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pelvic pain

Pregnancy-Related Back Pain: When Should I Worry?

Teaser: 

Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH,

is a Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor.

CLINICAL TOOLS

Abstract: Clinicians are often unsure if back pain during pregnancy is due to a musculoskeletal condition, an abnormality with the pregnancy or merely part of the common discomforts associated with gestational changes. Low back pain guidelines do not include pregnant women in their criteria and there have been no randomized clinical trials to determine specific causes of low back pain during pregnancy. This article will provide the clinician with a framework for identifying pregnancy-related back pain using a high yield history and key physical examination techniques to differentiate between mechanical back pain, sacroiliac instability and symphysis pubis separation. Risk factors for low back pain and warning signs for pregnancy complications will be identified. Appropriate management strategies will be provided for the management of pregnancy-related low back pain.
Key Words: pregnancy-related low back pain, pregnancy, pelvic pain, physical examination, management.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

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1. Probable Risk Factors for Low Back pain during pregnancy include: • Pre-pregnancy and past pregnancy low back pain • Low Back and Pelvic Trauma • Poor general physical condition • Joint Hypermobility • Increase body weight
2. Pregnancy related low back or pelvic pain is defined as intermittent or constant pain in the lumbar, buttock, pelvis, groin and/or upper thigh area lasting for more than one week.
3. Exercise, education and postural advice are the mainstays of treatment and can be enhanced by short term therapy with a rehabilitation professional.
1. Patients who have low back pain, in any trimester, associated with vaginal bleeding, uterine contractions, fever or hematuria should be immediately referred for obstetrical consultation.
2. The three most common causes of low back pain in pregnancy are mechanical low back strain, sacroiliac instability and symphysis pubis separation; they often occur together.1,2
3. Patient with Symphysis Pubis Dysfunction complain of significant pain during most of these activities: • Walking • Climbing Stairs • Turning in Bed • Standing on one Leg • Rising from a Chair
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