Pregnancy and Sciatica Pain
You will hear pregnant mums mention sciatica during pregnancy- but what is this? Sciatica describes pain felt along the sciatic nerve, which runs from your lower back through the buttock, hamstrings and into the lower leg. The sciatic nerve is the longest nerve in the body, originating from include L4, L5 and S1.
Sciatica causes pain that usually begins in the lower back and spreads through the buttock, leg, calf and, occasionally, the foot. The pain can vary between dull, aching, or burning sensations and sharp, shooting pains. Depending on the degree and cause of the sciatica, it can also cause tingling, pins and needles, numbness or muscles weakness in the affected leg. One or more of the following sensations may occur because of sciatica:
- Pain in the rear of the leg that is worse when sitting
- Burning or tingling down the back of the leg
- Weakness, numbness or difficulty moving the leg or foot
- A constant pain on one side of the rear calf
- A shooting pain that makes it difficult to stand
Whilst there are many causes different potential causes of lower back pain and sciatica (bulging or rarely herniated discs, spine degeneration, facet joint injuries, piriformis syndrome, spinal stenosis, spondoylolistesis, sacroiliac dysfunction) pregnancy can become a common cause. Low back pain and sciatica is commonly experienced during pregnancy (particularly the 2nd half) and is often poorly managed. Pregnancy lower back pain and sciatica typically happens where the pelvis meets the spine, at the sacroiliac joint (SIJ or the L5/S1).
The main reasons why pregnancy can cause sciatica are as followed:
Weight gain- during a healthy pregnancy, women will typically gain between 11-16 kilograms. The spine has to support this new weight, which can be a source of pain on its own, but If you already have a degenerative back this can make your pain worse by increasing the pressure and creating inflammation. Furthermore, increased weight through discs and facet joints can decrease the joint space and potentially compress the nerve roots of the sciatic nerve where they exit the spinal column. In the final trimester of pregnancy, the weight of the growing baby and uterus can also put direct pressure on the blood vessels and sciatic nerve in the low back and pelvis, which can cause sciatica.
Pregnancy related Postural changes are a huge contributor to sciatica.
Although it may be comfortable standing in a ‘sway back’ posture for too long is not good for your back. Due to the weight, your centre of gravity is shifted forwards, requiring you to lean back to try to compensate. In addition to weakened (or sometimes separated) abdominal muscles, you get increased extension (lordosis) through the lumbar spine and anterior pelvic tilt. This can compress facet joints and become a source of pain, as well as compress the nerve roots which irritate the sciatic nerve as demonstrated below.
Hormonal changes during pregnancy can also cause concerns with back pain. Relaxin, a hormone created by the body allows ligaments in the pelvic area to relax and the joints to become looser in preparation for the birth process. This same hormone can cause ligaments that support the spine to loosen, leading to instability and pain. This hormone generally takes 3-5 months after child birth to stop being released. Also, stress can cause muscle tension in the back, which may be felt as muscle spasms or pain can exacerbate your sciatica. You may find that you experience an increase in back pain during stressful periods of your pregnancy.
Sciatica is a clinical diagnosis based upon your symptom description, the behaviour of your pain and through physical examination. While the diagnosis of sciatica is reasonably simple, the primary cause of may require further investigations to eliminate or confirm its origin. The safest investigation for this while pregnant is MRI and can determine how significant the sciatic nerve has been compressed if this is occurring. Most of the time however, a scan is not necessary and can have a negative effect as it can increase worry and stress. At The Physio Movement our clinicians will examine you gently whilst paying particular attention to your spine and legs.
Depending on the cause of your sciatica found by your physiotherapist or chiropractor, there are treatment options available that can have great results for your pain. In early or acute stages, the focus will be on managing and reducing your pain and inflammation (if present). This can be done through pregnancy specific spinal mobilisations, manipulations (chiro), massage, bracing, taping, activity modification, education and specific exercises to address the causes. Once this initial stage is complete, the next phase will focus on restoring normal flexibility, posture and strength. After this the focus will be restoring full function and dynamic control and then preventing a recurrence if possible.
But if you are dealing with pregnancy related pains, please contact us at The Physio Movement to see one of our specialised women’s health expert, or book online Today.
References : Sehmbi, H., D’Souza, R., & Bhatia, A. (2017). Low back pain in pregnancy: Investigations, management, and role of neuraxial analgesia and anaesthesia: a systematic review. Doi: 10.1159/000471764
