Maternal low back pain is a common problem, which refers to the severe pain in the lower back and buttocks during pregnancy or after childbirth, with or without limited turning and radiating pain in the lower limbs, which can easily be confused with diseases such as lumbar disc herniation. Studies have shown that the incidence of low back pain during pregnancy is about 21%-50%, the incidence of postpartum low back pain is about 21%-50%, and the incidence of postpartum low back pain is about 50%, of which 1/3 is severe low back pain, which seriously affects the work and quality of life of pregnant women after childbirth.
Maternal low back pain: It can occur throughout pregnancy and after delivery for a short or long time. In the comfortable medical environment, the biggest obstacle to the development of labor analgesia is that most people think that neuraxial anesthesia is easy to give birth to postpartum low back pain, and the phrase "post-anesthesia low back pain" has been pitted by generations of mothers. However, there are various causes of low back pain in pregnant women, and the direct correlation between postpartum low back pain and anesthesia is not significant from existing medical research. The following are explanations and recommendations for low back pain in pregnant women:
Causes of prenatal (pregnant) low back pain, including but not limited to:
1. Have a history of low back pain before pregnancy
There is a history of low back pain before pregnancy, and there is a high probability of low back pain during pregnancy and postpartum, and even the degree of low back pain is aggravated.
2. Physiological calcium deficiency:
During pregnancy, pregnant women need to provide adequate calcium for the fetus, and if it is not replenished in time, it may lead to physiological calcium deficiency. Postpartum breastfeeding can also lead to a loss of calcium, which can trigger low back pain.
3. Anterior pelvic tilt:
The relaxin secreted during pregnancy relaxes the ligaments and joints of the pelvis and lumbar spine to accommodate the growth of the fetus. As the fetus grows, the center of gravity of the pregnant woman shifts forward, causing the pelvis to tilt forward, which in turn compresses the nerves and muscles of the lumbar spine and lumbar region, causing pain.
4. Diastasis rectus abdominis:
As the fetus grows, the abdominal wall continues to expand, causing the fascia that connects the rectus abdominis muscle to stretch.
5. Inadequate management during pregnancy:
Low back pain during pregnancy is also related to individual lifestyle habits, inadequate weight management and other factors.
Causes of postpartum low back pain, including but not limited to:
1. Imbalance of core muscles:
During childbirth, the intra-abdominal pressure is changed, the lithotomy position is changed, and the core muscles of the abdomen and lower back are excessively tensed, causing lower back pain after childbirth.
2. Pelvic floor muscle relaxation:
One end of the pelvic ligament connects organs such as the uterus, and the other end is fixed to the pelvis and lumbosacral region. Postpartum pelvic floor muscle relaxation increases the load of the ligament fascia that suspends the internal organs, resulting in lumbosacral stretching pain, postpartum rectus abdominis muscle relaxation, weakened strength, may lead to aggravation of anterior pelvic tilt, thereby affecting the physiological curvature of the lumbar spine and causing lumbar pain.
3. Exogenous diseases:
Acute and chronic pelvic inflammatory disease, benign and malignant pelvic tumors, uterine prolapse, postpartum sacroiliitis, and other diseases can also cause postpartum low back pain.
4. Long-term bed rest after childbirth
It further leads to a decrease in the strength of the lower back muscles, and cannot return to the normal physiological structure of the lumbar spine, resulting in the occurrence and development of chronic low back pain.
5. Wrong posture:
Behaviors such as getting up incorrectly, holding the baby, and bending over often can aggravate the strain on the lower back muscles.
6. Anesthesia-related:
When neuraxial anesthesia is performed, a small amount of local anesthetic is usually given at the needle insertion site to reduce discomfort. Even in rare cases, repeated needle insertions may cause short-term pain or discomfort, which usually resolves spontaneously within a few hours. Long-term chronic low back pain is associated with neuraxial anesthesia is low, and existing studies suggest that there is no direct causal relationship between the two.
Ways to relieve low back pain during pregnancy and childbirth
1. Improve living habits:
Keep your waist straight when you sit and maintain good posture when walking.
Sleep in a lateral decubitus position and change sleeping positions regularly.
Avoid bending or standing for long periods of time, give enough rest, and avoid overexertion.
2. Supplement nutrition:
Eat plenty of calcium-rich foods.
Ensure adequate sunlight hours to promote calcium absorption.
3. Exercise properly:
Control weight gain during pregnancy, eat a reasonable diet, and exercise moderately.
Do exercises that help strengthen the muscles in your abdomen and lower back, such as yoga or Pilates.
4. Physical therapy:
If you have unbearable low back pain during pregnancy, you can choose to treat it with buccal acupuncture. Postpartum electrical stimulation can help relax the lower back muscles, improve blood circulation, and increase muscle strength. Radiofrequency repair technology can work on the pelvis in a non-invasive and painless way to help repair damaged tissues and reduce low back pain. Of course, when the above conservative non-invasive treatment is ineffective, you can see a pain department and undergo ultrasound-guided invasive treatment through professional evaluation.
Self-assessment and correction
Ways to self-check if the rectus abdominis muscle is separated:
1. Lie flat on the bed, relax your body and bend your legs.
2. Gently raise the head and shoulders, look at the umbilicus, and place the tips of the index and middle fingers of the right hand on the medial edge of the rectus abdominis muscle.
3. Slowly draw from below the sternum to 1~2cm below the umbilicus, and feel the distance between the muscles. Normally it can accommodate one finger, but more than two fingers may separate.
Ways to self-check for anterior pelvic tilt:
1. Fork waist method
(1) Hands on the waist (index finger in front, thumb in back)
(2) The index finger looks for the most convex point in front of the pelvis (anterior superior iliac spine)
(3) The thumb finds the most prominent point behind the pelvis (posterior superior iliac spine)
(4) Imagine connecting your thumb and index finger in a straight line to see if they are on the same level
If the anterior tilt angle is greater than 30°, there may be a problem with anterior pelvic tilt.
2. Wall inspection method
(1) The head, chest, and buttocks are all attached to the wall
(2) Reach behind your waist to see how much space there is;
If you can stuff the whole fist into it and there is space, then there is a problem of anterior pelvic tilt.
Note: However, if the self-tester's buttocks are too large, the results will be wrong, so this can only be used as one of the evaluation criteria
3. Lie flat on the table
(1) Lie on your back on the table with your hips bent while your other leg remains relaxed and draped. Slowly place the person on their back so that the spine is placed in the middle of the thigh on the table. Make sure your waist touches the table.
(2) Then ask the subject to lift both knees towards the chest, then release one of the legs and slowly lower it.
If the pelvis is in the correct position, the other leg can be pressed against the table; If this is not possible, consider anterior pelvic tilt.
Of course, if you take a self-test, you may have more or less errors, so it is recommended to seek professional help.
Adjust according to the presence of problems such as anterior pelvic tilt or diastasis recti, and take relevant measures.
conclusion
There are many causes of maternal low back pain, from the existing medical research, the direct correlation between postpartum low back pain and anesthesia is not significant, no matter what the cause of low back pain, but often through the improvement of living habits, appropriate exercise and necessary physical therapy, can make the pregnancy and delivery of low back pain can be effectively relieved. If the pain persists or significantly affects quality of life, it is advisable to consult a doctor for professional evaluation and treatment recommendations to facilitate recovery.
Pang Yuchi, Department of Anesthesiology, Qingxian Branch, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei Province
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