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The post partum patient retains a higher risk for potential injury as compared to the patient who has not endured pregnancy or has not been pregnant for an extended period of time. Fertilization propels the release of estrogen, progesterone and relaxin, hormones essential to the growth and development of the embryo and fetus. These hormones that are essential to the pregnancy cause global relaxation to the ligaments and muscles in the female pregnant patient. A conglomerate of anatomical changes created by the global laxity in muscles and ligaments compromises the stability of the spine.
Spinal stabilizers, such as the abdominal muscles, lose their tone and affective ability to counteract the increasing lordodic curve. The zygapophyseal joint, the pelvis and ligaments and muscles surrounding the spinal column, lose their ability to stabilize the spine. Throughout the pregnancy, instability gradually increases. As the pregnant female proceeds from the first trimester to the third, postural adaptations can be noted.
These patients proceed through pregnancy with some experiencing back pain and some not. All, however, experience a change in there anatomy. Once hormonal homeostasis is reached, post-partum, global hardening of ligaments and muscles occurs. Patients may at this point begin to discover back pain previously not felt. Those who are tending to infants and small children may find themselves lifting and holding a toddler or infant for extended periods of time. Chronic contraction of the ipsilateral muscle of the arm, forearm and upper thoracic region can irritate an existing condition. Post partum women that have lax tissues and hypermobile spinal segments increase susceptibility to injury.
During the transition of post partum, hormones begin to reset. This event is the prerequisite to re-hardening of muscles and ligaments. The sacrifice of spinal stabilization that allows for growth and development of the fetus exposes the mother-to-be to an increased probability of back injury. Adaptations in posture, during pregnancy causes a posterior shift in the center gravity. Stabilization of the spine relies more heavily on the posterior joints.
Discogenic injuries can cause low back pain in women of childbearing years. The increase in ligament mobility and loss of muscle tone that creates hypermobility in the spinal segment may affect the material of the disc. The annulus fibrosis is designed to resist forward translation while containing the nucleus pulposus. Such architecture can be compromised, thus interfering with axial absorption, a function of the nucleus pulposus.
New mothers who are post-partum often resume the routine of child-care without obtaining full recovery. Laxity of the ligaments and muscles remains. Often mothers are lifting car seats, baby strollers, the child and/or other siblings into their arms and carrying the infant and other children. Many times this is done with reckless abandon to proper back ergonomics. Mothers are often fatigued and hurried to get to their destination, often with self-neglect. These activities, concurrent with laxity of muscles and tissues, create a canvas for injury to the tissues around the spine.
If you or someone you love has been suffering with low back pain, we can help. We Listen, We Care, We Get Results!
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