor prognosis is
correlated with the length of time from onset to surgical
decompression and the intensity of saddle anesthesia, a symptom of
cauda equina syndrome.4 In the present case, the treating physician
was reluctant to submit the patient to diagnostic MRI because the
onset of symptoms had occurred at approximately 16 weeks of gestation.
The literature clearly demonstrates that pregnancy at any stage is not
a contraindication to MRI.8 ? 10 In this case, according to the
symptoms and signs, pelvic MRI was unnecessary however, the spine MRI
was the definitive diagnostic procedure for establishing lumbar disc

Ask your obstetrician about these pregnancy support products:



Herniated/Bulging Discs in general

?Risk factors that you can change
?	Your job or other activities that increase the risk of developing a
herniated disc, such as long periods of sitting, lifting or pulling
heavy objects, frequent bending or twisting of the back, heavy
physical exertion, repetitive motions, or exposure to constant
vibration (such as driving)
?	Not exercising regularly, doing strenuous exercise for a long time,
or starting to exercise too strenuously after a long period of
?	Smoking. Nicotine and other toxins can impair spinal discs' ability
to absorb nutrients they need from the blood, making the discs more
prone to injury.
?	Being overweight. Carrying extra body weight (especially in the
stomach area) causes additional strain on the lower back.
?	Frequent coughing?

?Neurologically symptomatic herniated discs are rare during pregnancy,
yet, when indicated, pregnant women can safely undergo surgery.?

?If the disc is bulging, this is not necessarily a problem. The disc
is a unit with a tough fibrous outer layer (annulus) like the outside
of a radial tire. The inside is filled with something kind of like
toothpaste. As your disc begins to lose water (going down from 85% to
65%) it is like letting air out of a radial tire; the sides begin to
bulge. This can either cure itself as the annulus tightens up with
time, or as the joints in your spine enlarge and add more stability.
Most of the time these bulging discs are treatable by exercise (Lumbar
Stabilization or aerobics) and/or anti-inflammatories (ASA, Ibuprofen,
or Aleve), and learning not to over stress these bulging discs.
Usually this can get to a pain-free situation. Occasionally a disc
bulge can get so big that it squeezes the nerves and denies them
nutrition (blood supply), and causes continuing leg and posterior
thigh pain. This is called Central Disc Syndrome. Even still, this
often gets better with exercise and medications. If you smoke, the
chances of getting better are much less due to multiple factors.?

?Disc herniation is a rupture of the disc where the inner core of the
disc bulges out through the outer layer. If the bulging disc presses
on a spinal nerve, the pressure can cause pain. A common symptom of a
herniated disc is sciatica, the term used to describe pain that
travels downward along the sciatic nerve from the buttock to the thigh
and leg. Herniated discs are also known as ?slipped? or ?ruptured?

The nerve most likely to cause trouble is the sciatic nerve; at some
time, up to 40% of people experience pain caused by compression of
this nerve, which branches from the nerve roots that descend off the
spinal cord in the lumbar and sacral areas. Each of the two branches
of the sciatic nerve is about as wide as a thumb and threads through
the pelvis and deep into the buttocks, then down the hip and along the
back of the thigh to the foot. Sciatica usually occurs on one side
when a sciatic nerve has been stretched or pinched, usually by a
herniated disc, although spinal stenosis or other vertebral
abnormalities can also cause this pain. The sensation of sciatica can
vary widely from a mild tingling to pain severe enough to cause
immobility. Some people experience sharp pain in one part of the leg
or hip and numbness in other parts. The pain increases after prolonged
standing or sitting and is aggravated by sneezing, coughing, or
laughing. If spinal stenosis is causing sciatica, patients may also
experience it after bending backwards or walking more than 50 to 100

?Disc Abnormalities.
A herniated disc, sometimes but incorrectly called a slipped disc, is
the most common cause of severe sciatica. A disc in the lumbar area
becomes herniated when it ruptures or when the gelatin within the disc
protrudes outward. If the material breaks off or extends far enough
out to press against the nerve root, sciatic pain can occur. Disc
material that extrudes (that is, it balloons into the area outside the
vertebrae or breaks off from the disc) most likely is a cause of pain.
Sciatic pain is also sometimes present when there is no bulging or
extruding of the discs. Some cases of chronic low back pain may be
caused by inward growth of nerve fibers into intervertebral discs.
Some evidence also exists that nerves in the outer ring of the disc
may be the source of pain.?
Back pain attributed to medical conditions, such as arthritis,
osteoporosis, or pregnancy, either resolves when the condition does or
is treated as part of the overall therapeutic plan. Treatment for back
pain is available from a variety of health care practitioners; a
recent study of patients treated by primary care practitioners,
chiropractors, and orthopedic surgeons reports similar recovery rates.
When low back pain is not caused by a medical condition, about 90% of
people recover within a month without any treatment at all. In spite
of this encouraging statistic, back pain is the third most common
reason for surgery and costs the country up to $50 million each year
in medical and disability benefits. For most patients very moderate
treatment options are the correct course for low back pain. It should
be noted, however, that for certain patients with sciatica and spinal
stenosis, surgery may be the most effective approach.

Please see your obstetrician if you are in discomfort or pain, to rule
out anything other than a herniated disc.

I hope this has helped you! If any part of this answer is unclear, I
will be happy to assist you further, before you rate. Simply ask for
an Answer Clarification, and I will respond as soon as possible.
Sincerely, Crabcakes

Search Terms
Pregnancy + herniated discs
Sciatica + pregnancy
Bulging discs + pregnancy
Maternity pillows
Pregnancy slings
Pregnancy support belts
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