Musculoskeletal Pain Manifestations in Pregnancy
Musculoskeletal pain is extremely common during pregnancy, with low back pain occurring in up to two-thirds of pregnancies and pelvic girdle pain in nearly 20% of pregnant women, with prevalence peaking in months 6 and 7 of gestation. 1
Common Types and Locations of Musculoskeletal Pain
- Low back pain (LBP) is the most prevalent musculoskeletal complaint during pregnancy, affecting approximately 70% of pregnant women 2
- Back pain (mid-back) affects about 43.5% of pregnant women 2
- Pelvic girdle pain (PGP) occurs in nearly 20% of pregnancies and involves pain at the anterior and/or posterior aspects of the pelvic ring 1, 3
- Hand and wrist pain affects approximately 33% of pregnant women 2
- Hip pain is experienced by about 32% of pregnant women 2
- Most musculoskeletal pain symptoms worsen during the third trimester, with the exception of elbow, shoulder, and neck pain 2
Underlying Mechanisms
The pathophysiology of pregnancy-related musculoskeletal pain involves several factors:
- Joint laxity: Pregnancy hormones cause reduced ligament rigidity, weakening joint stability and increasing demand on stabilizing muscles 1
- Biomechanical changes: Increased abdominal mass and shifts in the center of gravity create additional load on the musculoskeletal system 1
- Postural adaptations: As pregnancy progresses, changes in posture to accommodate the growing fetus place stress on the spine and supporting structures 1
- Weight gain: Additional body weight increases stress on weight-bearing joints 2
Severity and Impact
- The prevalence of severe LBP/PGP symptoms ranges from 15% to 20% of pregnant women 1
- Serious pain occurs in about 25% of pregnant women, with severe disability affecting approximately 8% 4
- After pregnancy, about 7% of women continue to experience serious musculoskeletal problems 4
- Pain intensity during pregnancy averages 50mm on a visual analog scale, typically decreasing postpartum 4
Complications and Associated Conditions
Severe cases of pregnancy-related musculoskeletal pain can lead to:
- Sleep disturbances affecting maternal well-being 1
- Impaired activities of daily living and functional limitations 1
- Elevated depression risk among those with pregnancy-related LBP/PGP 1
- Postpartum weight retention due to activity limitations from LBP/PGP 1
- Delayed resumption of physical activity needed for health maintenance 1
- Persistent pain postpartum, especially in women who had both LBP and PGP during pregnancy 1
Risk Factors
Several factors increase the likelihood of developing musculoskeletal pain during pregnancy:
- Previous history of low back pain before pregnancy 4
- Previous pregnancy-related LBP or PGP 4
- Strenuous work, especially involving heavy lifting 4
- Obesity increases risk for musculoskeletal pain due to chronic overloading of connective tissue structures 1
- Heavy lifting (10-20 kg or 22-44 lb) more than 20 times per week 1
Clinical Course and Prognosis
- Pain typically worsens as pregnancy progresses, reaching peak intensity in the third trimester 2
- For most women, back pain resolves spontaneously after delivery 1
- Women at highest risk for persistent postpartum pain include those who:
Common Pitfalls in Management
- Underreporting: Women often don't report LBP/PGP to their prenatal providers, leading to insufficient clinical attention 1
- Overreliance on medication: Pregnant women should consider alternative and complementary methods before turning to medications for pain management 5
- Inadequate activity modification: Failing to adjust physical activities, especially heavy lifting, can worsen symptoms 1
- Ignoring persistent symptoms: Persistent pain requires evaluation as it may indicate more serious underlying conditions or risk for chronic postpartum pain 1
Understanding these manifestations of musculoskeletal pain during pregnancy is essential for appropriate clinical management and prevention of long-term complications that can affect maternal quality of life both during pregnancy and in the postpartum period.