II. Pathophysiology

  1. Musculoskeletal strain occurs with increased lordosis and soft tissue laxity in later pregnancy

III. Findings: Red Flags

  1. See Low Back Pain Red Flags
  2. Trauma in Pregnancy
  3. Vaginal Bleeding
  4. Severe Abdominal Pain
  5. Uterine contractions
  6. Uterine tenderness to palpation
  7. Decreased fetal movement
  8. Vaginal fluid loss
  9. Urinary Tract Infection symptoms

IV. Differential Diagnosis

  1. See Low Back Pain Causes
  2. Musculoskeletal causes
    1. Musculoskeletal Low Back Pain
    2. Sacroiliac Joint loosening
    3. Lumbar Disc Herniation
    4. Cauda Equina Syndrome
    5. Sacroiliitis
    6. Sciatic nerve pressure or lumbar plexus pressure
  3. Medical causes
    1. Pyelonephritis
    2. Ureterolithiasis
  4. Obstetric causes
    1. Placental Abruption
    2. Intrauterine Fetal Demise
    3. Uterine contractions (e.g. Preterm Labor)

V. Management: Musculoskeletal Low Back Pain

  1. Low back Exercises (adjusted for pregnancy)
  2. Physical therapy
  3. Back support devices
  4. Warm baths
  5. Medications
    1. Acetaminophen
  6. Procedures
    1. Acupuncture
    2. Epidural steroid injection
    3. Osteopathic back manipulation
      1. Franke (2017) J Bodyw Mov Ther 21(4): 752-62 [PubMed]

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