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Pregnancy woes: relieving musculoskeletal disorders

Given the numerous changes caused by their condition, musculoskeletal pain may disrupt pregnant women’s daily routines. In this article, you will learn about the most common disorders and how to treat them.

 

1 / Back pain

50% to 90% of pregnant women report lower back pain during pregnancy, while only 25% receive adequate care for this problem. Indeed, lumbar pain during pregnancy is still believed to normal, a situation that results in non-treatment of this pain. However, new studies report that when lower back issues are addressed quickly, pain can be significantly reduced, thus improving the expectant mother’s quality of life.

 

Where is the pain located?

Lower back pain is generally located in the centre of the lumbar spine. Pain can descend into the leg and foot and is increased by prolonged positions.

 

Why does this pain occur?

During pregnancy, a woman can gain up to 25% of her body weight in extra weight. This requires a change in posture to maintain balance.

 

What are the risk factors?

Some external factors may influence the risk of developing lower back pain. These include physically demanding work and a history of lower back or pelvic girdle pain.

 

What to do?

Following a thorough assessment, your physiotherapist will determine the probable cause of the pain and provide appropriate treatments, such as:

  • The use of lumbar support in the sitting position and postural correction in the standing position
  • Stretching and strengthening exercises
  • The use of a small bench to rest a leg in the standing position
  • A program of active aerobic exercises (swimming, walking, etc.)
  • Anterior pelvic rotation exercices to reduce stress on the lumbar spine.

 

2 / Pain in the pelvic girdle

25 to 50% of pregnant women experience pelvic pain during pregnacy and even post-partum. Pain in this area is frequently under-diagnosed and the number of women receiving care for this problem is often minimal.

 

Where is the pain located?

Around the sacrum, with pain that can radiate behind the thigh and knee and worsen when walking or going up or down stairs.

 

Why does this pain occur?

The source of pelvic girdle pain remains poorly understood by doctors. Similarly to lumbar pain, it is thought that changes in muscle activity and in the body’s perception of movement may contribute to pain in this region.

 

What are the risk factors?

The risk factors are essentially the same as those for lower back pain: physically demanding work and a history of lower back or pelvic girdle pain.

 

What to do?

Following a comprehensive assessment, your physiotherapist will offer treatments that may include:

  • Recommendations for decreasing activities that cause pain (exercises with a high rate of impact such as running)
  • The use of a sacral support belt for walking and other activities
  • Education on lying positions
  • Low-impact exercise programs
  • Exercises to strengthen the pelvic region.

 

3 / Wrist and hand pain

An estimated 67% of pregnant women suffer from pain in their hands or wrist. The most frequent conditions are arpal tunnel syndrome and De Quervain’s tenosynovitis.

 

Where is the pain located?

Pain can occur in the palm of the hand, fingers or thumb.

 

Why does this pain occur?

Carpal tunnel syndrome results from compression of the median nerve in the wrist, resulting in pain and possible numbness in the first three fingers.

De Quervain’s tenosynovitis results from inflammation of the tendons in the long abductor and short extensor of the thumb, causing wrist pain, near the thumb. This inflammation is mainly caused by water retention due to hormonal changes arising from pregnancy.

 

What are the risk factors?

Risk factors are mostly related to pregnancy-related hormonal changes. In case of post-partum pain, extreme and sustained postures may be to blame.

 

What to do?

Following a comprehensive assessment, your physiotherapist will offer treatments that may include:

  • Recommendations regarding activity level and incorrect postures
  • The application of analgesics to reduce pain
  • Gentle strengthening and stretching exercises
  • Appropriate orthopedic manual therapy treatments
  • Mobility exercises for the neural system, as required.

 

4 / Muscle cramps

5 to 30% of pregnant women suffer from muscle cramps, especially during the last months of pregnancy.

 

Where is the pain located?

Mainly in the calves and feet.

 

Why does this pain occur?

Muscle cramps have many origins. In pregnant women, the most plausible is a metabolic imbalance. A magnesium or calcium deficiency may explain night cramps.

 

What are the risk factors?

Risk factors are related to hormonal changes during pregnancy.

 

What to do?

To reduce acute cramping, the best remedy is to stretch the cramped muscle. You can also contract the opposite muscle to the one that is cramping.

For night cramps, a preventive stretching program is effective in reducing onset. In addition, wearing an elongation brace on the feet may also be helpful. Consult your physiotherapist for an effective stretching program.


 

5 / Transient osteoporosis

The main symptom is severe and persistent back pain in late pregnancy and persisting up to six weeks postpartum.

 

Where is the pain located?

In the back.

 

Why does this pain occur?

During pregnancy, a significant calcium transfer is required to build the fetal skeleton. This can lead to transient osteoporosis.

 

What are the risk factors?

There are many risk factors, including a history of osteopenia (low bone density), decalcification disorders, and vitamin D deficiency.

 

What to do?

To treat transient osteoporosis, it is important to get enough rest and avoid carrying heavy loads. Analgesics and proper nutrition will help treat the pain. Consult your doctor to discuss appropriate anti-osteoporotic medication.


 

6 / Diastasis recti abdominise

Diastasise refers to the separation of the superficial portion of the abdominal muscles. More than 60% of pregnant women have experienced this disorder and 30% to 60% of cases persist post-partum.

 

Where is the pain located?

Along the central abdominal wall.

 

Why does this pain occur?

The disorder is caused by stretching the right muscle of the abdomen bound to the growing uterus, which leads to a separation of right abdominal muscle into right and left halves.

 

What are the risk factors?

This condition is frequently seen in the third trimester or multiple pregnancies.

 

What to do?

To treat diastasis recti abdominise, your healthcare professional will suggest core and breathing exercises as well as education on postural hygiene.

 

By Guillaume Desroches and Andrée-Anne Lorrain, physiotherapists.


References :
  • Perkins J., Hammer R. L. & Loubert P.V. (1998). Identification and management of pregnancy-related low back pain
  • Bishop A. et al. (2015). Current management of pregnancy-related low back pain: a national cross-sectional survey of UK physiotherapists
  • Hu W.H., Meijer O.G., Uegaki K., Mens J.M.A., van Dieën J.H., Wuisman P.I.J.M. & Östgaard H.C. (2004). Pregnancy-related pelvic girdle pain
  • Balık, G., Balık, M. S., Üstüner, I., Kağıtcı, M., Şahin, F. K., & Güven, E. S. G. (2014). Hand and wrist complaints in pregnancy
  • Heckman, J. D., & Sassard, R. (1994). Musculoskeletal considerations in pregnancy
  • Borg-Stein, J., Dugan, S. A., & Gruber, J. (2005). Musculoskeletal aspects of pregnancy
  • Bracken, M., Enkin, M., Campbell, H., & Chalmers, I. (1989). Symptoms in pregnancy: nausea and vomiting, heartburn, constipation, and leg cramps
  • Miller, T. M., & Layzer, R. B. (2005). Muscle cramps
  • Dahle, L. O., Berg, G., Hammar, M., Hurtig, M., & Larsson, L. (1995). The effect of oral magnesium substitution on pregnancy-induced leg cramps
  • Daniell, H. W. (1979). Simple cure for nocturnal leg cramps
  • Sanz-Salvador L, García-Pérez MÁ, Tarín JJ, Cano A2. (2015). Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture
  • Spitznagle T, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population
  • Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year

 

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