By Maternity Physiotherapist Maria Jokela*
Change is a constant in a pregnant mum’s body, with the most noticeable adjustments happening in the abdominal area. The functions of the middle part of your body go through considerable transitions, due to drastic fluctuations in your hormonal activity, and the seemingly ever-growing belly.
As your belly grows, you whole body begins to reposition forward. This leads to your pelvis also tilting forward while the lower back flexes, increasing the arch of the sternum. With your abdomen increasing in size, you need to adapt to this change of balance: to not to fall forward, your body has to find a way to correct your position so that the balance is regained in the middle.
During the last trimester of pregnancy, all pregnant mums experience abdominal separation, of varying degrees. This is also due to your growing abdomen; when your belly increases in size, the white tendon seam between the straight abdominal muscles stretches, leading to these muscles to stretch as well and to shift to the sides.
At the same time, stretching happens in other abdominal muscles too, reducing the overall muscle support to the middle section of your body. Your body tries to find ways to make up for the decreased support to the core by utilizing your superficial back muscles, which can cause your lower back become tense, tired, and sore. As a result to this shift in the centre of your body, the pectoralis muscles (the large muscles in your chest) are also under strain, as is the area of the hip flexors (this is the group of muscles at the top of your thigh, in the pelvic region.)
Hormonal effects of pregnancy
Pregnancy is a whirlwind of hormonal fluctuation: in addition to oestrogen, relaxin and progesterone are key players when it comes to physiological changes in your body. These hormones prepare you for birth and labour by loosening your joints and muscles, ligaments and supporting tissues. You may notice an increased joint mobility, particularly in the pelvic area, as the sacroiliac joints (SI joints) and pubic joint become looser, to allow the pelvis to open during birth. Due to the loosening of ligaments and the weight gain, it is not unusual for the arches of your feet to also lower. This in turn also affects the position of your whole body.
What are the most common gestational pains?
These considerable anatomical changes inevitably lead to varying levels of discomfort in most pregnant women. Over 70% of pregnant mums experience pain in their lower back and pelvic area. The lower back pain is largely caused by the aforementioned changes, i.e., the growing belly and the softening of the supporting tissues.
What causes pelvic pain is not quite as clear cut, but the increased mechanical pressure on the pubic joint, due to the growing abdomen, and the softening pelvic support structures, together with changes in posture and challenges in pelvic control are believed to be likely contributors.
Round ligament pain as another relatively common pregnancy symptom. Round ligaments are a pair of ligaments in your pelvis, holding your uterus in place. In a non-pregnant body, the round ligaments are thick and short, contracting and loosening slowly. However, in pregnancy, as the belly size increases round ligaments stretch in response to the growth and they can become tense, like an overextended rubber band. Movement causes stretching of these ligaments, and can lead to shooting, sharp pain in the buttocks, hips, thighs, lower back, groin, or perineum (the area between the anus and the genitals) in addition to the pubic joint. Round ligament pain typically occurs during a physical activity and may be mild in intensity and occur only momentarily. In some cases, the pain can be debilitating, causing the pregnant mum to be very limited in her daily activities.
How can these pains be alleviated?
To prevent and ease off pain in the back and pelvic region, start by paying attention to your posture; relax your knees a little when standing to ease the lower back flexion. When sitting, don’t slouch, rather try to sit up and prop yourself up with a few cushions if need be. At night, have a support pillow or two handy; sleep on your side and place a pillow between your knees which should prevent your lumbar spine from twisting and causing pain. If you sleep on your back, tucking a pillow beneath your knees should stabilize your lower back and bring a bit of relief.
Like your whole body, your back doesn’t like to be in the same position for a long period of time. Keeping physically active is the key in preventing and relieving pain in the back and the pelvic area.
Try to incorporate a variety of exercises in your daily routine to strengthen the muscles that support your core and the pelvic area. When you lie down for a bit of a rest, lift your legs to a 90-degree angle on a stack of cushions, on a piece of furniture or up against a wall. Keep them bent at this angle at the hip and knee joints, with the knees and the ankles aligned with the hips. Once in the correct position, gravity goes to work and takes some of the pressure off your lower back.
Experimenting with heat and cold packs on your back could also be useful. Cold therapy reduces blood flow, helping to minimize swelling and inflammation, which, in turn, eases your pain. Heat treatment promotes blood flow and helps muscles relax. Try which one works for you.
Staying active is imperative during pregnancy, for the well-being of your back and hips (and for your mind!), but at the same time only exercise within your limits and take care to allow your body adequate rest. Listen to your body’s responses closely, to always make sure the exercises aren’t causing you or your baby any harm.
What kind of help can pregnancy support belts offer and to whom are they suitable?
A well-fitted pregnancy support band can help with discomfort or pain. There are quite a number of different types of support bands out there; try on different kinds of bands to find one that helps you to keep active; supports your core in the way that you can walk or do other exercises without pain or within a level of tolerable discomfort. A support band can relieve both, lower back and pelvic pain by assisting you to correct your posture, support your abdomen, hips and lower back. In a way, the belt acts as a reminder to retain a good posture, which in turn helps you maintain your balance.
Support to your abdomen may also give relief to the strained muscles in your lower back. There are different types of support bands for different stages of pregnancy – so long as the band feels good, they can be worn without a concern.
If the pain you are experiencing is severe, do consult a physiotherapist, osteopath or chiropractor who specializes in pregnancy treatments, to establish an exercise routine that suits your circumstances.
As you can see, pregnancy has a comprehensive domino effect on your entire core function and posture; the shift in hormonal balance and the growing belly change everything. These factors nudge and encourage the rest of your body to also get on with it, and to adapt to changing conditions.
*Maria is Lola&Lykke's Maternity and Pelvic Floor Physiotherapist and expert. Her areas of expertise include overall female health, in particular women's well-being during and after pregnancy. Maria is interested in the physical changes pregnancy brings to a woman's body. Regarding postnatal recovery, she specialises in pelvic floor dysfunction, pelvic pain and rehabilitation of diastasis recti. Treating babies and children too, her passion for women's health derives from own lived experiences during postnatal recovery.
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