Abstract
Up to 86% of pregnant women will have lumbopelvic pain during the 3rd trimester of pregnancy and women with lumbopelvic pain experience lower health-related quality of life during pregnancy than women without lumbopelvic pain. Several risk factors for pregnancy-related lumbopelvic pain have been identified and include history of low back pain, previous trauma to the back or pelvis and previous pregnancy-related pelvic girdle pain. During pregnancy, women go through several hormonal and biomechanical changes as well as neuromuscular adaptations which could explain the development of lumbopelvic pain, but this remains unclear. The aim of this article is to review the potential pregnancy-related changes and adaptations (hormonal, biomechanical and neuromuscular) that may play a role in the development of lumbopelvic pain during pregnancy. This narrative review presents different mechanisms that may explain the development of lumbopelvic pain in pregnant women. A hypotheses-driven model on how these various physiological changes potentially interact in the development of lumbopelvic pain in pregnant women is also presented. Pregnancy-related hormonal changes, characterized by an increase in relaxin, estrogen and progesterone levels, are potentially linked to ligament hyperlaxity and joint instability, thus contributing to lumbopelvic pain. In addition, biomechanical changes induced by the growing fetus, can modify posture, load sharing and mechanical stress in the lumbar and pelvic structures. Finally, neuromuscular adaptations during pregnancy include an increase in the activation of lumbopelvic muscles and a decrease in endurance of the pelvic floor muscles. Whether or not a causal link between these changes and lumbopelvic pain exists remains to be determined. This model provides a better understanding of the mechanisms behind the development of lumbopelvic pain during pregnancy to guide future research. It should allow clinicians and researchers to consider the multifactorial nature of lumbopelvic pain while taking into account the various changes and adaptations during pregnancy.
Highlights
Pregnancy-related low back pain (LBP) and/or pelvic girdle pain (PGP) are very common conditions, affecting up to 86% of pregnant women in the 3rd trimester of pregnancy [1]
The past decades have seen a significant growth in mechanistic research aimed at investigating the physiological processes involved in the development and chronification of LBP
Our understanding of biomechanical, motor control and neuromuscular adaptations to LBP has greatly improved and we know that changes in motor behavior associated to LBP involve complex [87, 88] and most likely non-stereotypical “adaptive strategies” [89]
Summary
Pregnancy-related low back pain (LBP) and/or pelvic girdle pain (PGP) are very common conditions, affecting up to 86% of pregnant women in the 3rd trimester of pregnancy [1]. LBP is defined as “pain or discomfort located between the 12th rib and the gluteal fold,” and PGP as “pain experienced between the posterior iliac crest and the gluteal fold” [2]. When both types of pain are present, the pain is frequently referred to as lumbopelvic pain (LBPP). Women suffering from LBPP during pregnancy will still experience LBPP beyond 3 months [33% [5]] and 12 months [25% [3, 6]] after delivery
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