Arrr, me back is aching

(Title of this post to be said like a pirate).

This is not a new complaint for me… I’ve have on-off back pain since my early teens. Mostly mechanical in nature, worsening after sports and bending over. My dear parents carted me off for X-rays and we found that I had (have) sacralisation of the lumbar spine. Sounds dramatic… but isn’t really.

Here’s a plain-English explanation of the condition and here’s also a pic (‘normal’ on the left, one variation of ‘sacralisation’ on the right):

sacralisation L spine

ANYWAY… in the last few weeks I’ve been getting a lot more back pain… is it because I’ve got this ‘pre-existing’ spine condition (I feel like Quasimodo when I type that)… or is it just another ‘pregnancy complaint’, and what’s the best way to manage it?

Here’s what I found:

Back pain during pregnancy is VERY common (it affects 50-70% of pregnant mammas).  It’s more common in women who are overweight, or who have had back pain prior to pregnancy.

Some reasons for the back pain:

  • Hormones (of course!): relaxin causing mischief again, loosening your ligaments;
  • Posture: it starts changing due to your change in centre of gravity (especially increased lumbar lordosis – the curvature of your lower spine becomes more pronounced); you also make other postural changes due to your increasing size (and increasing discomfort!);
  • Additional weight: increased weight will put increased pressure on joints, including your spine;
  • Stress: some hypothesise that stressors associated with pregnancy (mental, physical, socio-economic) manifest as increased discomfort and pain, including back pain.

What to do about it?

  • Keep your back (and in fact your whole body) strong with regular exercise, including exercise that strengthens your core;
  • As per your pre-pregnancy state, use your legs (and not your back) when you need to pick up something from the floor or carry something heavy;
  • Avoid high heels – honestly, I know that heels make you feel fab (trust me, I’m only 5 ft 5, I know) but they’re not good for anything much in terms of your health/ body;
  • Conservative measures for reducing pain: ice/heat are safe, braces/support devices are unlikely dangerous but have questionable efficacy;
  • Medications: avoid if possible, Panadol is safe.

When to contact your doctor

  • When the pain is so bad it interferes with your daily life;
  • If you have rhythmic cramping pain – it may not be back pain, it may be something more sinister, like pre-term labour;
  • If your GP is single and really good looking, and you suspect he has a secret yearning for your hot pregnant body*

* Again I’m obliged to say that I’m well aware of the Code of Conduct, and it’s not a good idea for doctor and patient to be ‘involved’… that being said, Dr Hot GP could refer your care elsewhere, and you could go on a nice date or something…

Here is a review article by yours truly on the Management of Acute Low Back Pain for your perusal. Please note that is refers to all types of acute back pain and while there’s a lot of important information in there, some may not be relevant if you’re pregnant (eg. there are very real risks with using NSAIDs during pregnancy).

References

  • Australian Medical Council (amc.org.au) 
  • Antonucci R, Zaffanello M, Puxeddu E, Porcella A, Cuzzolin L, Pilloni MD, Fanos V. Use of non-steroidal anti-inflammatory drugs in pregnancy: impact on the fetus and newborn. Curr Drug Metab. 2012 May 1;13(4):474-90.
  • Yuen NYF. Management of acute low back pain. HK Pract 2010;32:95-101.

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3 Comments

  1. Good morning l have just been recently told l have a partial sacralisation L5. I have had lower back pain the last year off and on quite regularly and thought it was from training (crossfit.) lt first started when l was told to change my way of squatting as l was squatting to low and with heavier load (60kg+) l would find it hard to stay tight and lose control and collapse, so told to squat just parallel which l found so difficult as it didn’t feel natural and l felt l would stop and than gear up to go up. l felt that maybe l should of worked on lighter weight and try to get low and work on driving out but coach just told me to stop and change but after 1 year l had only 10kg gain.
    The first time l really felt the pain hard and consistently is when we did the Squatober 3-4 days of squatting, than the open games on March. It was the deadlift wod with box jump that l felt it made me take notice of it. l almost got to the last part of the heavy deadlift almost starting on the 90kg lm so thankful l didn’t have to start as l really struggled on the 80kg (maybe 84kg) at 25 reps and than box jump. I am 59kg and my one rep is 110kg on deadlift.
    After that we (coach and I) decided to work on my weakness “strength” and did a 3 months of lifting program Takano. Every one knew l would complain of my back feeling sore and l just put it down to the heavy training program and kept on it. Got massage regularly until the after the last three comp l knew than l really had to see someone. Saw physio and recommended core exercise than l got scan saw osteo and doc and was told it has shown l had partial sacralisation of L5.
    Doc recommended not to lift any more and osteo said it not correctable but manageable and suggested no comp this year and to cxl any one that l have sign up for. I am still training but only strict movement pullup pushup no metcon yet and back at gym using the leg machine and seeing what caused any discomfort and stop. I am also doing lots of inner and outer core a lot more stretching and also swimming. I have a high pain thrushold so sometimes l think its sore but not extremely painful until later on l cant hardly bend over or it is painful to work or sit. The pain is there all the time but it comes in stages when its really painful.
    My question is would l ever be able to go back doing crossfit and compete eventually. If l Worked on strengthening my whole movement by perfect technique and all the muscle by lowering the weights starting by bar work and higher reps and increase slowly weights slowly when all movements are spot on or is this too much of a risk and look at doing something else that’s less load for my back. I was thinking going back to body building program at the gym its a lot more control and more leg exercise l can do (machine). The only time l felt this kind of pain was when l was pregnant l put it down to been normal pregnancy back pain. I am a person who needs goals to work on and l love trainings its a big part of my lift and my ME time. I have a business that l have started 6months ago and l also work as a Carer for disability and have two Children 12 yr old and 2.5 yr old and married. My life is busy and l love it but training is one of my 2hr (5 days) of me time that l look forward too. Feeling unsure and out of sort at the moment. I don’t want to be told what l cant do but what l can do.
    Your thoughts and opinion would be greatly appreciated.
    Thanx Elsa

    • Dear Elsa, thanks a lot for your post. While I am am (active) doctor and have a mild congenital deformity of the spine, let me preface my response by saying that everyone’s situation is different. For me, I was experiencing massive back pain no matter what sport I was playing, and of course everyone (including doctors) told me to stop sport (just as your doc has told you not to lift anymore). Unfortunately Western-trained doctors are taught time and time again, if a patient has pain when doing something, then you should advise them to stop doing it! I don’t personally believe this is advice that can be applied to every person you see, because you’ve got to take into account their specific situation / likes/ dislikes/ motivators etc. If you love CrossFit, I have no doubt you will be able to do it. I don’t know how much stretching you’re doing but (for me) my back pain literally disappeared when I started doing intensive hamstring stretching. It turns out that with the decreased spine mobility, and the hamstrings pulling on it, the back pain was just getting worse. Also (as in your case) there is only a partial fusion, which means that the spine movement and pulling of muscles on the base of the spine will be uneven. My recommendation in your situation would be to not lose hope (if you love CrossFit, then I doubt some other form of exercise that’s not goal-oriented is going to really work for you!), find a doctor that’s willing to work with you (not against you) and employ the help of allied health professionals (this is really person-specific as to what works for you – eg. chiro, physio, etc). As there isn’t a lot of evidence specifically relating to your condition and CrossFit (!) would also suggest reading some CrossFit boards for ideas and suggestions. They may not be evidence-based, but may help point you in the right direction. Finally, juggling CrossFit, marriage, kids, work – remember to be kind to yourself. Good luck!

  2. Pingback: Back pain… | Push Ups, Pull Ups & Pregnancy

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