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Night backache in pregnancy (also Pelvic pain after delivery)
NIGHT BACKACHE IN PREGNANCY
PELVIC PAIN AFTER DELIVERY See below... Julie Colliton, MD, please see "Gastaldo remarks," below. "Donna" wrote in message ... Hey everyone! My turn to ask for advice. I am having terrible back pain at night, lately. I'm generally fine during the day, but at night, I get bad mid-back and lower back pain, increasing until I get up again in the morning. It's been waking me up multiple times each night. (Wouldn't you know, just when my daughter started sleeping through the night again. grin) I have been going to bed with a hot water bottle to my lower back, which helps to go to sleep, but really, I'm fairly uncomfortable all night long. Any idea why this would be, or what I could do? I'm 18 weeks along, iirc. And our mattress is very firm, so it isn't a soft mattress thing. All suggestions and advice would be greatly appreciated. Thanks! Donna NIGHT BACKACHE IN PREGNANCY Donna, I liked Naomi Rivkis's reply (relating input from her childbirth educator and her doctor)... Naomi wrote: "Hate to say it, but it sounds exactly like mine and it's lasted straight through the present day (I'm 38 weeks). My childbirth educator says that the entire uterus is attached to the back by three ligaments all of which connect at pretty much the same place, so when you lie down they all pull with the weight. No wonder that place and the area around it hurt! "Best I've found for it is piling a lot of pillows around me, so that whatever way I turn I've got support under my legs, my breasts, my back and my belly. Unfortunately this works best when it is combined with turning over frequently, and getting up periodically (which I'd have to do to go to the bathroom anyway) and if you have the pillows all over, both of these can require rearranging annoying amounts of the time. (I've given up by now keeping large pillows on the outside edge of the bed -- I don't wanna have to climb over them to get to the bathroom!) I still hurt a lot of the time, I still go to bed with pre-emptive Tylenol about half the evenings, and morning still aches. But I can sleep. That's the best I've managed so far, and my doctor, while sympathetic, says it's the best she can suggest." Naomi MAY have tried joint manipulation but to no avail... She doesn't say... Then again, perhaps her doctor cautioned her against joint manipulation... Here's an excerpt from an article by an MD who says pregnant women "should avoid...joint manipulation procedures." My remarks follow... Julie Colliton, MD Back Pain and Pregnancy: Active Management Strategies THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 7 - JULY 96 Nocturnal pain. Some women have night back pain exclusively, others have both night pain and lumbar or sacroiliac pain.... Treatment Options Initial treatment for pregnant patients with low-back, sacroiliac, or night pain consists of modalities such as heat and ice. Acetaminophen may help relieve the patient's pain. Nonsteroidal anti-inflammatory drugs are contraindicated during pregnancy. When pain is extremely severe, certain narcotics may be appropriate. Massage therapy may provide short-term pain relief. Pregnant women with back pain should avoid whirlpool treatment as well as joint manipulation procedures... ....Physicians can teach women the neutral spine posture that avoids excessive lumbar lordosis and excessive reversal of lumbar lordosis. Women can be instructed to perform all activities in the neutral spine posture... Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.Dr Colliton is a physiatrist with Denver Spine & Rehabilitation in Denver. She is a member of the Women's Sports Medicine Committee of the American College of Sports Medicine and a team physician for the US Disabled Ski Team. --Julie Colliton, MD http://www.physsportsmed.com/issues/...6/colliton.htm http://www.kalindra.com/colliton.pdf GASTALDO REMARKS: Readers, Check with your licensed health care provider but... 1. I totally disagree with Julie's Treatment Options admonishment that "Pregnant women with back pain should avoid...joint manipulation." Two CNMwives, Benetti and Marchese may recommend joint manipulation. They indicate they make referrals to chiropractors "when necessary." [Benetti MC, Marchese T. Primary care for women: management of common musculoskeletal disorders. JNM 1996;41:173-87] I'm no longer licensed or in spinal adjusting practice - but pregnant women were my favorite patients - they are SO easy to adjust - and so grateful afterward - many hugs... I don't remember adjusting any women with solely night backache though... 2. I think Julie's advice to do everything with a "neutral spine posture that avoids excessive lumbar lordosis and excessive reversal of lumbar lordosis" may be wrong. I say this because squatting - near TOTAL reversal of lumbar lordosis - for prolonged periods - is a normal rest posture for most pregnant humans. Perhaps, though, when humans have low back pain they *should* do everything with a "neutral spine posture that avoids excessive lumbar lordosis and excessive reversal of lumbar lordosis." (?) I'm not so sure... Canadian orthopedic surgeon W. Harry Fahrni, MD indicated in 1975 (Orth Clin N Am) that reversing the lumbar lordosis helped people with back pain by letting the posterior quadrant of the disc heal... Then again: New Zealand (?) physiotherapist Robin McKenzie discovered a whole therapy system (his McKenzie Protocol) when a low back patient cured himself by getting on an exam table and INCREASING the lumbar lordosis - at least that's what I remember from a presentation Robin gave years ago at a spine conference. I don't think McKenzie advocates increasing the lumbar lordosis in all patients though. The fact that most humans on the planet routinely reverse their lumbar curves for prolonged periods (flat-footed squat) has always intrigued me. JUST THINK! This culture robs its children of a way to rest on their feet! I myself do "half-squats" for prolonged periods because I have lost my innate comfortable prolonged squatting ability. Standing, I often put one foot on a table so half of my body is in a full squat. I alternate sides... My recollection is that two spine researchers say that reversing the lumbar curve is true rest for the lumbar spine BECAUSE it reverses the lumbar lordosis thereby EVENLY squeezing fluid out of the discs thereby helping them to imbibe nutrition during the night when they aren't weightbearing. Bottomline, if you are suffering low back pain - or not - check with your licensed health care provider before implementing anything suggested here. Todd Dr. Gastaldo PS I'll cc Julie - maybe she can still be reached at Julie: I think you mentioned sacroiliac pain and prolonged sitting. I think late second stage on the back - on the sacrum - may cause sacroiliac pain or at least inhibit labor neurologically - the sacrum being torqued exactly the opposite direction it is supposed to move to let the baby through - which of course MECHANICALLY inhibits labor. The at-term sacroiliac biomechanics were described early last century. For details... See PhD husband of a CNM... http://health.groups.yahoo.com/group...t/message/2321 PELVIC PAIN AFTER DELIVERY According to Dutch researchers Mens et al. [1996], "Maximal flexion of spine and hips" during delivery might enhance the risk for peripartum pelvic pain (PPPP). [Mens JMA, Vleeming A, Stoeckart R, Stam HJ, Snijders CJ. Understanding peripartum pelvic pain: implications of a patient survey. Spine 1996;21(11):1363-70.] Unfortunately, Mens et al. don't state exactly what they mean by "maximal flexion of spine and hips." I suspect they may be referring to - and cautioning against - the birth-canal-closing "Bradley Classic" delivery position where the woman sits in maximal flexion - squarely (and only) on her buttocks/sacrum during delivery? (Semisitting delivery is also recommended by ASPO/Lamaze.) Norwegian physiotherapist N Bjørnstad similarly cautions against sitting on the sacrum at delivery: "Birth positions recommended are...various sitting positions where sacrum will not be locked against the bed...avoid unnecessary stretching of the pelvic ligaments and locking of the joints." [Bjørnstad N. Obstetric physiotherapy, observation and treatment (abstract). Scand J Rheumatology 1991; Suppl. 88:22-23. (N. Bjørnstad, Bjerkåsen 5, 1310 Blommenholm, Norway)] One last matter... Mens et al., just quoted, cited radiographic studies from the 1930s but failed to cite Borell and Fernström's 1957 radiographic study, when they referred to increased sacroiliac mobility during pregnancy as having been "observed in an anatomic study and in radiographic studies." Borell and Fernström's work is decades old but is still cited in the 1995 British Gray's Anatomy as evidence that "radiological pelvimetry has become a refined technique" (p. 671). British obstetrician Jason Gardosi, MD cites Borell and Fernström's 1957 work in the OB-GYN-List archive to support a point on which he and I agree: Many cases of shoulder dystocia are caused by jamming the sacral tip up to 4 cm into the pelvic outlet. See my posts in the OB-GYN-List archive... http://forums.obgyn.net/forums/ob-gy...9707/0128.html http://forums.obgyn.net/forums/ob-gy...9707/0153.html As noted above, the at-term sacroiliac biomechanics were described early last century. For details... See again: PhD husband of a CNM... http://health.groups.yahoo.com/group...t/message/2321 Thanks for reading everyone. Sincerely, Todd Dr. Gastaldo This post will be archived for global access at: http://health.groups.yahoo.com/group...t/message/2325 |
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