Should Pain be Expected when Expecting?

Pregnancy is a span of time in which a woman’s body undergoes many changes, some changes being
more comfortable than others.
Although we often picture pregnancy as a wonderful expectation in the growth of new life, the physical
changes a woman’s body goes through can feel anything but miraculous. Over 50% of pregnant women
report their biggest complaint during pregnancy is low back pain, sometimes lasting over 3 months!
Additionally, up to three-fourths of women will experience low back pain at some point during their
pregnancy. 1,2
Add to this pelvic girdle pain, which is experienced by up to 20% of women at some point during
pregnancy, 3, and it’s no wonder that pregnancy can be physically exhausting!
Although pain is usually experienced sometime between the fifth and seventh month of being pregnant,
it can begin as soon as eight to twelve weeks after becoming pregnant. 2
And as the fetus grows, a woman’s center of gravity changes to accommodate, shifting forward to
accommodate for the growth of the baby. The abdomen stretches, and the woman’s belly moves
forward and out accordingly to increase in the baby’s weight and development; so, too, does the shift in
gravity of a woman’s weight 3 on her low back, pelvis, knees, ankles, and feet.
In fact, the thoracic (mid-back) and lumbar (low back) spine curvature can change during pregnancy,
causing an increase in pain in the low back and pelvic regions. This can also cause alterations to balance
and gait patterns. 3 Think of the pregnant “waddle” that some women do while walking, and you have an
idea as to the changes that take place in the abdomen, low back, pelvis, and sacrum.
This can, and often does, place additional stress and strain on the joints in the low back and posterior
pelvis, known as the lumbar and sacroiliac areas. These postural changes lead to increased pain, muscle
tightness, tenderness, and discomfort. 2 Pregnancy can even lead to changes in the curvature of the
woman’s spine.
Low back and pelvic pain can also be major deterrents in a woman who could, and would, be otherwise
motivated to continue working and taking care of both herself and her home. Pain has shown to
influence pregnant women’s daily lives in the challenges they encounter concerning their physiological,
psychological, occupational, and social functions. 4
And it doesn’t always stop there. Sometimes women can experience low back and pelvic region pain the
year after birth, and even up to three years after labor and delivery. 1,5 Pregnancy-related low back and
pelvic pain, as well as post-partum mechanical spinal disorders, are not only common, but they can impede recovery, nursing, and caregiving – three very important components in taking care of the
newborn after labor and delivery. 5
How will a pregnant woman know if her pain is being caused by her pregnancy? What is pregnancy pain
like? Some women describe it as a deep discomfort. Others describe it as stabbing, continuous,
recurrent, and intense. 6 The discomfort can also vary in intensity; some days can be more difficult than
others, and there may be times when the pregnant woman feels like even basic tasks are difficult to do.
Where might pregnancy-related pain be felt on the body? For some, the pain occurs anteriorly, or in the
front, by the pubic bone. Others may feel discomfort directly at the low back above the gluteal area –
sort of around the belt-line. And for others still, the pain also occurs between the hip bones and the
gluteal fold.
Sometimes this discomfort even travels down the back of the thigh to the knee and the calf 6 , or even
down to their feet. 2,7 Most women say that their pelvic and low back pain is more intense during
pregnancy than after labor and delivery, and it is still physically limiting as it may cause a pregnant
woman to withdraw from activities that she would normally gravitate toward, such as social interactions
or work. 6
Since pregnancy can drastically change a woman’s body in such a relatively small period of time with
lasting effects, how can chiropractic care help with physical changes encountered during pregnancy,
especially ones that contribute to pain?
While a chiropractor cannot help with changes in hormones that naturally occur with fetal growth, the
resulting biomechanical changes that occur in a woman’s body during pregnancy can be lessened or
alleviated by the help of a knowledgeable chiropractor.
A chiropractor who is well-versed in addressing pregnancy-related issues will be able to accurately
assess, diagnose, and treat low back pain and pelvic girdle pain.
Some options for treatment include chiropractic spinal manipulation, soft tissue therapy, exercises, and
ergonomic advice, as well as encouraging regular visits to her obstetrician. Treatment could improve
functional activities such as sitting, traveling comfortably in a car, walking, and more. 3 And, addressing
this discomfort sooner rather than later is preferred, especially if employment or maternity leave is a
concern. Low back pain is the most common cause of sick leave after delivery. 7
Maintaining optimal function and reducing pain levels to more manageable levels are goals that should
be discussed with a doctor of chiropractic as well as an OBGYN when it comes to pregnancy-related
pain. 2 A detailed history and clinical examination are essential for determining what biomechanical
source is causing a pregnant woman’s low back or pelvic pain. 6

A knowledgeable chiropractor will be able to accurately assess changes in pelvic positioning, curvature
changes in the upper and lower back, stress on the lower back including muscle tension and tightness in
the lumbosacral area, and any radiating (shooting) pain that can travel from the low back into the legs or
lower extremities.
A chiropractor can also help identify any areas of stiffness 7 that may accumulate in weak areas of the
body 8 , contributing to an increase in back pain during pregnancy. This may be the case if poor posture,
excessive standing, and bending over trigger or escalate any back and pelvic pain.
Low back pain and pelvic pain do not have to be an inevitable part of pregnancy. If you are one of the
50%+ of pregnant women experiencing pain during your pregnancy, there are options for treatment
available to help make your pregnancy more comfortable and productive!
Even as your body changes, a well-trained chiropractor will be able to give you conservative
management options for your low back and pelvic pain. Your doctor will work with your OB/GYN to
make sure that your options for treatment are safe and effective.
References
1. Yoo, H., Shin, D., and Song, M. (2015). Changes in the spinal curvature, degree of pain, balance
ability, and gait ability according to pregnancy period in pregnant and nonpregnant women. J
Phys Ther Sci. 2015 Jan; 27(1): 279–284.
2. Montgomery, S.P. “Management of back pain during pregnancy.” (2009). Retrieved March 2020
from: https://www.spine-health.com/conditions/pregnancy-and-back-pain/management-back-
pain-pregnancy
3. Verstraete, V.H., Vanderstraeten, G., and Parewijck, W. (2013). Pelvic Girdle Pain during or after
pregnancy: a review of recent evidence and a clinical care path proposal. Facts Views Vis Obgyn.
2013; 5(1): 33–43.
4. Bernard, M., and Tuchin, P. (2016). Chiropractic management of pregnancy-related lumbopelvic
pain: a case study. J Chiropr Med. 2016 Jun; 15(2): 129–133.
5. Maiers, M., et al. (2018). Chiropractic in Global Health and wellbeing: a white paper describing
the public health agenda of the World Federation of Chiropractic. Chiropr Man Therap. 2018; 26:
26.
6. Katonis, P., et al. (2011). Pregnancy-related low back pain. Hippokratia. Jul-Sep; 15(3): 205–210.
7. Sabino, J., and Grauer, J.N. (2008). Pregnancy and low back pain. Curr Rev Musculoskelet Med.
2008 Jun; 1(2): 137–141.
8. “Back pain during pregnancy: causes, treatment and prevention.” American Pregnancy
Association. Retrieved March 2020 from: https://americanpregnancy.org/pregnancy-
health/back-pain-during-pregnancy