Pregnancy is a special time and a woman’s body experiences many changes in preparation to nurture the developing fetus and prepare the mother for labor and delivery. Symptoms like breast tenderness in the first trimester to backaches in the third trimester are common.
These changes influence normal body biomechanics, changes in the center of gravity, and increasing ligament laxity from the release of the relaxin hormone, which is crucial for loosening the muscles, joints and ligaments during pregnancy to prepare for the birth of the fetus. The relaxin hormone affects all the muscles, joints and ligaments in the body, not just the abdomen and pelvis.
There are other physiological changes that occur during pregnancy, including cardiovascular, respiratory, hematological, immune, and hormonal. For the purpose of this article, let’s focus on the musculoskeletal changes that occur during pregnancy and how we can help our patients manage them.
Postural Changes of Pregnancy
A pregnant woman’s entire posture changes as the fetus increases in size and weight. The abdomen transforms from flat to convex (bulging outward), increasing the lordosis of the lower back and creating additional strain on the lumbar muscles that compensate for the loss of abdominal muscle tone and strength. The weight of the fetus, the enlarged uterus, the placenta, and the amniotic fluid add to the increasing lordotic curvature.
These changes increase the axial load of the spine and change the center of gravity, causing forward tilting of the pelvis and hyperextension of the upper back, which puts a large strain on the woman’s joints, bones, ligaments, and muscles.
Low Back / Lower Extremity Pain
As a result, pregnant women often experience back, pelvic, knee, ankle and foot pain and swelling. The pain could radiate into the buttocks, thighs, and legs, similar to sciatica-type symptoms. Pain may be constant, interfere with sleep, and/or reduce overall function. While the symptoms usually resolve spontaneously after delivery, some women may experience these conditions as chronic disorders.
Studies had shown that about half of the reported lumbopelvic pain was diagnosed as pelvic girdle pain (PGP) during pregnancy and about one-third as low back pain (LBP).
Women with pre-existing lower back problems are typically at a higher risk of developing postpartum-related back pain, with continued back pain complaints and symptoms up to two years postpartum.
Foot Problems Can Also Occur
Many women also experience changes in foot growth and shoe size during pregnancy, increasing the shoe size and width while lowering the foot arch height.
Overpronation of the foot occurs when subtalar eversion, ankle dorsiflexion and forefoot abduction are excessive. These three distinct motions of the foot occur simultaneously during the pronation phase of gait, causing the feet to turn in, abnormally creating flat feet.
Overpronation develops when the dense band of tissue in the arch of the foot becomes strained and inflamed due to increased weight coupled with ligament laxity produced during pregnancy. Increased flexibility of the ligaments and dropping of the arch results.
Walking can become very painful, and women may experience increased discomfort and strain on the feet, calves and low back.
Increased foot pronation alters the biomechanics during the gait cycle, which in turn may lead to changes in posture (specifically the lumbar and pelvic region), contributing to LBP and PGP during pregnancy.
Having a low arch or flat feet is a known cause of foot pain in the bottom of the feet (plantar fasciitis), swelling along the inside of the ankle, and increased knee and hip problems.
Other symptoms may include foot drop seen in patients pre- and postpartum, a complaint of inability to dorsiflex the foot while walking, creating gait instability.
How to Help Alleviate Symptoms
Great treatments for back and foot pain include chiropractic manipulation, acupuncture, total body support from custom flexible orthotics that support all three arches of the foot, a healthy diet, and exercise such as walking or water aerobics for low-impact exercise to promote overall good health.
It is recommended that patients maintain a healthy weight. An increase in body weight adds to the pressure on the feet, which can cause the arches to flatten out, resulting in the feet gaining width or length of up to one-and-a-half shoe sizes.
Also recommend that patients avoid wearing excessively high heels, as they increase pressure on the feet; as opposed to wearing low heels or flats, which will keep the feet much more comfortable.
Choose shoes with cushioning; stretchy ballet flats and loose-fitting over-the-counter flip-flops are tempting, but they lack the support needed by the feet. Custom, flexible three-arch orthotics provide extra cushion to the feet and arches, and are available in styles for many shoe types.
Giving arches the support they need by adding custom orthotics to the shoes or providing flip flops with custom stabilization built in will keep the feet comfortable as they change during pregnancy. Other recommendations include:
- Taking short breaks during the day and elevating the feet to relieve pressure and swelling
- Wearing seamless socks that do not constrict circulation
- Stretching the legs frequently and avoiding crossing the legs when sitting
- Stretching the body daily and avoiding walking barefoot
- Regular use of custom orthotics to support the feet while stabilizing the heels, thus helping prevent overpronation while their bodies return to their pre-pregnancy status
Clinical Takeaway
Pregnancy is a time of amazing physical change and adaptation in response to the continuing stresses placed on the body. Help your patients adapt to these changes with continued chiropractic care and your outstanding lifestyle recommendations.
Resources
- Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database Syst Rev, 2015 Sep 30;2015(9):CD001139.
- Poděbradská R, Šarmírová M, Janura M, et al. The effect of physiotherapy intervention on the load of the foot and low back pain in pregnancy. Ceska Gynekol, 2019 Winter;84(6):450-457.
- Ojukwu CP, Anyanwu EG, Nwafor GG. Correlation between foot arch index and the intensity of foot, knee, and lower back pain among pregnant women in a South-Eastern Nigerian community. Med Princ Pract, 2017;26(5):480-484.
- Hall H, Cramer H, Sundberg T, et al. The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain: a systematic review with meta-analysis. Medicine, 2016 Sep;95(38):e4723.
- Carvalho MECC, Lima LC, de Lira Terceiro CA, et al. Low back pain during pregnancy. Rev Bras Anestesiol, 2017 May-Jun;67(3):266-270.
- Karadag-Saygi E, Unlu-Ozkan F, Basgul A. Plantar pressure and foot pain in the last trimester of pregnancy. Foot & Ankle Int, February 2010;331(2).
