Persistent and Pernicious: Postpartum Lower Back Pain

Pregnancy brings with it a slew of side effects, child aside, including morning sickness, swollen feet, cravings, and of course, back pain. 50-80% of pregnant women report lower back pain (LBP), whilst one-third of them deem it a significant problem [1]. In particular, post-partumback pain is concentrated in the lower lumbar area and is musculoskeletal in nature. Typically, pregnant women experience both lumbar and pelvic pain, and mechanical, hormonal, circulatory, and psychosocial factors have been implicated as causes. We have an article that delves more deeply into lower back pain during pregnancy and how our product, the Biostabilizer, can help in its treatment. Nevertheless, for many women, lower back pain persists far after pregnancy, a topic that has not received nearly as much attention from the scientific community [2].

The research investigating whether the persistence of LBP before pregnancy is a strong predictor of continued LBP after delivery is hotly divided. A prospective study conducted by Turgut and colleagues suggests that pregnant women who have a history of back pain prior to pregnancy were more likely to experience LBP postpartum [3]. Similarly, To and Wong (2003) found that a history of back pain prior to pregnancy or during pregnancy was a strong predictor of persistent postpartum LBP [4]. However, these results were found to be especially true for young multipara women by Turgut and colleagues but for older women by To and Wong (2003). Contrastingly, Padua et al. (2005) recommend the converse based on their study; women who do not have a history of LBP prior to pregnancy but report LBP while pregnant should receive more attention because the possibility of improvement is poorer [5]. On the other hand, women with a history of back pain prior to pregnancy experience a temporary worsening of the condition. While there is credible literature supporting both perspectives, these discrepancies in findings call for more research to be done.

Postpartum LBP may have long-lasting consequences; Norén and colleagues found that out of 173 women who had experienced LBP during pregnancy, 23% reported continued LBP 3 years after delivery [2]. Using a self-reported disability scale, these researchers investigated lumbar pain, pelvic pain, and combined pain during housework, shopping, walking for more than 20 minutes and exercise. Interestingly, they found that different types of pain made certain activities more difficult than others. For example, women who had pelvic pain found walking and climbing stairs more painful while women with lumbar pain did not. These researchers also conducted specific endurance tests for back muscles from which they hypothesized that persisting postpartum LBP was a result of insufficiency in the large pelvic and dorsal muscles.

Consequently, To and Wong (2011) found a possible correlation between reduced bone density and persistent postpartum LBP [6]. Of the 60 women who reported back pain during pregnancy, 40% reported persistent back pain after childbirth. These researchers compared bone mineral density (BMD) levels during pregnancy and after and found that women who did not experience persistent LBP after delivery had recovered the BMD loss they had during pregnancy. These results suggest that persistent LBP is related to an inability to recover from the BMD loss during pregnancy.

Other risk factors for persistent postpartum LBP at 24 months that have been cited in the literature include the onset of severe pain early on in the pregnancy and an inability to reduce weight to that prior to pregnancy [4].

Lastly, the effectiveness of physiotherapy and exercises for LBP relief have had mixed findings. A study on Korean women suggests that back pain relief programs could not reduce the severity of postpartum LBP [7]. Then again, To and Wong (2003) note research that shows active physiotherapy has beneficial effects in reducing postpartum LBP [4].

To conclude, postpartum LBP might have its roots in LBP prior to and during pregnancy and has been linked to BMD and weight gain. However, research evaluating postpartum LBP and LBP is divisive, and as a result, more research is needed to draw confident conclusions.

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References

1. Sabino, J., & Grauer, J. N. (2008). Pregnancy and low back pain. Current Reviews in Musculoskeletal Medicine, 1(2), 137–141. https://doi.org/10.1007/s12178-008-9021-8
   
2. Norén, L., Östgaard, S., Johansson, G., & Östgaard, H. C. (2001). Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. European Spine Journal, 11(3), 267–271. https://doi.org/10.1007/s00586-001-0357-7
   
3. Turgut, F., Turgut, M., & Çetinşahin, M. (1998). A prospective study of persistent back pain after pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 80(1), 45–48. https://doi.org/10.1016/s0301-2115(98)00080-3
   
4. To, W. W., & Wong, M. W. (2003). Factors associated with back pain symptoms in pregnancy and the persistence of pain 2 years after pregnancy. Acta Obstetricia Et Gynecologica Scandinavica, 82(12), 1086–1091. https://doi.org/10.1046/j.1600-0412.2003.00235.x
   
5. Padua, L., Caliandro, P., Aprile, I., Pazzaglia, C., Padua, R., Calistri, A., & Tonali, P. (2005). Back pain in pregnancy: 1-year follow-up of untreated cases. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 14(2), 151–154. https://doi.org/10.1007/s00586-004-0712-6
   
6. To, W. W. K., & Wong, M. W. N. (2011). Persistence of back pain symptoms after pregnancy and bone mineral density changes as measured by quantitative ultrasound – a two year longitudinal follow up study. BMC Musculoskeletal Disorders, 12(1). https://doi.org/10.1186/1471-2474-12-55
   
7. Oh, H. E., Lee, Y. S., Shim, M. J., & Kim, J. S. (2007). Effects of a Postpartum Back Pain Relief Program for Korean Women. Journal of Korean Academy of Nursing, 37(2), 163–170. https://doi.org/10.4040/jkan.2007.37.2.163