PREGNANCY & SCIATICA
Sciatica Pain During Pregnancy: What Should You Do?
When the joy of being pregnant is overshadowed by low back pain, these are your next steps. Whether this is your first or fifth baby, there is much to look forward to and prepare for. Unfortunately, the excitement of becoming a mother can be overshadowed by back pain and sciatica (less common).
The number of women who experience pregnancy-related back pain varies widely, and symptoms may develop. To help you prevent or ease back pain caused by sciatica, we provide answers to why symptoms often develop and what you can do to make the months ahead easier.
What Is Sciatica?
Sciatica is the term used for the pain that occurs when nerves in the lower back become pinched, irritated, or inflamed. This pain will radiate down the back of the leg, sometimes past the knee, and occur with numbness/tingling and muscle weakness.
Is It Sciatica or a Different Pinched Nerve? How to Tell
You may have heard any type of leg pain being called “sciatica.” However, there are many conditions associated with leg pain that might have symptoms similar to sciatica but require slightly different treatments. Some examples include:
Problems with Spinal Joints
This category can include many joint conditions, including arthritis. Joint problems cause pain associated with inflammation. The symptoms can be similar, but treatment focuses on preserving joint motion and reducing chronic pain with anti-inflammatory drugs.
Sacroiliac (SI) Joint Dysfunction
SI joint problems are a relatively common cause of back and leg pain. Having either too much or too little movement in the sacroiliac joints of the hips can lead to pain that radiates down the leg. This pain may be similar to sciatica, but it will likely affect one side more and be easier to pinpoint, compared to sciatica. SI joint dysfunction can also be linked to injury, osteoarthritis, or infection. Treating SI joint pain involves restoring normal motion to the joint. Severe cases may need surgery or sacroiliac joint injections.
Piriformis Syndrome
Piriformis syndrome happens when the piriformis muscle—which is in the buttocks—irritates the sciatic nerve. If the sciatic nerve is involved, this is considered a separate condition from sciatica. Treatment involves anti-inflammatory medication and specific physical therapy.
So how can you tell the difference between sciatica and these other conditions? There is an easy test that doctors often perform to check for sciatica that you can also do at home.
- Lie down flat on your back.
- Straighten your affected leg.
- Raise your leg to form a 30 to 70 degree angle with the ground
If your pain becomes intense when you try this, there’s a good chance that your pain is caused by sciatica. This test straightens the sciatic nerve, and raising the leg will make it impossible to miss if the nerve is pinched.
Symptoms of Sciatica While Pregnant
Problems with lower back pain are common during pregnancy. Sciatica is a less common cause—only about 1% of lower back pain is due to sciatica. However, when it does occur during pregnancy, it’s most common during the third trimester. This is because the weight or position of the baby can put pressure on the sciatic nerve.
Some common symptoms of sciatica during pregnancy include:
- Pain on one side of your buttocks or leg that is either constant or comes and goes.
- Pain that travels from your buttocks down the back of your thigh and possibly to your foot.
- Sharp, shooting, or burning pain.
- A sudden jolt of pain that is often compared to an electric shock.
- Tingling, numbness, or weakness in the affected leg.
- Trouble walking, standing, or sitting for long periods.
While back pain and sciatica during pregnancy can be uncomfortable, they don’t cause any harm to the baby. However, you should contact your health care provider if you have severe symptoms or are concerned.
See a health care provider immediately if you experience any of these red-flag symptoms of back pain:
- Sudden, severe pain
- Trouble controlling your bladder or bowels
- Loss of feeling in the buttocks and inner thighs (saddle anesthesia)
- Fever
These symptoms are not signs of sciatica and could indicate a health condition that needs urgent medical treatment.
Sciatica Causes During Pregnancy
The changes to your body throughout pregnancy affect more than physical appearance, as you’re well aware.
Familiar to most women is weight gain. The increase in body weight and stress when bending puts pressure on a bulging or herniated disc in the low back. Back and leg pain (eg, sciatica, which is also called lumbar radiculopathy) are common complaints.
Weight gain may cause piriformis syndrome and sciatica. The piriformis muscles (located in the buttocks) assist thigh movement. Piriformis syndrome can develop when the muscle compresses the sciatica nerve, which passes through the buttock into the thigh.
What might not be immediately obvious is, as the uterus grows larger, the body’s center of gravity is thrown off. Sometimes, as the uterus expands within the pelvis, the spinal nerves in the lumbar and sacral spine (low back) that feed into the sciatic nerve become compressed and irritated. This is another cause of back pain and sciatica.
Plus, hormones are at work. In particular is relaxin, a hormone that relaxes pelvic ligaments and helps to ready the mother’s body for birth. Relaxin also loosens ligaments in other parts of the body, but mostly the joints in the pelvis, low back, and knees. This is important to know when exercising or lifting objects because it is easy to strain yourself during pregnancy. Move slowly, and avoid sudden movements.
What to Do
- Work with your health care provider to keep body weight in check.
- Pay attention to your posture. Stand up straight, shoulders back, buttocks tucked under, and avoid leaning backward.
- Try a pillow—such as a standard-sized pillow or body pillow to help make sleeping comfortable. A pillow can be positioned between the knees and under the abdomen for support.
- Prenatal yoga helps stretch and tone muscles, helps you maintain flexibility, improves balance and circulation, and relieves tension. Deep breathing is a huge part of yoga and an added benefit for mothers-to-be. Learning how to breathe deeply and relax can help during labor, too. Combined with simple cardiovascular exercise such as walking and/or swimming, these activities can help keep your weight under control and body in shape. Ask your doctor or health care provider if these exercises are right for you.
- Prenatal massage may help relieve pain and tension. Massage therapists trained in prenatal massage can be a pain relief resource during pregnancy and labor. This type of massage eases anxiety (helps to stabilize hormone levels), back pain, pelvic and hip pain, improves circulation and digestion, and helps reduce fatigue.
- A warm shower or bath helps ease back pain. However, expectant mothers should avoid certain aromatic oils (aromatherapy, candles) such as basil, juniper, peppermint, rosemary, and star anise. Some oils can cause contractions.
EXERCISES TO RELIEVE BACK PAIN DURING PREGNANCY
Exercises to Support the Lower Back and Strengthen the Core
Here are exercises that should be suitable for any pregnant woman since the range of motion is small and they are gentle. These movements shouldn’t hurt. If they bother you or increase your pain, stop immediately and consult a physical therapist who can offer other exercises better suited to you.
Whole Abdomen Strengthening
Sit up tall on a chair, hands clasped behind your head. Take deep breaths, and as you exhale, practice pulling your entire abdomen (including your baby) back toward your spine. Imagine your lower spine lengthening and softening as your abdominal muscles contract.
If you do not feel pain, add a small tilt backward as you exhale. Keep your spine straight, and try to feel the increased strength required of your abs to support your lower spine. The tilt can be tiny—a little goes a long way.
Standing Glute Strength
This exercise is especially good for instability and pain in the SI joints. Stand up tall, with your heels together and your toes turned out in a V shape (like first position in ballet).
As you exhale, squeeze your glutes (your buttocks) together, and feel how this helps you externally rotate your legs. At the same time, gently bring your abdomen back toward your lower back, imagining your lower back lengthening and softening.
Side-Lying Glute Strength with Abdominal Support
This exercise strengthens the glute muscles along the sides of the hips—crucial for stability in walking. Lie on your side, with a pillow under your belly to support that baby. Tuck your lower leg up with the knee bent, and lengthen your upper leg long, as though you’re standing on it.
As you exhale, first practice drawing your abdominals in toward your lower back, lengthening and supporting it. When you’re ready, add a lift straight up of the top leg. Look to feel the effort right at the top of your hip, on the side.
Pregnancy is a great adventure, topped only by what comes after. It’s a challenge for anyone’s body, especially those women predisposed to lower back pain. Take time for some serious self-care while you’re pregnant, including setting time aside to maintain your abdominal and glute strength.
Your lower back will thank you, and you’ll hopefully feel stronger postpartum as well.
Stretches for Back Pain During Pregnancy Relief
The following are five simple and safe stretches that you can start today. Note that all stretches should be done on the floor to prevent falls and/or injury. For added comfort, use an exercise or yoga mat. As with any physical activity during pregnancy, do not continue if these stretches cause pain or discomfort.
Sit on the floor with legs crossed, hands on knees, facing forward. This is the neutral position. With your right hand on your right knee, stretch your left hand out and behind your left hip. Gently rotate first your head, then your shoulders, then your torso, and finally your waist to the left. Hold this position for 30 seconds, then release back to the neutral position. Repeat the stretch on the other side. Repeat this stretch five times on each side.
Start in an all-fours position with your hands shoulder-width apart and your knees hip-width apart. Your back should be straight and your face pointed toward the mat or floor. Imagine a straight line running from your tailbone to the crown of your head. Your belly should not sink toward the floor. Gently arch your back toward the ceiling as you tuck your chin to your chest. Hold this position for 30 seconds, then release the stretch to neutral position. Repeat this stretch five times.
Once again, start on all fours with your face pointed toward the mat. Hands and knees should be shoulder- and hip-width apart. Keep your back flat. Do not allow it to sink or arch. Without moving your hands or knees, slowly fold your hips back toward your heels into a seated position while simultaneously dropping your face toward the mat. Hold this position for 30 seconds, then release the stretch to neutral position. Repeat this stretch five times.
Stand upright with your feet shoulder-width apart and your hands on your hips. Rotate your elbows inward toward one another behind your back. Gently tilt your head to the ceiling. As you bend slightly backward, place downward pressure on the hips with your hands. Hold this position for 30 seconds, then release the stretch to neutral position. Repeat this stretch five times. Stand with your feet shoulder-width apart with your back against a wall. Tighten your lower abdominal muscles, then your buttocks, and gently tilt your low back to shift your pelvic floor forward. Hold this position for 30 seconds, then release the stretch to neutral position. Repeat this stretch five times.