Well….Lets back up a few months.
Stacy as we will call my patient for privacy is a 32-year-old new mom who began to experience low back pain at week 30. She described the pain as achy and unstable. Now if you are a mom, you can probably relate to this. Many women report low back pain at some point during their pregnancy. The interesting part about low back pain during pregnancy is it’s very unpredictable. Some of my patients go into pregnancy with low back issues that completely goes away during pregnancy and returns after giving birth and some patients have never had low back pain in their life and have terrible low back pain during pregnancy and it goes away the day the child is born.
Why is that you ask? Well, the answer is complicated because every patient is vastly different. If we’re just going based off my past experiences over the last 20 years, I find that my patients who are more into fitness and training entering pregnancy tend to do a little better regarding low back pain during pregnancy. Although not always. Remember these are just generalizations and don’t correspond to every patient.
Now back to Stacy. Stacy was super into surfing and beach volleyball. We love our beaches here in San Diego! As her pregnancy progressed, she was unable to do these as much as she would like. For obvious reasons. Stacy is very tall and lean so she was all belly. This created some biomechanical challenges.
The most common situation with low back pain in pregnancy is the instability of the sacroiliac joints due to ligament laxity in my experience. Remember ligaments attach bone to bone and don’t have a lot of elasticity. They are for support of the joints.
This was Stacy’s issue.
During the last trimester we worked on stabilizing the lumbar and pelvic areas, however nature wants to let that pelvis spread and give some laxity to the ligaments that support the pelvis in order to allow the baby to fit though the pelvic outlet during the birth process. Fortunately, we were able to give her some temporary relief through joint mobilization and pelvic stabilization which allowed her to survive that last 10 weeks.
Fast forward 3 months after her son was born. Once Stacy and her husband came up for air from the initial shock of caring for an infant, she was ready to tackle this now chronic low back pain. She was very anxious to get back in the water and playing beach volleyball. Due to limitations in time when having a newborn, I like to give as few exercises as possible so that I know the patients will do them. I went to my favorite…. The Glute Bridge. However, we put a little spin on it because most people can easily cheat doing a bridge. This one was focused on stability and coordination of movement of the muscles that support the pelvis and lumbar region.
In most cases involving new moms with low back pain, I find this more useful as opposed to a lot of joint manipulation. The reason being is many times the ligaments of the lumbar and pelvic joints are still hypermobile at this point and really crave stability. So even though it feels like they want to be “cracked” for lack of better terminology, what they really need is joint stability.
After 30 days of conservative care in the office and a home rehab plan Stacy is back to surfing and volleyball with no pain!