Night backache in pregnancy (also Pelvic pain after delivery) 
Author Message
 Night backache in pregnancy (also Pelvic pain after delivery)



See below...

Julie Colliton, MD, please see "Gastaldo remarks," below.

> Hey everyone!

> My turn to ask for advice.  :)  I am having terrible back pain at night,
> lately.  I'm generally fine during the day, but at night, I get bad
> and lower back pain, increasing until I get up again in the morning.  It's
> been waking me up multiple times each night.  (Wouldn't you know, just
> my daughter started sleeping through the night again.  <grin>)   I have
> going to bed with a hot water bottle to my lower back, which helps to go
> sleep, but really, I'm fairly uncomfortable all night long.   Any idea why
> this would be, or what I could do?  I'm 18 weeks along, iirc.  And our
> mattress is very firm, so it isn't a soft mattress thing.

> All suggestions and advice would be greatly appreciated.

> Thanks!

> Donna



I liked Naomi Rivkis's reply (relating input from her childbirth educator
and her doctor)...

"Hate to say it, but it sounds exactly like mine and it's lasted
straight through the present day (I'm 38 weeks). My childbirth
educator says that the entire uterus is attached to the back by three
ligaments all of which connect at pretty much the same place, so when
you lie down they all pull with the weight. No wonder that place and
the area around it hurt!

"Best I've found for it is piling a lot of pillows around me, so that
whatever way I turn I've got support under my legs, my {*filter*}s, my
back and my belly. Unfortunately this works best when it is combined
with turning over frequently, and getting up periodically (which I'd
have to do to go to the bathroom anyway) and if you have the pillows
all over, both of these can require rearranging annoying amounts of
the time. (I've given up by now keeping large pillows on the outside
edge of the bed -- I don't wanna have to climb over them to get to the
bathroom!) I still hurt a lot of the time, I still go to bed with
pre-emptive Tylenol about half the evenings, and morning still aches.
But I can sleep. That's the best I've managed so far, and my doctor,
while sympathetic, says it's the best she can suggest."

Naomi MAY have tried joint manipulation but to no avail...  She doesn't

Then again, perhaps her doctor cautioned her against joint manipulation...

Here's an excerpt from an article by an MD who says pregnant women "should
avoid...joint manipulation procedures."

My remarks follow...
Julie Colliton, MD
Back Pain and Pregnancy: Active Management Strategies
Nocturnal pain. Some women have night back pain exclusively, others have
both night pain and lumbar or sacroiliac pain....

Treatment Options
Initial treatment for pregnant patients with low-back, sacroiliac, or night
pain consists of modalities such as heat and ice. Acetaminophen may help
relieve the patient's pain. Nonsteroidal anti-inflammatory {*filter*} are
contraindicated during pregnancy. When pain is extremely severe, certain
narcotics may be appropriate. Massage therapy may provide short-term pain
relief. Pregnant women with back pain should avoid whirlpool treatment as
well as joint manipulation procedures...

...Physicians can teach women the neutral spine posture that avoids
excessive lumbar lordosis and excessive reversal of lumbar lordosis. Women
can be instructed to perform all activities in the neutral spine posture...

Remember: This information is not intended as a substitute for medical
treatment. Before starting an exercise program, consult a physician.Dr
Colliton is a physiatrist with Denver Spine & Rehabilitation in Denver. She
is a member of the Women's Sports Medicine Committee of the American College
of Sports Medicine and a team physician for the US Disabled Ski Team.
--Julie Colliton, MD



Check with your licensed health care provider but...

1. I totally disagree with Julie's Treatment Options admonishment that
"Pregnant women with back pain should avoid...joint manipulation."

Two CNMwives, Benetti and Marchese may recommend joint manipulation.  They
indicate they make referrals to
chiropractors "when necessary." [Benetti MC, Marchese
T. Primary care for women: management of common musculoskeletal
disorders. JNM 1996;41:173-87]

I'm no longer licensed or in spinal adjusting practice - but pregnant women
were my favorite patients - they are SO easy to adjust - and so grateful
afterward - many hugs...

I don't remember adjusting any women with solely night backache though...

2. I think Julie's advice to do everything with a "neutral spine posture
that avoids excessive lumbar lordosis and excessive reversal of lumbar
lordosis" may be wrong.

I say this because squatting - near TOTAL reversal of lumbar lordosis - for
prolonged periods - is a normal rest posture for most pregnant humans.

Perhaps, though, when humans have low back pain they *should* do everything
with a "neutral spine posture that avoids excessive lumbar lordosis and
excessive reversal of lumbar lordosis." (?)

I'm not so sure... Canadian orthopedic surgeon W. Harry Fahrni, MD indicated
in 1975 (Orth Clin N Am) that reversing the lumbar lordosis helped people
with back pain by letting the posterior quadrant of the disc heal...

Then again:  New Zealand (?) physiotherapist Robin McKenzie discovered a
whole therapy system (his McKenzie Protocol) when a low back patient cured
himself by getting on an exam table and INCREASING the lumbar lordosis - at
least that's what I remember from a presentation Robin gave years ago at a
spine conference.   I don't think McKenzie advocates increasing the lumbar
lordosis in all patients though.

The fact that most humans on the planet routinely reverse their lumbar
curves for prolonged periods (flat-footed squat) has always intrigued me.
JUST THINK!  This culture robs its children of a way to rest on their feet!

I myself do "half-squats" for prolonged periods because I have lost my
innate comfortable prolonged squatting ability.  Standing, I often put one
foot on a table so half of my body is in a full squat.  I alternate sides...

My recollection is that two spine researchers say that reversing the lumbar
curve is true rest for the lumbar spine BECAUSE it reverses the lumbar
lordosis thereby EVENLY squeezing fluid out of the discs thereby helping
them to imbibe nutrition during the night when they aren't weightbearing.

Bottomline, if you are suffering low back pain - or not - check with your
licensed health care provider before implementing anything suggested here.


Dr. Gastaldo

Julie:  I think you mentioned sacroiliac pain and prolonged sitting.

I think late second stage on the back - on the sacrum - may cause sacroiliac
pain or at least inhibit labor neurologically - the sacrum being torqued
exactly the opposite direction it is supposed to move to let the baby
through - which of course MECHANICALLY inhibits labor.

The at-term sacroiliac biomechanics were described early last century.

For details...

See PhD husband of a CNM...


According to Dutch researchers Mens et al. [1996], "Maximal flexion of
spine and hips" during delivery might enhance the risk for peripartum
pelvic pain (PPPP). [Mens JMA, Vleeming A, Stoeckart R, Stam HJ, Snijders
CJ. Understanding peripartum pelvic pain: implications of a patient
survey. Spine 1996;21(11):1363-70.]

Unfortunately, Mens et al. don't state exactly what they mean by "maximal
flexion of spine and hips."

I suspect they may be referring to - and cautioning against - the
birth-canal-closing "Bradley Classic" delivery position where the woman sits
in maximal flexion - squarely (and only) on her buttocks/sacrum during
delivery? (Semisitting delivery is also recommended by ASPO/Lamaze.)

Norwegian physiotherapist N Bj?rnstad similarly cautions against sitting
on the sacrum at delivery:

"Birth positions recommended are...various sitting positions where sacrum
will not be locked against the bed...avoid unnecessary stretching of the
pelvic ligaments and locking of the joints." [Bj?rnstad N. Obstetric
physiotherapy, observation and treatment (abstract). Scand J Rheumatology
1991; Suppl. 88:22-23. (N. Bj?rnstad, Bjerk?sen 5, 1310 Blommenholm,

One last matter...

Mens et al., just quoted, cited radiographic studies from the 1930s but
failed to cite Borell and Fernstr?m's 1957 radiographic study, when they
referred to increased sacroiliac mobility during pregnancy as having been
"observed in an anatomic study and in radiographic studies."

Borell and Fernstr?m's work is decades old but is still cited in the 1995
British Gray's Anatomy as evidence that "radiological pelvimetry has
become a refined technique" (p. 671).

British obstetrician Jason Gardosi, MD cites Borell and Fernstr?m's 1957
work in the OB-GYN-List archive to support a point on which he and I

Many cases of shoulder dystocia are caused by jamming the sacral
tip up to 4 cm into the pelvic outlet.

See my posts in the OB-GYN-List

As noted above, the at-term sacroiliac biomechanics were described early
last century.

For details...

See again: PhD husband of a CNM...

Thanks for reading everyone.



Dr. Gastaldo

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Thu, 10 Aug 2006 10:29:53 GMT
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