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Low back pain effects approximately 50 to 80 per cent of pregnant women. There are numerous etiologies for pregnancy-related back pain, such as mechanical effects of gravid uterus, positional stressors, and hormonal effects resulting in pain at pubic symphysis and sacroiliac joint.

Lumbar radiculopathy or true sciatica is rare and accounts only for 1 per cent of low back pain in pregnancy.

What is sciatica?

Sciatica is also known as lumbo-sacral radicular syndrome defined as a radiating pain along the course of the sciatic nerve. The pain travels from the lower back, buttocks, posterior of the thigh, leg and the foot. It can be a deep, dull pain or a shooting, sharp pain. Sciatic pain can range from mild to severe. It often resolves with treatment.

Causes of sciatica during pregnancy

Sciatic pain is typically caused by lumbar spine problems, such as:

A bulging or herniated disc

Spinal narrowing or stenosis,

Osteoarthritis or degenerative disc disease

Spondylolisthesis

These situations can put pressure on the sciatic nerve, causing symptoms. Sciatica due to a herniated disc during pregnancy isn't common. But, sciatic-like symptoms are common with low back pain in pregnancy.

Sciatic like symptoms can also be caused by

* Muscle tension and unstable joints

* Pelvic bone pain

* Sacroiliac (SI) joint dysfunction

* Piriformis syndrome



Pelvic girdle pain (pelvic bone pain)

Pelvic Girdle Pain (PGP) describes pain in the joints that make up your pelvic girdle; this includes the symphysis pubis joint (SPJ) at the front and the sacroiliac joints (SIJ) at the back. Majority of pregnancy-related low back pain is PGP and is often misdiagnosed as sciatica.

PGP discomfort is often felt over the pubic bone at the front, below your tummy, or across one side of your lower back, or both sides. At the front, below your tummy, or across one side of your lower back, or both sides. A diagnosis of PGP can be reached based on certain signs and symptoms that you may experience during the pregnancy or afterwards. Having one or more of them may indicate the need for a physiotherapy assessment followed by advice on appropriate management.

You may experience pain in all or some of the areas shaded in the diagrams above. You may also experience the following:

� Difficulty walking

� Pain when standing on one leg (e.g. Climbing stairs, dressing, or getting in or out of the bath)

� Pain or difficulty moving your legs apart (e.g. Getting in or out of the car)

� Clicking or grinding in the pelvic area -- you may hear or feel this

� Limited or painful hip movements (e.g. turning over in bed)

� Difficulty lying in some positions (e.g. On your back or side)

� Pain during normal activities of daily life

� Pain and difficulty during sexual intercourse

With PGP, the degree of discomfort you are feeling may vary from being intermittent and irritating, to being very upsetting.

Piriformis syndrome

This is a problem with one of the main stabilizing muscles in the buttocks. This is a common cause of sciatic pain during pregnancy and can present with PGP. This is due to the tightness of the muscle and change in posture in pregnancy.

Piriformis syndrome can be due to both muscle pain from the baby's weight that can also add stress to SI joint because it puts extra pressure on your pelvis and hip joints. Occasionally, the position of your baby can add pressure to your sciatic nerve.

Causes:

* Obesity or weight gain (including weight gained during pregnancy)

* Prolonged sitting can also increase risk of developing sciatic pain

* Muscle tension and stress to the pelvic joints, sacroiliac joint problem

Symptoms of sciatic pain during pregnancy

* Occasional or constant pain in one side of your buttocks or leg

* Pain along the sciatic nerve path, from the buttocks down the back of your thigh and to the foot

* Sharp, shooting, or burning pain

* Numbness, pins and needles, or weakness in the affected leg or foot

* Difficulty walking, standing, or sitting

Activities to avoid:

* Avoid sitting for long periods

* Avoid doing pain exaggerating activity

* Forward bending

* Do not lift heavy weights often and beyond your ability



General advice

* Warm packs or cold packs depending on the comfort

* Rest from the pain exaggerating activity

* Upright posture

* Managing weight gain during pregnancy

* Sleeping on the side that is not affected

* Use a pillow for comfort and support

* Stretches (as per recommend by your physiotherapist)

If the symptoms persist it is recommended to consult your Obstetrician and get referred to see a physiotherapist. These sign and symptoms should not be dismissed as normal aches and pain.

(Shazia Shadab, Senior Physiotherapist, Cloudnine Group of Hospitals (Jayanagar))