Sciatica during pregnancy can be common. Sciatica is the general term used to describe pain along the nerve into the buttock, leg, and/or foot. The sciatic nerve runs from your lower back down through the buttock on each side and into the back of each leg to the foot.
If the nerve becomes irritated it can send pain anywhere along the line of the nerve, often described as shooting or burning pains, and is usually only one-sided. The leg can feel numb or weak sometimes, and there may be tingling sensations anywhere along the leg or into the foot.
It can range from mild to severe in some cases and can be quite debilitating for some people, affecting their movements and lifestyle. Often it is worse with standing or walking, turning over in bed, and moving from sitting to standing. Coughing and sneezing may make the pain worse, especially if the nerve is being irritated by a disc in the lower back.
Sciatica can happen at any time in our adult lives, but it can be more common to get lower back and leg pain symptoms during pregnancy due to the increased pressures around the back and pelvis, and the mechanical changes around the joints, muscles and nerves. It may be more likely to occur if you have had lower back or nerve symptoms before your pregnancy and if you have had more than one pregnancy, but it can affect anyone, irrelevant of lifestyle or fitness. If you sit for long periods, for example working at a desk, it’s possible the static positions can cause more pressure through the lumbar discs and nerves.
Causes of sciatica-type pains
Although there may be buttock and leg pain symptoms, not every case is caused by the sciatic nerve being irritated or compressed. In pregnancy, the term ‘Pelvic Girdle Pain’ is used to describe pain around the pelvis, buttocks and thigh, so if you are having ongoing pain it is good to have an assessment to work out what might be causing the issues. If you have any major changes to your bladder and/or bowel habits, or increasing numbness in the leg/buttock or genital area you should seek advice ASAP as this could mean that the nerves at the base of the spine have been affected, and this needs diagnosing immediately, so don’t put off asking for help in this situation.
Below are possible factors that could cause pain in these areas:
- Lower back (lumbar) disc lesions / bulging disc
- Spinal joints (facet joint)
- Pelvic girdle pain / Sacroiliac Joint dysfunction/hip joint issues
- Muscular dysfunction such as piriformis syndrome
- Veins / varicosities / vascular issues
- Anatomical changes – increased lumbar curve (lordosis) due to postural pregnancy changes, position of the womb and if it may be pressing on spine or sacroiliac joints, or pelvic nerve entrapment
- Increased mobility around the joints due to hormonal changes relaxing ligaments in the body
- Foot posture issues affecting the mechanics of the knee and hip joints
What can you do about it?
If you are starting to get some symptoms of pain in your back and buttocks/legs it is wise to try and do something about it quickly, so that it limits the risk of it worsening.
Make sure that you change positions regularly, especially if you sit for long periods. Have some support from a cushion or rolled-up towel in your lower back (waist level) to help keep the natural curve in your spine supported. It may be easier to go for two short walks in one day rather than one long walk and make sure you are wearing supportive shoes, as the arches in your feet can flatten in pregnancy.
When bending try to make sure that you do it with knees and hips bent in a slight squat position and limit lifting as this also puts pressure on the spine and pelvis.
Try sleeping with a pillow between your knees if you are lying on your side.
If you are feeling well enough to do some exercise it can be beneficial to try some core-based exercises such as pregnancy Pilates or yoga. If your pain symptoms worsen doing this, reduce the amount you do, or stop the activity and seek some advice.
Pelvic floor (Kegel) exercises are also vital as these muscles usually support the pelvis and spine, and make up part of the core group of muscles.
We would recommend looking at the Pelvic Obstetric and Gynaecological Physiotherapy Group information leaflets which have lots of excellent information and exercise advice to follow. This leaflet may help with suggestions for good postures and basic exercise advice.
Getting the right advice
If your pain is not settling after 2-3 weeks it may be wise to get things checked out. During pregnancy, there are multiple factors that can impact pain, so it’s important to be assessed by an experienced clinician such as a pelvic health physiotherapist, or a musculoskeletal physiotherapist who is trained to assess and treat women during pregnancy. During an assessment, they would ask lots of questions about your pain, how it is affecting you, and about your lifestyle and exercise levels. Carrying out a full physical assessment usually gives an idea about where the pain may be coming from, and then a plan can be created from which treatment techniques, stretches or exercises might be of benefit.
There are several studies that have shown that manual therapy may not be not beneficial for pregnancy-related symptoms of sciatica or back pain symptoms. We would recommend that everyone is assessed individually to see what might be of benefit to them, as each person may have different requirements for their daily activities, and adaptions can be suggested on an individual basis.
- Manual therapy techniques if the lower back joints are stiff on assessment
- Maternity belts might be of benefit but this is not always the case, some pelvic conditions feel worse with compression from a belt, so having an assessment is vital
- Activity adaption – suggestions can be made for work or daily activities which could be impacting on pain symptoms.
- Active exercises and stretches– again this needs to be assessed for each individual as it depends on what level of fitness they had pre-pregnancy, what exercise they have been able to do in pregnancy, and what they are physically capable of at the time of being seen. An exercise regime should be monitored initially to be able to adapt and progress. Often the focus is on core exercises to get the muscles around the pelvis and lower back stronger to support the area.
- Postural care and adaption of work positions, advice on sleep positions, correct bending, lifting and sitting postures
After your delivery
Often once your baby arrives the symptoms of back and leg pain usually settle, sometimes surprisingly quickly as the pressure is taken off the pelvis and spine.
(In my experience when we see ladies on the maternity wards once they’ve delivered their baby around 80% of women will find the pain has settled within a couple of hours after the delivery. For some, the pain can remain but usually settles within 1-2 weeks. It’s very unusual for pain symptoms to continue longer than this).
- Give yourself some time to see if things are improving, but seek help quickly if it’s not easing, or if your pain is worsening.
- The most important factor after your delivery is to look after your body positions and make sure that you are aware of your postures, especially with feeding your baby. Whether you bottle-feed or breast-feed it’s vital to make sure that you sit well supported by pillows in an upright chair if you can. The commonest issue is in the first few days if you and baby are learning how to breastfeed; often it takes practice, and we can end up in slumped, twisted postures which put more pressure on the spine and pelvis.
- Make sure that you change baby’s nappy in a good upright position if possible, waist-height is better rather than leaning forward bent over a low bed or sofa.
- When bending make sure you keep your knees softly bent, with hips flexed, and stick your bottom out in a slight squat position. This puts the spine and pelvis into a good position, uses the leg muscles correctly and is a great habit to get into straight away.
- Bathing baby can be difficult if you are leaning over the side of the bath. In the early days, it may be better to have a baby bath on a table and fill/empty the water with a jug so you are not lifting. Ask for help lifting baby out of the bath as well.
- Doing some gentle postnatal exercise is wise, even if you can only do small amounts at a time. The information leaflet below produced by the POGP covers both caesarean and vaginal delivery advice. There are some exercises you can start straight after delivery (even after a caesarean!)
After 6 weeks post-delivery you can usually start to develop an exercise regime, but the type of exercise will vary depending on what type of delivery you had, and how well your recovery is going. Don’t be too quick to go back to full exercise, it takes time to gradually increase activity levels and you may feel fatigue come on quite quickly. Think about what your body has gone through in pregnancy, it’s very hard work! Your body needs time to recover and especially if you have had pelvic or sciatica-type pain. Starting some core exercise alongside pelvic floor muscle exercises should reduce the risk of pain symptoms remaining, and stop it from returning.
It’s always wise to have a postnatal check-up first. This could be with your GP, midwife, consultant or physiotherapist. If you are still having sciatica-type symptoms it would be wise to see a chartered physiotherapist to guide you back into exercise once they have completed a physical check.
By Liz Kirton, Clinical Specialist Physiotherapist in Pelvic Health, and Grace Keene Senior Specialist Physiotherapist in Pelvic Health, from The Portland Hospital for Women and Children, London, (part of HCA Healthcare UK).