Pregnancy is an amazing time. The female body undergoes some wondrous changes in order to grow a baby and prepare for delivery. However, all of these changes can lead to discomfort and sometimes, downright pain. There are so many varieties of pregnancy related pains that it can be hard to keep them straight. Here is a list and short description of some of the most common muscle, ligament and connective tissue issues seen during pregnancy. Being able to describe your pain might help determine the best way to deal with it.
Low Back Pain
As the uterus expands upwards and outwards, the lower back muscles often struggle to keep up with the challenge of holding the spine upright. The muscle fatigue and strain can be very uncomfortable. Also, in an effort to counterbalance the growing abdomen, most pregnant women lean back even farther increasing their lumbar lordosis (lower back curvature). This does help to keep your centre of gravity over your feet but it also compresses the lower vertebrae of the spine in extension. This too can contribute to the pain. On top of all this, most women just want to stretch their lower back muscles forward (into flexion), but because of the large, firm uterus, even that can be difficult! This type of pain seems to be worsened with long periods of standing or walking.
Pelvic Girdle Pain (& Pubic Symphysis Dysfunction)
Pain in the pelvis (or pelvic girdle) can be felt across the back of the pelvis, one side of the back portion of the pelvis (sacroiliac joint) around the hips and into the groin. This can even include pubic bone pain also called pubic symphysis dysfunction (PSD). It is thought that this is caused by strain through any of the pelvic joints, possibly due to an asymmetry in the pelvis. This could be brought on by one side of the pelvis changing shape faster or slower than the other side. Or it could be caused by muscles being used differently around a changing body shape. Whatever the reason, the pain can be sharp, burning, achy or sore. It may come and go or be there almost all the time. It can make everyday activities like walking, standing, sitting, rolling over in bed, climbing stairs, bending and lifting very difficult.
Sciatica
Sciatica is an irritation to the sciatic nerve. Pain can be felt along the nerve as it travels from the bum cheek down the back of the thigh, outer portion of the leg and into the heel. Some women feel the pain only in the top portion of the nerve, while others can feel the pain all the way down the leg. Sciatica during pregnancy is often attributed to the expanding pelvis, changes in glute muscles and swelling. As the pelvis opens to accommodate the growing baby, it can put increasing strain and pressure on the muscles and connective tissue near the nerve, or the nerve itself.
Round Ligament Pain
The round ligament attaches to the uterus (where the uterus meets the fallopian tubes) and descends through the pelvis to the mons pubis and labia majora. This ligament helps to hold the uterus in its correct position. During pregnancy, as the uterus grows the round ligaments (there is one on either side) get stretched. This can lead to sharp and intense pain felt in the lower abdomen or groin area. It’s often associated with quick movements and is short lasting, but for some women the pain can last for several hours at a time.
Tailbone (Coccyx) Pain
Fluctuating hormones during pregnancy cause increased flexibility of connective tissue and ligaments including those in the pelvis and pelvic floor. Because of this, the tailbone has the ability to move more than normally. Sitting on the tailbone (and who doesn’t need a good sit when they are pregnant!?) can put pressure on the tailbone leading it to curve under more than normal and contributing to pain when then getting back up and into standing. With increased constipation during pregnancy, pressure with straining can exacerbate coccyx pain. In late pregnancy, the baby’s head can start to press into the coccyx area. It tends to feel like an ache or bruise often at the tip of the tailbone but sometimes slightly higher up, or to the left or right of the tailbone where the ligaments attach.
Abdomen Pain
As the uterus grows the overlying muscles have to adapt. The connective tissue that runs between the abdominals must stretch to make way for a growing babe. This often leads to a diastasis recti, which is a very common effect of pregnancy. It can appear as a bump…over your bump. Perhaps more like a dome or tent that can be especially noticeable when straining in a sit-up movement. Occasionally this muscle straining can be uncomfortable, or sometimes the abdomen feels itchy as the abdominal skin thins.
Rib Pain
Rib pain can be felt anywhere along the ribs. Rib position can change quite dramatically during pregnancy. The chest circumference increases 5 to 7 cm, the diaphragm elevates 4 cm and the angle where the ribs attach to the breastbone changes from 45 degrees to almost 90 degrees. This can put strain on the joints where the ribs attach to the spine leading to spine or upper back pain. It can also cause strain to the intercostal muscles, the muscles that lie between the ribs. Add any sort of spine curvature (scoliosis) and you could see an exacerbation of these issues. Since lung expansion becomes more difficult you can easily get a spasm or “stitch” in the breathing muscles, felt in the side of the ribs. Add to this, tiny baby feet and elbows that like to tuck up and under the ribcage.
Upper Back Pain
Excluding the above mentioned rib involvement; other factors can contribute to upper back pain. Once again, postural changes due to pregnancy can lead to discomfort. A growing uterus makes it difficult to move the thorax and the upper back. Additionally, the breasts increase by 500-800 grams. Both of these changes can lead to upper back slouching, or thoracic kyphosis. The limited ability to move the torso can lead to muscle strain and fatigue.
Pelvic Floor Pain and Heaviness
Combine increased muscle and connective tissue flexibility with strain to the pelvic floor and you can end up with an achy, heavy feeling around the genitals. The strain can comes from the weight of the growing baby, changes to the gastro-intestinal tract (ie: constipation) or changes to the circulatory/lymph system causing vaginal varicose veins and hemorrhoids. Being up on your feet can bring on the symptoms or make things a little more uncomfortable.
Foot and Lower leg pain
Swelling, weight gain, very flexible connective tissue and a shift in standing and walking postures can all lead to achy feet and leg muscles. Swelling can get quite dramatic leading to changes in shoe size. It can also cause pitting edema, which is when fluid pools in a body part and becomes a little bit thick. Want to test for it? Press your thumb into the swollen body part, with firm pressure, and hold for 6 seconds. If you see an indent from your thumb, you might have pitting edema. This is usually accompanied by an achy feeling in the legs, especially if you’ve been up on your feet for a while. With looser foot ligaments and tissues and increasing weight there is also an increased risk of plantar fasciitis; pain in the sole of the foot, usually felt upon standing or during walking. Balance can also worsen in the second and third trimesters leading to sprained ankles.
All of these aches and pains should be discussed with your family physician or obstetrician. This list is not exhaustive and some types of pain during pregnancy can be of a serious nature. There are a variety of ways to manage each of these conditions. A physiotherapist with advanced knowledge in women’s health or pelvic health can offer exercises, equipment, tips and tricks in managing each of these issues, leading to a more comfortable and active pregnancy.
Katie Kelly,
Physiotherapist
BSc., MSc. PT