Whilst low back, pelvic pain or referred 'sciatic' pain can be common in pregnancy, it is not normal or something that we as women should have to just put up with.
Many women in pregnancy will complain of low back or sacral pain at the base of the spine, pubic pain at the font of the pelvis, or buttock and leg pain, which can be compression of the sciatic nerve from over active buttock muscles or actually referral from the pelvis or lower back themselves.
Despite common beliefs pelvic pain in many cases will not just go away once the baby is born. If you are experiencing pelvic pain it is likely due to an underlying issue that needs to be addressed.
Why is pelvic pain so common?
As most women are aware the female body undergoes huge changes during pregnancy and these occur quite rapidly.
Hormone changes including increases in the hormone relaxin - as the name suggests - result in a relaxing of the ligaments to allow the pelvis and spine to move more to accommodate a growing baby and allow the baby to fit through the pelvis for delivery (this is most significant during the 4th-7th months).
But the relaxin doesn’t just affect the pelvis and spine, it acts on ligaments throughout the whole body. Relaxin receptors are even found in the ACL ligament in the knee! Hence why we women are more inclined to rupture our ACL in sport. But back to pregnancy!
Given that ligaments provide stability to joints throughout the body, this means that in pregnancy all of your joints become a little more mobile. Because of this, your muscles now have to work a little harder. However the muscles that support the pelvis and back are undergoing some changes too.
Your deep core muscles - your pelvic floor and all of your stomach muscles are being stretched so it gets a little harder for them to work to their full capacity. Furthermore, changes in your posture to accommodate growing a small human, place these muscles and the core muscles in your back in a different position to work and therefore they can’t quite kick on as well as they used to.
The female body is amazingly adaptable and can usually cope with these changes quite well. The biggest risk factor for developing pelvic pain in pregnancy is not age or lack of fitness. It's actually 'asymmetrical lack of control' – the muscles on one side of the pelvis or spine are not kicking on as effectively as the other side.
This imbalance can result from an old injury that may not have been fully rehabilitated (but your body could probably cope with previously), or from uneven postural habits.
Many women who are naturally hypermobile worry that they'll struggle through pregnancy. But clinically we don't always see this, and there's no evidence to suggest that more laxity before pregnancy will lead to further problems. Whilst your muscles may need to work harder, a lot of the time your muscle control is up to the task!
The good news is that pelvic and low back pain in pregnancy is, in most cases, completely manageable and usually treatable, with the right assessment and the right exercises.