hello this week we are going to talk about the aches and the Pains of pregnancy and
what you can do about them SI joint pain SPD round ligament pain sciatica lightning crotch
I have page with me about these things all the time and I have experienced them all myself so
hopefully this episode can help you if this is your first time meeting us I'm Sarah I am
a board certified OB GYN currently in the third trimester of pregnancy with baby number two and
I'm Kurt I'm a board certified pediatrician and Dad and we are the doctors bjorkman
foreign
welcome back as we mentioned this week is all about the aches and pains of pregnancy as they
are so common and almost everyone has to deal with them so we're going to start with why you feel
these pains and talk specifically about different paints like round ligament pain SI pain which is
tailbone pain SPD or symphysis pubis pain which is the front of the pelvis and sciatica which is
those shooting pains that go down the legs and at the end we're going to talk about things you
can do to prevent and help if you're feeling these symptoms so let's get right into it pregnancy pain
can really suck sometimes and understandably so so during pregnancy on average patients gain 25
to 35 pounds they have a shift in their center of gravity and you undergo many hormone changes and
some biomechanical alterations that put strain on your axial skeleton and your pelvis yeah and
now that weight gain and those hormone changes can lead to increased Force across some joints up to 2
exaggerating lower doses or curvature of that low back forward flexion of the neck and movements of
the shoulders to try to compensate for some of this enlarged uterus and include in change in
center of gravity then you add on the stretching weakness and separation of those abdominal muscles
as the uterus grows and it further hinders neutral posture and puts even more strain on
the paraspinal muscles of the back yes there's also more joint laxity in those ligaments of
the lower back which creates instability and then predisposes you more to muscle strain this joint
laxity can also be seen in the knee as well as widening and increased mobility of the sacroiliac
joints in your back RSI SI joints as well as your pubic symphysis there's also that increase in the
anterior tilt of the pelvis and The Stance is kind of widened to maintain trunk movement and all of
this can result in changes in gait AKA You may notice a little bit of a pregnant waddle or change
in your gait now there's also sometimes food retention which can compress nerves especially
in the wrist and some pregnant patients will experience some numbness and tingling in their
hands yes ultimately some of these changes seem to be media mediated by a hormone called relaxin
which is produced in early pregnancy by the corpus luteum and then later by the placenta and so as
these ligaments are kind of relaxing in addition to that increased estrogen and progesterone in
pregnancy it can affect the stability of all weight-bearing joints from the pelvis all the
way down to your foot yeah in most cases back pain is due to Mechanical factors resulting
from altered posture muscle weakness joint laxity and or vertebral Facet Joint irritation but we're
going to talk more specifics of the different types of pregnancy pain you may experience
so one of the earliest pains that patients experience in pregnancy often is something
called round ligament pain AKA lightning crotch now that sounds exciting yes so the round ligament
is one of a pair of ligaments that supports your uterus it kind of runs from the top of your uterus
down around toward the groin kind of where your pelvis connects to your leg and then into the
labia so as your uterus is growing it pulls on and kind of stretches those ligaments and
so many patients start to notice that pulling or tugging sensation around 13 to 14 weeks is
that uterus is really starting to grow and start to come out of the pelvic now pregnant patients
often seem to notice this when they are changing positions suddenly these Sun movements can cause
that ligament to stretch or tighten kind of like a rubber band being snapped so you may notice this
sudden sharp belly pain or this pain radiating down into your groin AKA that lightning crotch
when you get up quickly when you roll over in bed when you sneeze or cough or if you're doing some
strenuous exercises the pain is typically brief kind of sharp and shooting pain but sometimes it
can last for longer now unfortunately this can last throughout pregnancy but many patients seem
to adjust and notice that it can self-resolves on its own within the first few weeks after first
noticing it there really isn't anything major to do for this kind of pain but maybe a heating pad
gentle stretching movements it may help along with maybe some Tylenol all right thinking back through
pregnancy the pain I experienced next um was SI joint pain so let's talk about that one next
um I feel like I noticed that as I low back pain in the first pregnancy around that 18 to 20 week
Mark um pretty intensely and that's really kind of the classic time that this shows up
this is another kind of ache and pain that can get worse as pregnancy progresses and then often
just spontaneously resolves within three months of delivery yeah now the SI joints or sacroiliac
joints are the joints where the sacrum that's the lowest part of the spine tailbone connects to the
ilium which is the winged part of the pelvis now the SI joint is a very strong and normally stable
weight-bearing joint that really doesn't move a whole lot due to its natural structure now the
main role of the SI joint is to allow those forces to be transmitted effectively through the body it
absorbs impact from the legs to the spine during activities such as walking running and jumping
and like many of the other joints in the body it becomes more relaxed or loose during pregnancy
because of those hormone changes and also muscles that stretch and become weaker thus not supporting
the pelvis as well as they normally do yes so this pain is usually felt in the very very low back and
kind of on each side of your tailbone it is often dull and achy pain but can sometimes be sharp or
radiate kind of down your back a little into your thighs the pain is typically a lot worse when
you're standing for a long time if you're walking or climbing stairs and even prolonged sitting or
lifting the pain is often improved and laying down yeah now in the first line treatment for pregnancy
related SI joint pain and dysfunction is physical therapy and exercises that focus on core stability
of the trunk and pelvic girdle sometimes a sacroiliac belt is prescribed to complement
core stability during exercises and give quick pain relief yes one study actually found that
80 percent of women found a benefit from wearing a support belt and so this is the one I use it's
made by AZ Med it's simple um and I definitely noticed a difference when I didn't wear it
yeah now that same study found that good physical fitness reduced the risk of back pain in the next
subsequent pregnancy and you found this to be true for you too correct I did I have felt you know
certainly experienced aches and pains of pregnancy here in pregnancy number two but I felt like I
hurt a lot more during pregnancy number one and so during this pregnancy I've really focused more on
strength training and focusing on the interconnectedness of a strong low back
a strong pelvic floor strong pelvic girdle some of these different things that as I was trying
to rehab myself during that first pregnancy which is a challenge because again A lot of times these
problems are just getting worse as your uterus grows and you know you gain some more weight it
can you can get a little bit behind and so being a little more proactive I think has helped yeah
this is definitely a strong plug here for strength training in general and exercise during pregnancy
yes all right moving on to our next ache um I remember in pregnancy number one kind of right
around that 32 week Mark I was quite sure that my pelvis was going to split in half so let's
talk about synthesis pubis dysfunction next so the pelvis is made of multiple bones with
joints and the pubic bone is kind of connects the two halves of the pelvis in the front
um and there's a joint between those two halves and that is called the pubic symphysis yeah and
now as we've already talked about those hormone changes in pregnancy can cause joint laxity and
movement of a joint that is otherwise supposed to be very stable like the pelvis yes and that
is what is so painful it can hurt to walk roll over in bed put your shoes on anything with kind
of an uneven shift of your balance can be really brutal yeah now is there anything that can be done
to help with this so yes and no it can be tricky to try to rehab something that is only going to
continue to be aggravated as pregnancy progresses and your uterus is getting bigger that being said
um there are some things you can do and many patients talk about an almost instantaneous
relief right after they deliver of course it can take longer to resolve for some patients but most
have spontaneously resolved within three months of delivery yeah and now I remember in that first
pregnancy it seemed like there were some things that definitely caused some benefit and helped
with this for you right yeah so first things first if you are experiencing this pain talk to
your doctor they can direct you to some experts in your local area as one of the big things for
SPD is physical therapy you want someone who can walk you through specific exercises that help
strengthen those muscles that support the pelvis as well as other Maneuvers and modifications to
minimize discomfort yeah and now you also did things like War recipes you started doing some
gentle stretching and strength training exercises and then you also saw a chiropractor right who's
kind of specialized in pelvic floor rehab stuff and I definitely felt like those things helped
but I did have to make an intentional effort to do that every day and keep up with it so other
Pro tips and things I tell my patients with SPD number one if it hurts don't do it and so for some
of those things that are hurting walking upstairs rolling over in bed etc some modifications that
can help you can go up the stairs one at a time or try going up sideways if you're trying to put
on or take off your pants and it's really tough do it from a seated position or kind of laying on
the bed get yourself some slip-on shoes so you do not have to bend over definitely happen with this
pregnancy yes and then kind of use shorter strides when you're walking and kind of finally if you are
getting out of the car or rolling over in bed you kind of want to swivel your hips and keep
your knees together kind of like imagine you're a mermaid and your legs kind of have to go together
and last but not least something many pregnant patients experience sciatica
so sciatica is entrapment of the sciatic nerve and it can be really uncomfortable that sciatic
nerve travels kind of through the back through the glute and then down the back of the leg yeah
this nerve pain can be very severe shooting pain that travels right kind of where that nerve is
down the back through the butt and down the leg this happens because somewhere along the path of
that nerve it's pinched and usually it happens on one side or the other because we tend to kind
of favor one side over the other you carry your baby on one hip you drive with your right leg
Etc and so generally it's just one-sided but you can unfortunately absolutely have this pain on
both sides and like the other aches and pains of pregnancy sciatica is one of those aches that we
can't always fully fix during pregnancy not to sound like a broken record but this is another
one where we recommend Physical Therapy gentle stretching and strength training to sum this
whole episode of pregnancy sounds like it can be a real pain in the back yes and the neck and
the shoulders and all of the above and while the conditions we talked about today are really benign
it doesn't mean you shouldn't do anything about it or suffer you want to be comfortable and feel well
in pregnancy and your doctor and OB team wants to help you get there so talk with them yeah now
I've gotten very good at low back massages putting on your socks and shoes there for a while yep yep
um you did and I was very very grateful yeah and so hopefully this episode is helpful for you to
understand some of the causes of those aches and pains you may be feeling in pregnancy and
hopefully it offers you some tips to try to help you survive and thrive life know that relief is
coming with delivery of that sweet baby and that there are some things you can do to help minimize
the pain along the way yeah that's going to be all we have for this week yes so please share
any tips or tricks or resources you had to deal with SPD SI joint pain sciatica anything
in the comments below all the other Mamas and Pregnant patients are so grateful yeah next week
we're doctors but not your doctors anything we've said in this video
is for education or entertainment purposes only it is not medical
advice any specific medical questions you have should be directed to your provider