This document discusses backache in pregnancy, which is very common and affects 50-80% of women. It can be caused by mechanical factors like muscle strain, changes in posture and center of gravity due to pregnancy. The pain most often occurs between 20-28 weeks and can be lumbar or sacral. Management includes pain medication if needed, calcium/vitamin D, physiotherapy, exercise and posture correction. Diagnosis of underlying issues like disc prolapse should not be missed.

1. BACKACHE IN PREGNANCY
Prof. M.C. Bansal
MBBS., MS. MICOG. FICOG.
Ex Principal and Controller
Jhalawar Medical College & Hospital.
MGMC & Hospital. Sitapura, Jaipur.

2. • The Life incidence of low back pain ranges from 50-
70 %.Sciatica is less common , with life time
incidence of 10-40 %.
• All structures of lower spine , pelvis ,e.g. the
muscles , ligaments .joints , Inter vertebral discs and
nerve root can cause back pain.
• It is very common in pregnancy, often patients
ignore it, though it worsens and disability develops
due to increasing lordosis. 50 -80 % women do have
discomfort but seldom take medication, a few of
them have such limited mobility as to be at risk of
venous thrombosis due to prolonged bed rest.
• Back pain most frequently presents between 20 –
28 weeks of gestation.

4. Types of Back Pain
• 1. Lumber.
• 2. Sacral / pelvic.
(1) Lumber pain tends to be central over the lover
lumber vertebrae but may be associated with
radiation of pain in to legs,. Usually aggravated by
prolong maintenance of same position , be it be
sitting in chair or standing.
(2) Sacral / pelvic pain is 4 times more common.
Women describes it on sacral region ,may radiate to
buttocks , back of thighs and pubic area. Pain is not
eased by short period of rest .Rolling over the bed ,
rising from seat and climbing stairs tend to make the
pain worse.

5. Causes of back pain in General
1. Mechanical 
Muscle pain , prolapse of inter vertebral disk,
Spondyolisthesis , lumber spondylosis ,
fibromyelgia , osteoarthrits ,spinal stenosis .
2. Traumatic 
Fracture of vertebra ,soft tissue injury , shot
pallets .
3 .Inflammatory
Rheumatoid arthritis , ankylosing spondilytis .
Reiter’s syndrome , psoriatic arthritis.
4. Infective
Osteomyelitis ,tuberculosis.

6. Causes of Backache in General
5. Metabolic
osteomalacia , Paget’s disease of bone ,
osteoporosis and vertebral collapse,
6 . Tumours
Primary of bone –benign / malignant , secondary's
, Multiple myloma.
7. Haematological
Sickle cell disease .
8 . Referred from other organs
Gastric ulcer , duodenal ulcer , gall bladder
disease , pancreatitis ,renal infection-stones or
tumours .
9 . Vascular  Aneurysm .

7. Cause of low backache in pregnancy
• Relaxation effect of hormones on joints.
• Postural changes.
• Change in center of gravity.
Imaging has shown that the lordosis of the lumber vertebrae in reality
decreases in latter half of the pregnancy.
• Obesity, smoking , H/O sudden lifting weight ,
• Wrong posture, pre pregnancy backache may also
be noted . Most pregnancy related back pains
resolve in post partum period by proper diet ,
exercise, change in posture habit and appropriate
rehabilitation .
• One third will continue to have pain for 4 weeks
after delivery and 1/6th up to 9 weeks post partum .

8. Management-
• History of pre existing backache , its diagnosis and
treatment given / still taking .
• Clinical examination , orthopedic consultation ,and
require investigations avoiding radiation exposure to
mother and fetus.
• Pain killers / muscle relaxant if necessary . Calcium
and vit D supplementation , adequate rest till pain is
intolerable ,Physiotherapy and Exercise to
strengthen the back muscles e.g. swimming ,
correction of posture , avoiding prolong sitting or
standing .
• Avoidance of aggravating factors ,wearing shoes
with low / no heels .

9. Management
• To avoid litigation , proper documentation is
mandatory.

10. Diagnosis should never be missed ---
1. Acute lumber disc prolapse
2. Cauda Equina Syndrome.
Magnetic resonance (MR) can safely be done in pregnancy

11. Thank you