A Guide To Managing Post Natal Back Pain
So, the baby is born, the pregnancy is over and you are immediately able to get back to the body and health that you had nine months back, right? So, after you stop laughing, the answer is right in front of you: No! Besides the obvious change in your life, frequently there are undesired reminders of the previous nine months that are still sticking around: weight, scars, pain, etc.
When it comes to pain, the etc. stops right there, as this memento from pregnancy can greatly affect your quality of life. Low back pain has been observed to occur in over 60% of women at some point during pregnancy. Of those women, 15-20% will experience persistent pain that lasts for six months or longer after giving birth. Many factors are related to this, including birth trauma and breast feeding.
The good news is that, in many cases, making basic activity modifications will help to counter the pain. When these aren't effective, there are several simple, minimally invasive treatments available to help relieve pain and improve your quality of life.
Why does my back hurt after giving birth?
Multiple factors are said to be associated with persistent post-natal back pain, for example a higher number of pregnancies, back pain prior to pregnancy, back pain in previous pregnancy, etc. Moreover, there are events that can occur during the birthing process and post-partum period that may contribute to prolonged pain:
- During labor, women are activating muscles in the pelvic floor that are not used routinely in daily life. If the labor period is prolonged, the muscles become fatigued and strained. This can lead to chronic pain symptoms.
- As the baby is passing through the birth canal, the pelvis and lower spine are maximally stretched to allow delivery. If the woman has a small pelvis, the baby is large or is out of position during delivery, hairline fractures can occur in the sacrum and coccyx (tailbone).
- When women have a C-section, the abdominal muscles are separated surgically to allow for delivery of the baby. This causes a weakening of the abdominal muscles. Keeping a stable spine is dependent upon a proper balance between the strength of the abdominal and spinal muscles. When this balance is disrupted, increased low back muscle strain and pain will occur.
- After delivery, the hormonal effects of Relaxin (refer to part 1 of this series) continue to persist for approximately 3 months, leading to persistent joint hypermobility in the pelvis and spine. This can lead to joint inflammation, soft tissue strain and chronic pain.
- During pregnancy, the abdominal muscles are stretched out to allow for growth of the baby. After birth, the muscles will return to their normal shape over the course of several months. However, the muscles are very weak during that time. This weakness can lead to muscle imbalance with the spine, and increased stress on the low back muscles and joints, causing pain.
- Nursing is a major source for persistent low back pain. When mothers start nursing and are focused on the baby latching on, body positioning tends to be awkward, with a bent trunk and neck twisting to look at the baby. This can cause significant muscle and joint strain, leading to pain.
- Mothers tend to hold their babies between 5-6 hours each day. This added weight of carrying a newborn weighing 3.5kg, quickly increasing to 8kg after 6 months, puts increased stress on the back and may cause pain.
Once your child gets up and starts walking, the carrying duration may be reduced, but the pain may not. Carrying bags of clothes, toys, running after your child, etc., all put excessive strain on your spine and soft tissues, leading to increased pain.
What can I do to manage my back-pain?
In the event you continue to experience pain months after delivery, the focus should initially be on modifying basic activities to reduce strain and stress on the body. In addition to the changes that were discussed in part 1 of this article, here are some tips that pertain to post-pregnancy back pain management:
1) Nursing – this is one of the most important areas for new mothers to focus on when managing back pain after pregnancy. Correct positioning is key for reducing muscle and joint strain. Always bring your baby to your breast, rather than the other way around. If you are nursing your baby in the "cradle hold" position, be sure to sit in a chair with supportive arm rests or a bed with lots of pillows. Keep your feet supported on a stool to avoid the tendency to lean forward. If you are unable to tolerate nursing in this position, you may want to consider the "reclining" position, which is performed while lying on your side on the bed.
2) Exercise – any return to an exercise program needs to be discussed with your health care provider before you start. The American College of Obstetricians and Gynecologists recommends that initiating a walking program days after giving birth is safe (regardless of vaginal or caesarian delivery), as it stimulates healing, reduces pain and improves energy levels. Read this [link] article for more ideas. Other specific exercises one can consider include:
• Pelvic tilt – Lie on the floor with your knees bent and feet flat on the ground. Take in a deep breath and when you exhale, gently tense your abdomen and tilt your tailbone towards your abdomen, pushing your lower back into the floor. Maintain this position for 8-10 seconds, then repeat 8-10 times. Do not perform this exercise for 6-8 weeks after C-section.
• Abdominal strengthening – simple exercises such as crunches and leg lifts can be very effective in regaining abdominal muscle strength after pregnancy. However, these exercises should not be started until after the gap between the abdominal muscles has closed, which can take 4-8 weeks after delivery.
3) Handling your child – Here are a few tips on different scenarios on how to position yourself when carrying your child to avoid injury:
• Avoid carrying your child in a car seat for prolonged periods of time. The seat has to be carried away from your body, which puts incredible stress on your low back.
• When lifting the child up out of the crib, put the crib side down and pull the child toward you. Do not bend over the crib wall and lift the baby over the top.
• Do not stand outside the car and try to place the child in the car seat. Kneel on the back seat as you place the baby into the car seat.
• Consider using a "baby sling" to carry your child when walking. Do not carry a child on your hip; this overloads the back muscles.
Can anything else be done?
In the event that activity modification or other conservative treatment (physical and massage therapy, medication, acupuncture, chiropractic, etc.) do not adequately control your symptoms, remember that you do not have to give in and just live with the pain. There are many simple, minimally invasive procedures that can significantly improve your pain, improve your quality of life and allow you to be an active mother without feeling constrained. Some of these procedures include:
1) Facet joint injection – this is used for people who have low back pain related to the small joints in the spine. Many times, because of the increased stress placed on these joints during pregnancy and afterwards, the joints become irritated. This can be difficult to treat, as the inflammation can persist for months. By placing medication into the joint, the inflammation can be reduced and pain alleviated.
2) Sacroiliac joint injection – during pregnancy, this joint (formed between the spine and pelvis) is excessively mobile and can become painful and inflamed. Additionally, the tissues inside the joint become overstretched, inflamed and painful. Under X-ray guidance, steroid medication can easily be placed in the joint to reduce pain and break the inflammation cycle.
3) Coccyx injection – during the delivery process, excessive pressure and mobility can occur at the coccyx (tailbone). Pain after pregnancy over this bone is referred to as coccydynia. This can very debilitating, as women with this have difficulty sitting, going to the bathroom, etc., due to pain. By performing a nerve block to the coccyx, the pain can be significantly reduced, improving quality of life.
Thankfully 4 out of 5 women do not have any post-natal back pain issues. However, for the 1 in 5 that do experience persistent pain, it can be a significantly debilitating condition. Now that you know even a debilitating condition is treatable, the key to successful outcome would be to seek treatment with a medical professional who specializes in managing these conditions. Also, make sure that any treatment you receive is performed in a safe manner (injections under X-ray guidance, etc.). This way, you can ensure you get the results you want: no distraction from back pain, lending way to a more peaceful mind and person to devote to your family.
The information and images in this article were provided by Dr Ryan Pfeifer and IWS. Dr. Pfeifer is Medical Director of the Back Clinic with IWS, focusing on minimally invasive, non-surgical management of neck and back pain. He is seeing patients full-time in Shanghai (clinics in Pudong and Puxi) and Guangzhou. For more information, please visit www.westernsurg.com. Dr Pfeifer recently joined our panel of experts as pain management specialist.