Musculoskeletal Issues in Pregnancy

Adele Meron, MDPain Medicine Fellow

Physical Medicine and Rehabilitation University of Colorado School of Medicine

Disclosures

• Nearly 100% of women experience musculoskeletal discomfort during pregnancy

• 32% report low back pain to their providers

• 25% of prenatal providers prescribe specific treatment for low back pain

• 25% of pregnant women experience temporarily disabling symptoms

Hormonal Changes in Pregnancy

Relaxin Progesterone Estrogen

Physiologic Changes in Pregnancy• Anterior Pelvic Tilt• Increased lumbar lordosis• Pubic symphysis widening • Ligamentous laxity• Edema• Peripheral nerve compression• Weight gain -> increased joint load• Vascular compression

Gravid Uterus

Abdominal muscle stretch

Muscle incoordination

Loss of pelvic compression

Pelvic Instability

Pubic SymphysisDiastasisRelaxin

Ligamentous laxity

SI joint shear

Compensatory muscle adaptations

Anterior center of gravity

Anterior pelvic tilt

Increased lumbar lordosis

Lumbar strain

Lumbopelvic Pain Low Back Pain Pelvic Girdle Pain Combination LBP

and PGP

12-18 week prevalence

11% 33% 18%

35 week prevalence 71% 65%

Risk Factors: advanced maternal age, Hx of peripartum LBP, multiparity, high BMI, hx of hypermobility

Not associated: maternal weight gain, fetal size

Sources of Lumbopelvic Pain in Pregnancy

• Pelvic ligamentous strain

• Sacroiliac joint pain• Discogenic pain• Nerve root compression• Vascular compression• Hip pathology

Pubic Symphysis Pain in PregnancyPubic Symphysis Pain and Diastasis Incidence: 20-30%Presentation: stinging pain at PS with radiation into thighs. Worse with walking, stair climibing. Risk Factors:

- fetal macrosomia- hx of pelvic trauma- multiparity

Osteitis Pubis

Hip Pain in PregnancyTransient Osteoporosis • Presents in third trimester • Weight bearing hip pain• Diagnosed with MRI• Treat early with protected weight

bearing to prevent fracture

Avascular Necrosis• Presents in third trimester• Weight bearing hip pain • Diagnosed with MRI• Treat early with protected weight

bearing to prevent progression

Other MSK conditions to watch out for

• Labral tear• Meniscus injury

• Recurrent ankle sprains • ACL tear

• Lower extremity stress fractures

Identifying the source

Physical Exam

General Treatment Principles

US Guided SI Joint Injection

Peripheral Neuropathies of Pregnancy

Carpal Tunnel Injection

Discussion • How do we optimize delivery of MSK care to

our pregnant patient?

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Questions?