Oh My Aching Back!

    I am now six weeks postpartum and I just got my doctors OK to get back into my exercise routine. With a toddler and a newborn one thing I need to be mindful of is my back. I never had back problems, until I became a mom.  After my first was born I remember all the late night feedings, rocking to sleep, into the crib, out of the crib, until one night I bent over to put him down and I couldn't move.  I guess that's what people mean when they say my back went out. 

     Then with my second, my back pain came in the third trimester.  She was sitting on my nerve endings for the last month and the only time I wasn't in pain was when I was sitting still, but with a toddler how do you do that?   

     But how do you prevent getting injured in the first place? What should moms know during pregnancy and postpartum?  I asked Chiropractor Dr. Dalya Rubanenko. 

What are the most common problems/issues you see in pregnant women?

• 2/3 of expectant mothers will suffer low back and pelvis pain by week 36. One reason is the hormone called relaxin and the second is the change in body structure. Relaxin is present in 10x the normal concentration in expectant mothers. This hormone relaxes the joints in the pelvis so that the baby has room to pass through the birth canal, unfortunately it can cause abnormal motion in many joints and cause inflammation and pain. It's a misconception that pregnant women have various pains because of the weight gain. I will often see women in their 14th week with severe low back or midback pain.   
• Besides low back pain (more often right side over left), sacroiliitis pain, sciatica, mid back pain (along the bra line), headaches and neck pain, pubic symphysis pain, carpal tunnel sydrome (secondary to pregnancy), round ligament strains, swelling in the lower legs, calf cramps and foot pain (plantar fasciitis) are common.

What can women do proactively to avoid these problems?

• Motion for the spine-through motion blood flow is increased in the spine which helps with healing and repair.
• Light Exercise-walking, swimming and doing light weights early on in the pregnancy can help prevent pain in the future. No jarring or bouncing motions are not recommended.  
• Strengthen low back and core early on in pregnancy.
• Increase upper body strength -The baby may only be 6-10 lbs, however the constant carrying of the baby, lifting of the car seat and other baby equipment and other activities often puts a lot of undue stress on a woman's upper body leading to neck pain and upper back pain. 
• Get a pregnancy brace in the 3rd trimester-The right brace can make all the difference between being housebound vs. working and/or doing the necessary errands. 

How do you treat these problems?

• Ice over heat. Heat will make you feel better, ice will GET YOU BETTER. Preferably a soft gel pack for 15 minutes on the site of pain (never on the abdomen).  Ice goes through four stages. Cold, burny, achy and numb. In order for it to be beneficial it needs to get to the numb stage. So hang in there. The first three stages pass within 3 minutes.
• Often expectant women have sacroiliitis (low back pain) with associated sciatica (leg pain) because the relaxin has caused the SACRO-ILIAC joint to slightly shift.  A very gentle adjustment of that joint (or whichever joint has shifted incorrectly) there is significant improvement of the symptoms within 1-5 days in most cases.
• Having adjustments every one to two weeks throughout your pregnancy will help to keep your joints moving properly. I usually combine the adjustments with massage. 

What are some simple exercises women can do?

• Standing extensions-Rocking backwards, while your feet are placed hip length apart and then standing up straight  (10-15 every hour). This will slacken the nerve root and also bring blood flow into the spine. You may feel some light pressure in your abdominal area, but you will feel a decrease in pain. This cobra like stretch can be done very early on in the pregnancy (up to week 14, depending on a woman's growth) to help give relief. Later on in the pregnancy this can be performed on pregnancy tables.
• Upper body strengthening- Bicep curls, half pushups, hammer curls and rotator cuff strengthening are really important. 
• Single Leg Raises-During the third trimester many pregnant women are slightly off balance  because of the shift of their body weight. I have seen many women in my office who have tripped or stepped off a curb incorrectly or with ankle strains. To prevent this, I emphasize simple exercises like single leg raises to strengthen the calves and also standing on one foot during the day to improve their balance.
• Quadricep Stretches-The hip flexors can also become shortened and tighter during pregnancy. Simply doing quadricep stretches while standing on one leg or placing a knee on a chair and leaning backwards can help prevent the hip flexor tightness and decrease low back pain.

Dr. Dalya Rubanenko , also known as "Dr. Ruby" is a licensed Chiropractor serving the San Diego community for 10 years and has worked with dozens of pregnant women and new moms.