Pregnancy and Unresolved Back Pain: Part 2 – Post-Partum Pain
Last week we focused on back pain during pregnancy. This week I want to focus on back pain after pregnancy. As mentioned before, 68% of women who experienced moderate to severe low back pain during pregnancy continue to have back pain after birth, according to Skaggs, 2004. Here are a few of the reasons back pain persists and what can be done to help.
There are significant postural changes that occur over the later 4-5 months of pregnancy. With those changes some muscles become shorter and others become longer. If exercises and stretches are performed during pregnancy, this is minimized. Unfortunately, those exercises aren’t always performed or sometimes aren’t enough to counterbalance the effects of pregnancy. In those instances, the imbalances persist and alter biomechanics going forward, giving rise to continued back pain.
To fix these changes it might be as easy as giving the same exercises and stretches we give to our expecting mothers. Stretch the quads and pecs, strengthen the glutes and back extensors, adjust a couple of joints and things are good. If that doesn’t work we start looking for trigger points and muscle adhesions (built up scar tissue). These trigger points and adhesions can cause muscles to be chronically tight or prevent a muscle from properly activating. To treat these we incorporate a mix of soft tissue techniques such as Functional Dry Needling (FDN), Active Release Techniques (A.R.T.) or Graston Technique. These techniques allow us to manually release trigger points and adhesions. FDN is a bit more invasive, but if a patient is willing and can tolerate a small needle, we can often get more beneficial results and sometimes even fix things A.R.T. and Graston cannot.
Causes of Scar Tissue Formation
Cesarean sections (C-section) are one of the most common causes of built up scar tissue and back pain in post-partum women. A C-section involves an incision that cuts completely through the abdominal wall. After the baby is delivered, the incision is sewn together and a scar forms in the muscles and skin. Scars, if properly healed, allow near perfect function of tissues, as long it forms a separate scar in each layer. Often this doesn’t happen. Even if the visible scar looks good, it can be attached to the layers below. This will prevent the different layers from moving independently.
Ordinarily, the skin, fatty tissue, and multiple layers of muscles stretch at different rates and independently of each other as we lean backwards or side to side. When a scar heals across these layers, the abdominal wall is prevented from stretching like it needs to. At this point, the lumbar vertebra (lower back bones), extend beyond their normal range of motion to make up for the lack of lengthening in the abdomen. As a result, chronic back pain comes about.
With post-partum women, especially those having had a cesarean section, we will assess their abdominal wall and scar (if present), for any adhesions. If found we strongly urge these patients to consider FDN. Putting a needle into these adhesions and scar tissue allows the body to rebuild the healed area. Eventually this allows the layers to move properly, taking strain off the low back.
Many women struggle with back pain after birth. Some even choose not to have any more children because of their back pain. Most post-partum women we treat have quick resolution of their pain with a few take home exercises and some additional soft tissue treatments.