Sacroiliac Joint Dysfunction during Pregnancy
Treating Lower Back Pain Caused by the SI Joints in Pregnant Women
Jul 6, 2009
Pregnancy is full of aches and pains, including backache. But many cases of lower back pain in pregnancy (many incorrectly diagnosed as sciatica) are actually due to problems with the sacroiliac joint.
Location and Function of Sacroiliac (SI) Joint
The sacroiliac joints, or SI joints, join the sacrum (located at the base of the spine) and the ilium of the pelvis. People have one on the left and one on the right, about an inch from either side of the spine at the small of the back.
SI joints are critical weight-bearing joints in the body. They absorb shock while walking, provide stability during the initial "push off" step, and maintain balance by locking and unlocking as weight is transferred from one leg to the other.
Lower Back Pain in Pregnancy
Most women experience some degree of back pain during pregnancy, and assume that it is due to the weight of the baby pulling the back forward.
But it is estimated that 20% of all pregnant women suffer from back pain due to hormonal changes to their SI joints. Pregnant women's bodies release a hormone called relaxin, which loosens the ligaments (including those around the SI joints) in the pelvis in preparation for delivery.
Signs and Symptoms of SI Joint Pain
Women with sacroiliac joint problems describe a sharp, stabbing pain felt in the lower back or hip during weightbearing activities. It may feel like one leg suddenly "goes out" when walking and makes it impossible to go on without limping.
Staying in one position for too long may cause a dull aching sensation. SI joint problems usually appear during the second trimester, are concentrated on one side of the body, and get worse as the day goes on.
Activities that cause sharp back pain include climbing stairs, rolling over in bed, walking (especially across uneven surfaces or downhill,) getting up from a sitting position, sitting down from a standing position, jogging or running (even for just a few seconds,) and getting into and out of the car.
Misdiagnoses of Sacroiliac Dysfunction: Hip Problems and Sciatica
Sacroiliac joint pain can be extremely hard to diagnose, even for health professionals. Since it is often felt in the hips, doctors may end up searching for a nonexistent hip problem.
SI joint pain often radiates through the thigh and leg, causing it to be mistaken for sciatica. True sciatica, however, is very rare in an otherwise healthy pregnant woman with no previous history of back problems.
Relieving Sacroiliac Pain during Pregnancy
Practically every motion of the human body involves the sacroiliac joint, which means that a stretched-out SI joint can be extremely debilitating.
Temporary at-home back pain relief in pregnancy could come from using a heating pad or taking acetaminophen (Tylenol.) Doctors can also prescribe a special sacroiliac belt that holds the pelvis tightly together.
The following self-care lifestyle modifications can also help:
- Avoid climbing or descending stairs when possible
- Always sit with pelvis firmly tucked underneath the body, legs parallel to the hips, both feet flat on the floor (never with legs crossed)
- Walk slowly and smoothly to minimize shock to the SI joints
- Don't step into the car with one leg and swing the other in after it; sit down with both legs out of the car, then swing them both in together
- Sleep on one side with a pillow between the knees
- Never bend and twist at the same time
- Lower slowly to sitting rather than "plopping" or "falling" into a chair
- Vary between sitting, standing, walking, and lying down; do not keep to one position for more than 30 minutes
- Lie on the floor with the knees bent and do a pelvic tilt (squeezing the buttocks and pushing the pelvis upward) when it feels like the SI joint has slipped out of place
Sacroiliac Joint Problems Persisting Beyond Pregnancy
Most pregnancy related SI pain symptoms go away after the pregnancy is over. However, nursing mothers may find that their pain continues, because lactating women release higher-than-normal levels of relaxin as well. A doctor may advise to discontinue nursing in the case of severe SI joint pain.
Physical Therapy and Surgical Treatments for SI Joint Problems
A physical therapist can teach women the best way to perform daily activities with the least damage to the SI joint, and can also demonstrate stretches and exercises to improve back pain. It is not recommended to visit a chiropractor for SI joint problems, as they may accidentally cause irrevocable damage to the joint.
In extreme cases of sacroiliitis, surgery to fuse the joint may be performed. However, having the joint fused extremely limits a person's possible range of motion and may lead to other complications. For this reason, surgery should be used only as a last resort.
The release of the hormone relaxin causes many pregnant women to suffer from back pain due to loose sacroiliac joints. In most cases the problem will resolve itself after the pregnancy, but in the meantime there are many postures and home remedies that can relieve SI joint back pain.
Sources:
www.spine-health.com
www.webmd.com
personal experience with SI dysfunction in pregnancy
personal interview with a sufferer from severe pregnancy SI dysfunction
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