Ligament pain and pregnancy
by Noémie Vanden Dael
Musculo-ligament pain is a common complaint during pregnancy. Although not serious, varying between discomfort and intense pain, they can have a significant impact on the quality of life and even be disabling in 9% of cases.
Among the conditions concerned, we find back pain (lumbago), pain in the pelvic girdle (sacroiliac joints and pubic symphysis) and upper or lower limb pain. Symptoms can occur throughout pregnancy and mainly between the 5th and 7th month (1,2)
Low back and pelvic pain in pregnant women are partly due to the causes that relate to all “classic” low back pain, and partly to factors specific to pregnancy, such as postural and hormonal changes (1)
To allow the development of the fetus and facilitate childbirth, the woman’s body experiences an increase in ligament laxity, and mobility and distension of the pelvic floor which would be explained by hormonal changes, in particular an increase in the levels of relaxin, estrogen, progesterone, cortisol and estradiol.
The secretion of relaxin by the corpus luteum and the placenta increases from the beginning of pregnancy, reaching a peak at the end of the first trimester, to then stabilize until delivery and during the breastfeeding period (2 ,3,4,5,6.)
2) AREAS CONCERNED
What does laxity mean for pregnant women? In fact, a correlation between the level of these hormones and lumbopelvic pain has not been clearly established (3, 6, 7). However, the weight gain induced by pregnancy and the increasing weight of the uterus will modify the center of gravity and thus cause lumbar hyperlordosis (that is to say, a strong arch in the lower back) and a anteversion of the pelvis (tilting forward). These biomechanical factors combined with ligament laxity can lead to complaints of the lumbar region and the sacroiliac joints (2, 3, 5, 6).
To accommodate the passage of the baby, the pubic symphysis also softens and widens little by little under the influence of hormones. This may be accompanied by mild pain exacerbated by physical activity (2, 5). Beyond 10mm of physiological opening, we then speak of diastasis pubis, which is a rare complication of childbirth (2, 8).
The lower abdomen and groin folds are another area of potential discomfort during pregnancy. Why ? The ligaments of the uterus, the round ligament in particular, are not immune to the various gestational changes mentioned above. As the uterus grows and under hormonal influence, it stretches and increases in diameter and length, which may give rise to a feeling of tightness or cramping in the groin (9 , 10).
As you will have understood, bodily changes during pregnancy can be accompanied by certain pains or uncomfortable sensations. Whether mild or intense, although considered “normal”, they should not be minimized, but heard and relieved when possible. Fortunately, most pregnancy symptoms disappear after birth within a few weeks.
In the meantime, to avoid the appearance of ailments, it is recommended to practice appropriate physical activity (ideally before) and during pregnancy. See this article for detailed recommendations. Risk factors relate to women with a history of low back pain and a high body mass index1, 2.
Among the various complementary medicine approaches and manual therapy (physiotherapy, acupuncture, etc.), osteopathy is effective in relieving or reducing pain thanks to techniques adapted to pre and postpartum2, 5, 11. It can be beneficial to consult once a quarter for a check-up and support in the face of changes in the body of the future mother.
Do not hesitate to contact our therapists specialized in perinatality.
WE CARE, U PERFORM
- Foltz, V., & Rozenberg, S. (2021). Lombalgie et grossesse. Revue du Rhumatisme Monographies, 88(1), 34-40.
- Borg-Stein, J., & Dugan, S. A. (2007). Musculoskeletal disorders of pregnancy, delivery and postpartum. Physical medicine and rehabilitation clinics of North America, 18(3), 459-476.
- De Cagny, H., Wirth, T., Lafforgue, P., & Guis, S. (2021). Douleurs musculo-ligamentaires de la grossesse. Revue du Rhumatisme Monographies, 88(1), 25-28.
- Gachon, B., Desseauve, D., Fradet, L., Decatoire, A., Lacouture, P., Pierre, F., & Fritel, X. (2016). Modifications de la statique pelvienne et de la laxité ligamentaire pendant la grossesse et le post-partum. Revue de la littérature et perspectives. Progrès en Urologie, 26(7), 385-394.
- Casagrande, D., Gugala, Z., Clark, S. M., & Lindsey, R. W. (2015). Low back pain and pelvic girdle pain in pregnancy. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 23(9), 539-549.
- Marnach, M. L., Ramin, K. D., Ramsey, P. S., Song, S. W., Stensland, J. J., & An, K. N. (2003). Characterization of the relationship between joint laxity and maternal hormones in pregnancy. Obstetrics & Gynecology, 101(2), 331-335.
- Aldabe, D., Ribeiro, D. C., Milosavljevic, S., & Dawn Bussey, M. (2012). Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. European Spine Journal, 21(9), 1769-1776.
- Urraca-Gesto, M. A., Plaza-Manzano, G., Ferragut-Garcías, A., Pecos-Martín, D., Gallego-Izquierdo, T., & Romero-Franco, N. (2015). Diastasis of Symphysis Pubis and Labor: a Systematic Review. Journal of Rehabilitation Research and Development, 52(6), 629-640.
- Chaudhry, S. R., & Chaudhry, K. (2018). Anatomy, abdomen and pelvis, uterus round ligament. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2021.
- Suarez, J. C., Ely, E. E., Mutnal, A. B., Figueroa, N. M., Klika, A. K., Patel, P. D., & Barsoum, W. K. (2013). Comprehensive approach to the evaluation of groin pain. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 21(9), 558-570.
- Keriakos, R., Bhatta, S. C., Morris, F., Mason, S., & Buckley, S. (2011). Pelvic girdle pain during pregnancy and puerperium. Journal of Obstetrics and Gynaecology, 31(7), 572-580.