Low back pain during pregnancy - an osteopathic approach

As has been mentioned earlier posts (coccyx pain and gastric reflux) pregnancy puts a great demand on the body as the increased weight leads to mechanical changes in the body and especially the spine. Areas which the osteopath may be unfamiliar with addressing in patients that are not pregnant are the uterosacral ligaments. As pregnancy develops and the size of the uterus increases the uterosacral ligaments have to adjust and become taught. Due to their mechanical attachments to the sacrum and the sacrum's mechanical attachments, the coccyx, pubic symphysis lumber spine and sacrum, all have to adjust accordingly. In some cases the mother may not be able to adapt well due to mechanical restrictions elsewhere in the body and this can put excess strain on the uterosacral ligaments causing back pain. A method for the osteopath to determine the role of the uterosacral ligaments is to ask the mother to stand whilst the osteopath gently lifts and supports the uterus. If the mother describes a relief from pain and ease of movement then the osteopath can start to build up a diagnosis.

As the pregnancy develops the weight of the mother increases anteriorly, the pelvis rotates and lumber spine gets pulled into extension. Ideally the extension should occur throughout the lumber spine, however if the upper lumber spine does not adapt well and most of the extension occurs at the lumbo-sacral junction then most of the weight bearing will occur on one set of facet joints (zygo-apophyseal joints) that are not designed for such a task. Eventually the facet joints will become irritated and inflammation and muscle spasm will develop leading to pain. The osteopath, by improving the function of the other lumber vertebrae can help to spread the weight bearing load that is now required of the back. The osteopath must of course pay due attention to the illiolumber ligaments which will be under strain due to the nutation and counter-nutation of the sacrum throughout pregnancy.

Disc herniations are also common due to the increases leverage applied to the back due to the increase in anterior weight. This can obviously be most uncomfortable for the mother who has to adapt to the regular pregnancy-related changes. The osteopath can significantly aid the pregnant mother by applying techniques to help the body accommodate the physical changes in her body. Soft-tissue massage to the muscles of the spine, articulation to the appropriate areas – especially the junctional vertebra – dorso-lumber junction, cervical-dorsal junction and the lumber sacral junction. Regular osteopathic treatment in this fashion can be very helpful in allowing the mother to adapt to the changes and hopefully to stop pain occurring.