Pregnancy is a beautiful and transformative time in a women’s life, but it’s not without its physical challenges. While each pregnancy is unique, many women experience some common conditions that can cause discomfort or even pain. These include sacroiliac (SI) joint pain, pubic symphysis pain, low back pain, sciatica, and even pelvic organ prolapse. The good news is that most of these conditions are treatable, and with proper management, pregnant mommas can maintain a healthy, active lifestyle throughout their pregnancy. Okay Momma, let’s talk about common pregnancy-related conditions and how to manage them so you can get through this pregnancy!
SI Joint Pain
What is SI Joint Pain?
The sacroiliac (SI) joint connects the sacrum, the triangular bone at the base of your spine, to your iliac bones, the large bones that form your pelvis. These joints are crucial for distributing weight between the upper body and the legs, but during pregnancy, the added pressure and hormonal changes can cause a feeling of instability and pain. Pain can be felt in the areas that we think of as “the back dimples” on the lower lateral portion of our back, just to the sides of out very low back and can radiate throughout the back and into the glutes.
Why Does SI Joint Pain Happen During Pregnancy
Relaxin and Estrogen, hormones produced during pregnancy, loosens the ligaments that support the SI joints, causing them to be more mobile than usual. As the uterus and baby grows and the center of gravity shifts forward, the added strain on the pelvis can worsen the feeling of instability. This often leads to SI joint pain, which can present as sharp, shooting pains in the lower back and buttocks.
Managing SI Joint Pain
- Strengthening exercises: Focus on core stability exercises, working on movements that work on the rotation frontal core muscles can help stabilize the SI joint and reduce pain. Make sure to also work on strengthening your inner thigh muscles called your adductors during this time too!
- Avoiding asymmetrical movements: Be mindful of activities that put uneven pressure on one side of the pelvis, like standing on one leg or sitting with crossed legs.
- Postural adjustments: Maintain good posture, especially when standing or sitting, to minimize stress on the SI joints. Work on keeping pelvis under rib cage and not jutting your bottom too far forward and keeping toes more forward vs rotated too far outward as this places unnecessary stress on those back side joints.
- Pelvic support belts: These belts can provide external support to the pelvis, helping to stabilize the joints and reduce pain. Try the ones specifically made for SI joint pain to help with allowing for some relief with your day to day.
Pubic Symphysis Pain
What is Pubic Symphysis Pain?
The pubic symphysis is the cartilage joint where the two sides of the pelvis meet at the front. During pregnancy, this joint can become more mobile due to hormonal changes and increased pressure on the pelvis and pelvic floor muscles, leading to a condition called Symphysis Pubis Dysfunction (SPD).
Why Does Pubic Symphysis Pain Happen During Pregnancy?
Similar to SI joint pain, the hormones estrogen and relaxin loosens the ligaments around the pubic symphysis, making the joint more mobile. The increased weight of the baby, coupled with pelvic widening, can cause misalignment and pain in the pubic area. It commonly gets aggravated with single leg movements and wide leg positioning.
Managing Pubic Symphysis Pain
- Avoiding activities that aggravate pain: Try to avoid movements that put extra strain on the pelvis, such as lunges, wide squats, or getting in and out of bed without rolling. Try sitting while you are changing to avoid standing on one leg and work on stepping sideways up and down stairs to avoid wide forward legged positions that can be aggravating
- Pelvic floor exercises: Strengthening the pelvic floor can help stabilize the pelvis and reduce strain on the pubic symphysis.
-Glute and Back Exercises: Working on the muscles known as your posterior rotational chain (glutes and back muscles) can help with providing some relief in your pubic symphysis. They help provide more stability and strength to avoid pain exacerbations.
- Using a pregnancy pillow or king size pillow between your legs. When sleeping, a pillow between the legs can help keep the pelvis aligned and reduce pressure on the pubic symphysis. Make sure your knees AND ankles are supported to have better hip alignment in sidelying.
Low Back Pain
What is Low Back Pain?
Low back pain is one of the most common complaints during pregnancy. It’s usually caused by the increased weight of the growing baby, postural changes, and the relaxation of ligaments due to hormonal shifts. Women who had back pain prior to pregnancy are more at risk for this worsening in pregnancy, but is something that can still be treated.
Why Does Low Back Pain Happen During Pregnancy?
As your baby grows, your center of gravity shifts forward, putting extra strain on the muscles and ligaments that support the lower back. There can be 2 main reasons a pregnant momma can get back pain.
- Not enough strength and support. Postural shifts and growing baby make your core, glute, and back muscles struggle more to turn on which means less lower back stability.
- Too much rigidity in the joints and muscles of the hips and low back due to attempting to overly stabilize, causing strain and pain muscularly.
Managing Low Back Pain
- Strengthening the core canister: A strong core canister can help support the lower back and reduce pain. When I say core canister, I mean pelvic floor muscles, deep core muscles, back muscles, and diaphragm. We want to work on stability of the middle of the body to make sure our other joints and muscles can work to move us through life. Working on exercises like bird dogs, dead bugs, bridges, paloff presses, and modified planks can all be helpful to build up stability strength.
- Maintaining good posture: Keep your shoulders back and your spine neutral to avoid excessive strain on the lower back. Keep pelvis lined up under your rib cage and avoid jutting your belly excessively forward
- Gentle stretching and yoga: While stability is important, we also need mobility in a controlled manner. Mobility can help alleviate tension in the back. Working on gently movement like cat cows, pelvic tilts on a physioball, happy baby pose, and child’s pose are great to start adding to your routine to reconnect to your body and work on some controlled mobility of your low back and pelvis.
Sciatica
What is Sciatica?
Sciatica occurs when the sciatic nerve, which runs from the lower back down through the buttocks and legs, becomes compressed or irritated. This can result in shooting pain, numbness, or tingling in the lower back, buttocks, and back of the legs.
Why Does Sciatica Happen During Pregnancy?
There are many reasons the sciatic nerve can get irritated. The most common is postures that place more strain and compression on the low back, muscles, and pelvic ligaments that the sciatic nerve travel under. The other more common one is the growing uterus can press on the sciatic nerve, especially in the third trimester when the baby’s head begins to move lower into the pelvis. This pressure can cause inflammation of the nerve, leading to the shooting pain called sciatica.
Managing Sciatica:
- Stretching exercises: Gentle stretches that target the piriformis and glutes can help relieve pressure on the sciatic nerve. The pigeon pose, figure 4 stretch, and seated cross body piriformis stretch are particularly effective.
-Sciatic nerve mobility: Working on nerve flossing can be helpful in promoting movement of the nerve to allow in to breath better and move better to relieve pain
- Postural adjustments: Avoid sitting or standing for long periods, and work on preventing the jutting forward of your hips to reduce strain on the lower back and sciatic nerve.
-Massage therapy/ physical therapy/ chiropractic care: Work with someone trained in relieving the muscular and ligamentous tension around the pelvis that may be causing excess pressure around the sciatic nerve.
- Swimming or Inversions: The buoyancy of water with swimming and inversion can take pressure off the sciatic nerve and provide relief from pain.
Pelvic Organ Prolapse
What is Pelvic Organ Prolapse?
Pelvic organ prolapse occurs when one or more of the pelvic organs, such as the bladder, uterus, or rectum, drops from its normal position and presses against the vaginal wall. This can happen due to the weakening of the pelvic floor muscles during pregnancy and childbirth.
Why Does Pelvic Organ Prolapse Happen During Pregnancy?
During pregnancy, the weight of the growing baby, combined with the increased pressure on the pelvic floor, can weaken the muscles and connective tissues that support the pelvic organs and cause more pressure on the pelvic organs themselves. Hormonal changes also contribute to the loosening of ligaments around the pelvic organs and bowel movement patterns can change causing more strain and pressure on the pelvic floor muscles. Childbirth, especially vaginal deliveries, can further increase the risk of pelvic organ prolapse due to the excess intra-abdominal pressure that happens with pushing and then the stretching and weakening of the pelvic floor muscles that happen with a vaginal birth.
Managing Pelvic Organ Prolapse
-Pelvic floor exercises: Strengthening the pelvic floor muscles through Kegel exercises can help support the pelvic organs and reduce the risk of prolapse. We want to work on longer endurance holds of these muscles, like holding for 5-10 seconds and releasing. You can work on these endurance strengthening skills with co-contraction of your deep core muscles as well to work on increased fascial support that can happen with transverse abdominis activation too. It’s important to focus on both contraction and relaxation of these muscles as sustained contractions all day are not beneficial as these muscles will fatigue
-Brace properly for heavy lifting: Lifting heavy objects can put additional strain on the pelvic floor, so it’s important to be mindful of pre-activating and bracing the pelvic floor and deep core muscles when lifting heavier weighted objects. Work on using your exhale and not holding your breath when lifting to prevent excess strain and pressure downward on the pelvic floor muscles.
-Posture and alignment: Maintaining good posture and proper pelvic alignment with pelvis under rib cage while avoiding rib flared postures can help reduce pressure on the pelvic organs.
-Consulting a pelvic floor physical or occupational therapist: A specialist can provide tailored exercises and advice to help manage symptoms and prevent worsening of the condition.
Modifying Movements During Pregnancy
While it’s important to stay active during pregnancy, modifying exercises and daily activities can help prevent the exacerbation of conditions like SI joint pain, pubic symphysis pain, low back pain, and sciatica. Here are some tips for safe movement:
- Modify high-impact activities: High-impact exercises, such as running or jumping, can put extra strain on the pelvis and spine and if these are causing you pain you may need to modify. Pain is not gain during this phase of your life and pushing through pain right now can make it worse for you. Opt for low-impact activities like walking, swimming, or stationary cycling instead.
- Focus on postural alignment: Proper alignment is key to avoiding pain and injury. Pay attention to your posture during activities, keeping your spine neutral and your pelvis aligned. Work on postural strengthening exercises as your body keeps changing throughout pregnancy to help avoid these aches and pains. (Attach link for postural strengthening IG reel)
- Listen to your body: If you experience pain during a movement, stop and assess. It’s important not to push through pain, as this can lead to further injury. Again, work on modification of a movement to see if you can make it less painful and still get the stimulus you are looking out of it.
- Use support: A pregnancy belt or abdominal support band can provide additional stability to the pelvis and lower back, reducing the risk of pain or injury during pregnancy.
Why It's Important to Address These Conditions
Pregnancy-related pain and discomfort can significantly affect a woman’s quality of life, making it difficult to enjoy this special time. Untreated conditions can also lead to more serious issues postpartum, such as chronic pain or pelvic floor dysfunction. By addressing these conditions early, mommas can improve their pregnancy experience and set themselves up for a smoother postpartum recovery.
It’s important to modify exercises and daily activities as needed to prevent the worsening of these conditions. Ignoring pain and pushing through discomfort can lead to long-term consequences, including postpartum pelvic floor issues, chronic back pain, and reduced mobility. Working with a pelvic floor physical or occupational therapist or another healthcare provider can help ensure that pregnant women are moving safely and effectively throughout their pregnancy.
Pregnancy brings about many physical changes, and while conditions like SI joint pain, pubic symphysis pain, low back pain, sciatica, and pelvic organ prolapse are common, they are not inevitable. Understanding the anatomy behind these conditions and how they develop can help mommas manage and prevent pain and discomfort throughout pregnancy. We hope you use the combination of education, modified movement, and external support recommendations to maintain your fitness and feel your best you prepare for motherhood!
References:
1. Artal, R., & O'Toole, M. (2003). Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. *British Journal of Sports Medicine*, 37(1), 6-12.
