Question
Hi, I'm hoping you can help me with my back pain. I am a 27 yo female, currently 5 weeks pregnant with a history of lower back pain during military service 7 years ago. The first occurrence left me unable to touch my toes, and I was prescribed muscle relaxers and bed rest. After two days, my back felt better, and I continued on. The next incidence happened about a year later after the birth of my daughter. I had severe back pain lower right hand side at the round bones that protrude where back and buttocks meet. Noticed that right bones is about two inches lower than the opposite side. Causes achiness and sharp pains on occasion. Pain is always bone deep, and is not resolved with Motrin, Heat, or Massage. At times the pain will take my breath away, and I will be unable to stand straight, or bend over. I'm stuck in the middle hunched over. It's easier to sit or lie down, however getting up from the floor when flat on my back, also causes pain in that region. Almost like I have to unlock the hinges. Pain is on and off and I'm not sure what is causing it and who I should consult. When I go to medical, they just prescribe muscle relaxers. I've yet to have an X-ray or an actual exam. I can not remember one person even touching me. Only asking me to touch my toes, asking a few other questions, and then prescribing the muscle relaxers. Is there anything I can do, or someone I should talk to to receive help in this area. At times, I can't even push a grocery cart and it is severely decreasing my quality of life. Any suggestions you can give me would be greatly appreciated.
Thank you so much,
Christina

Answer
Dear Christina,

First of all, nobody is going to take an x-ray of your low back while you are pregnant.. Even though the American College of Radiology states that a lumbar or pelvic x-ray is safe in pregnancy (as it does not even come close to meeting the established threshold for injuring the fetus)...most doctors will not do it unless there is a life threatening issue at hand.

I am however not surprised that you have not been examined and frankly bee blown off.  This seems to be almost standard care for back pain these days...just send them away with pain killer and/or muscle relaxers.

Well, from what you have described, I think there are two main issues at hand.  First:  you most likely have an anatomical short leg which is increasing the stress in the pelvic joints, and second:  you have sacroiliac joint dysfunction.  Both of these issues are frequently overlooked in medical practice, and usually will not be dealt with at all.  You need a chiropractic physician!!

In reality, both of these issues are pretty easy to deal with and respond quickly to active care in the chiropractic office.  The fact that you are pregnant will complicate the issue a bit.  This is because you need to have a weight bearing x-ray taken of the pelvis to determine if you have a true short leg, and that needs to be compared to the sacral base so that the magnitude of that short leg on the sacroiliac joint and spine can be determined.  A heel lift (inside the shoe) can easily help this issue and they are cheap!!

Moreover, your ligaments are becoming loose in preparation for the birth.  A hormone called Relaxin is circulating in the blood that allows the pelvic ligaments to loosen up and this can actually ad to the problem by creating a bit of instability in the pelvic joints.  However, this is also relatively easy to treat with chiropractic adjustments of the sacrum utilizing a drop table of very gentle manual manipulation of the pelvis at the sacrum.  We see this every week in our clinic...we get lots of referrals from the local OB/GYN's in our area.  

Find yourself a good local chiropractor and have then examine the pelvis and spine...since you are fairly far along in your pregnancy, you may need 2-3 adjustments a week for a few weeks to stabilize the area.  However, some women respond faster than others.  After the birth, you can get the standing pelvis views taken to measure for the heel lift if indicated.  And lastly, have the doctor check for Psoas muscle contraction and imbalance...I find this on almost every pregnant patient, and this is easy to treat as well with active stretching techniques.  A tight psoas will pull on the spine and when in spasm can create significant back pain.

If you would like to see the research on this, please feel free to write me back.  I am at home right now and do not have access to my work computer where I house research articles and reviews.

Hope this helps Christina.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net