Sciatica and Low Back Pain in Pregnancy
If you’ve ever felt that zinger going down the back of your leg or experienced that “nervy ache” during pregnancy, then it’s likely that you’re familiar with sciatica! While you may have experienced the symptoms, you may be wondering what exactly it even is and why it happens - especially during pregnancy. In this blog post, I will address what sciatica is, what symptoms to be on the lookout for, why it can be more symptomatic during pregnancy and some tips and tricks for combatting that irritating (and sometimes debilitating) nerve pain. Make sure to read ALL the way to the bottom for a some postpartum relief hope and tools to combat if it does continue on past pregnancy.
If you’re a visual learner like myself…
…then the picture down below will be super helpful for you to visualize where the sciatic nerve comes out from the spine and to see that this nerve is actually a MASSIVE nerve (the largest one in our entire body) that goes through the whole length of the leg (breaking off into different sections on the way down) and even into the foot! The size of the sciatic nerve does play a factor in how easily it can be aggravated when space is limited…like with pregnancy.
What does sciatica feel like?
For some, the symptoms can be very obvious and leave you with no doubt that you have sciatica, but for others, you may not be sure exactly what is going on. If you’re unsure if you’ve ever experienced sciatica, either during pregnancy or other, the following are the typical symptoms that can be associated with it:
Pain in the low back or buttock area or down the legs
Tingling into the foot or down the back of the leg
Difficulty walking or standing
Pain or discomfort in low back, buttock, or back of leg when sitting for longer periods of time
As with all nerves, one of their main functions is to innervate certain muscles, which basically just means to stimulate them or allow them to work properly. If a muscle has no nerve innervation, then it will not be able to contract on command. So with the sciatic nerve, if it’s being pinched, stretched or irritated along any part of its pathway, it will present with those nerve symptoms or potentially even make you feel like your leg is “giving out” due to the lack of proper innervation.
Why does sciatica increase during pregnancy?
There are several reasons why sciatica can start or become exacerbated during pregnancy. One main reason is simply that there can be a lack of space for both the nerve and the growing uterus and baby. As the uterus and baby grow, it can put pressure on the spine and cause some compression of the nerves, and again, since the sciatic nerve is the largest, it’s often the most likely to be affected. This is also why sciatica is usually more common in the third trimester.
Another reason for this increase in sciatic symptoms during pregnancy is because of the hormone relaxin. While relaxin often gets unfairly blamed for many negative pregnancy symptoms, it is true that this hormone plays a role in increasing the susceptibility of the sciatic nerve to being irritated. The reason for this is because it causes the joints to become more lax, which is great for preparing the body to give birth, but not so great when the nerves exiting the spine need stability in order to avoid increased compression. Compression of the sciatic nerve can occur either directly from the joints of the spine getting closer together OR from the muscles surrounding the nerve becoming overly tense and also compressing the nerve.
Aside from space and hormones, another thing to consider is the positional and postural changes that occurs with the belly growing outward. This is referred to as your “center of gravity” changes. When you’re not pregnant, your center of gravity is likely exactly as it sounds - fairly central! But as the baby grows and begins to push outward, this causes the center of gravity to move further away from center and therefore causes more pressure on our low back and pelvis, which are both trying to counteract that forward pull in order to keep you upright and looking straight ahead (instead of bent over looking at the ground). And if you refer back to that picture above, the low back and pelvis are RIGHT where that nerve is located!
And lastly, another factor to consider is the overall weight gain that happens during pregnancy. An increase in fluids and overall weight during pregnancy can definitely apply extra pressure to these nerves and cause them to flare up. And the thing about nerves is, once they are flared up, they can be real stubborn about returning to an unflared state! Which is why I want to share with you a few things that you CAN do during your pregnancy to combat this!
5 Options for Combatting Sciatica During Pregnancy
1. Modalities
Modalities (along with movement) can help with relieving symptoms. Modalities that may be beneficial during a flare up would be ice or heat, ultrasound, massage or electrical stimulation (like a TENS unit).
Taking a bath can also help ease the pressure on muscles, joints and nerves. *Pro tip: Adding epsom salt to your bath can help with inflammation as well!
2. Posture
It’s can be so helpful to increase our awareness of our general posture, in sitting, standing and during activity. Often times, sciatica is not brought on by one event or instance, it’s something that may seem to come on suddenly, but is actually likely caused by repetitive or ongoing things, like chronic poor posture, for example.
As you can see in the above pictures, when you are placed in an anterior pelvic tilt (picture on the left), your low back gets forced into an increased arch position, which can lead to narrowing of the spine and pinching of the nerves. With a posterior pelvic tilt (picture in the middle), the low back is in an overly flattened position which can also lead to excess pressure and stress to the low back and cause the muscles that attach to have to work harder to do their job. In a neutral pelvic position (picture on the right), the low back has a slight arch and shoulders are stacked over the hips, which is the natural and most optimal position!
In a seated position, you can really see how the rounded or slouched postural position can lead to a symptomatic low back or sciatica. In this position, the posterior or back of the spine will be spaced out; however the anterior or front part of the spine will be pinched together. As far as the muscles go, the ones in the back are stuck in a stretched out position while the muscles in the front are close together leading to increased tension. Sciatic nerve issues can happen from being pinched OR overly stretched, which is why postural awareness is so important, especially during pregnancy when the belly tends to either pull you forward into an anterior tilt or cause you to dip into the slouched position (often due to muscle fatigue or weakness) making your core muscles essentially shut off.
In that slouched or posterior pelvic tilt position with the core muscles being turned off or inactive, you are essentially relying on your ligaments, tendons and bone structure to support you instead of your stability/core muscles! This is a huge reason for core muscle weakness to start to develop during pregnancy and lead to overall loss of mind to muscle connection to the core once you are postpartum.
In the middle and right pictures, you can see that the neutral position you want to promote is one where your shoulders are stacked over your hips (instead of shoulders being pulled forward or behind the hip) and the hip, knee and ankle are in a 90/90 position (90 degrees of flexion at the hip and 90 degrees of flexion at the knee).
A birthing ball can be so beneficial to help you find neutral by rocking your hips all the way forward, then all the way back (into anterior and posterior positions) and then coming out of those and finding the middle of those two extremes. If holding that neutral position is too difficult or you find your muscles fatiguing after a short period of time, that’s when you can utilize the pillow trick (picture on the right) to maintain neutrally optimal positioning!
3. Exercises
To combat sciatica, often a combination of pelvic floor strengthening AND relaxation is key. My go-to exercises for calming sciatica and keeping it away includes:
Lower extremity nerve flossing
Pelvic tilts
Hip thrusts
Tripod rock back
Take a look at the videos below for examples!
4. Pelvic Floor Physical Therapy
Seeking out a pelvic floor physical therapist in your area who specializes in pregnancy will give you an individualized approach. If you’ve tried some standard remedies or you feel like NOTHING is working for your sciatica and/or low back pain, this would be a GREAT option for you.
5. Alternative Treatment
Chiropractic care and acupuncture can be good options to look into as well, which can help promote nerve relaxation and down-regulation of the nervous system.
Aquatic therapy is another alternative treatment option to help take the weight off your body and get some pain free mobility in.
Give these 5 options a try and see what works for you!
And if you already feel like you’ve tried EVERYTHING, and nothing is helping, make sure to check out my Mind Body Core Prenatal Program. This program is an all-encompassing program that helps not just with strengthening during pregnancy, but core, mobility and labor prep as well. Inside the program also has sections designated to various dysfunctions, such as low back pain and sciatica. Check it out by clicking below.
Will it go away postpartum?
In many cases, sciatica will subside during postpartum. If the main culprit for your sciatica was mostly due to the lack of space from the growing baby and uterus, then once the baby is born, a lot of those symptoms will improve naturally. However, there could be some residual discomfort due to the weakness of the core and glutes that can occur during pregnancy, especially if general movement and mobility was limited for an extended period of time or postural changes leading to a weakened core became habitual following your pregnancy.
This is why postpartum rehab is SO important! When you’ve spent 9 months (give or take) being pregnant, that is a significant amount of time to have some major changes that we cannot just expect to bounce back or return to pre-pregnancy state on their own. In order to promote best possible healing after giving birth, adequate rehab really is something that should be initiated.
My Mind Body Core (MBC) postpartum program addresses a full-body approach to healing, INCLUDING low back pain and sciatic. It provides a step-by-step guide to healing the core, pelvic floor and common postpartum and pelvic floor dysfunctions (like your low back and/or sciatic pain). It is a 12-week rehab protocol that targets the deep core AND pelvic floor as well as encompasses that full body holistic approach that is SO important for long-term healing. To learn more about my full-body postpartum program, click the button below!
If low back pain and/or sciatica has been a continued struggle…
…and you’re looking for a cost-effective way to get going and start feeling better, take a look at my 4-week program where each week you will find a set of exercises that are to be performed 4 times per week. This whole program is only $45 and has practical exercises, educational content and insights into pain management. When you purchase this program it also includes a BONUS section, “SI mobility flow” for enhanced mobility and can be utilized at any time. Click the button below to go directly to this “Low Back/SI Joint Pain” Program!
And remember…
…low back pain, sciatic pain, ANY pain during pregnancy and postpartum is NOT normal! Is it common - absolutely. But is it NORMAL to be in pain?? No! Most definitely not. Let’s not settle for pain being our new norm and instead learn how we can promote healing and health during one of the most significant time periods of our life.