World of Education/World of Education.iso/world_b/bkache56.zip/PART2.EXE/PREG.TXT

Text File | 1992-12-04 | 15KB | 249 lines

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                            PREGNANCY AND BACK PAIN
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       Pregnancy and childbirth is a special time for all women. In the
       short space of nine months a variety of hormonal and physical
       changes take place leading to the eventual birth of a child.
       Physicians wisely suggest a series of exams, tests and
       counseling for all pregnant women. Adjustments to diet, exercise
       and work habits are usually suggested.

       For most women it would seem that back pain is one of those
       inevitable side effects of pregnancy. Something that is simply
       to be endured as a necessary consequence of the process.

       Surprisingly, however, there is much more to the situation. Not
       only can back pain be managed with an active exercise regimen,
       but also it is wise to consider that ignoring back pain as
       inevitable may lead to chronic back strain, disc damage or other
       permanent injury after pregnancy has passed. The possibility of
       back pain and even spinal damage should make a woman spend some
       time with her physician and ask questions about her backaches as
       well as her diet before, during and after pregnancy.

       In the early stages of pregnancy strong hormonal adjustments
       begin within the body of the now expectant mother. Fatigue, the
       need for additional sleep, and nausea or classic morning
       sickness may become apparent. The spine and lower back posture
       begins to change and become more relaxed. The muscles of the
       abdomen and back relax under the forces of hormonal control,
       gravity and for some women the effects of previous poor posture.
       The lumbar curve begins to accentuate slightly and the pelvis
       begins to tilt backwards. This new posture begins to play on the
       weakened and now fatigued lower back muscles which may display
       mild painful spasm - the first sign of a nagging backache in
       early pregnancy.

       As the baby grows and the abdomen protrudes, the forces of both
       gravity and hormonal changes continue to relax the muscles of
       the back and abdomen and a pronounced "swayback" appearance
       begins to appear. The stresses on the lower back muscles and
       spine increase and backache frequency may dramatically rise.
       Muscle spasm and pain may rise accordingly if no correctional
       action is taken.

       As the delivery date approaches, dramatic changes take place as
       new hormones are produced which loosen the ligaments of the
       pelvis so that it may expand and allow passage of the baby
       through the birth canal. A side effect of this late hormonal
       burst is that not only the ligaments of the pelvis are relaxed,
       but also ligaments in the nearby lower spine are allowed to
       become more flexible. This hormonally-driven joint relaxation is
       non-selective and affects joints other than those in the pelvis.
       The lower spine loses additional support and the lumbar curve
       becomes even more distorted which can further increase backache
       and muscle spasm.

       A direct cause of back and lower leg pain during pregnancy can
       also derive from the increased size of the baby itself. The
       large fetus can place pressure directly on the nerves of the
       lumbar area causing direct pressure and immediate pain. The
       nerves passing though the area of the psoas muscle which serve
       the lumbar region are especially subject to this source of pain.

       Vein congestion from the added pressure of a large fetus can
       also be a source of lower leg pain. Finally, the possibility of
       a ruptured disc is present in women who are overweight or have
       poor muscle tone or other pre-existing spinal disorders prior to
       pregnancy.

       Sometimes the structural weaknesses induced by pregnancy do not
       completely return to normal after the birth of the baby. If poor
       posture, excessive weight and poor exercise habits are allowed
       to continue, the back problems brought on by pregnancy can
       become chronic, organic and permanent. Some women who have had
       minor backaches prior to pregnancy or borderline spinal
       instability and muscle weaknesses may find that after pregnancy
       back pain may become a way of life. In most of these cases the
       pregnancy did not cause the back pain, it simply aggravated pre-
       existing poor posture and muscle tone thus providing the "straw
       that broke the camel's back."

       It is especially important that a woman clearly inform her
       physician of ANY prior back pain as early as possible during
       pregnancy. Special exercises, posture adjustments and even back
       braces are available. Diet and adjustments for rest are usually
       the first things on a woman's mind during pregnancy, but chronic
       back pain may be the most painful symptom of pregnancy which is
       neglected by a woman in discussion with her physician. For most
       healthy women simple exercises and posture adjustments are all
       that is required to further strengthen the back and abdominal
       muscles for the return to normal posture after the baby is born.

       The coccyx, the small vestigial tailbone at the end of the
       spine, can create unique problems and special pains during
       pregnancy. By function, the ligaments of the coccyx are directly
       attached to the bones of the pelvis. The additional weight of
       the fetus and other hormonal changes produce an unusually high
       amount of pressure and stress to the ligaments of the coccyx
       during pregnancy.

       During labor in the hospital delivery room the pressure on the
       ligaments of the coccyx increases further. Immediately after
       delivery this normally silent area of the spine may present
       severe pain for many women. The pain quickly disappears as the
       stretched ligaments and joints mend and reposition themselves
       into normal alignment. However, it may become difficult for a
       post-delivery mother to lie directly on her back if any pressure
       is placed on the area of the coccyx.

       Treatment depends on the severity of pain. Most hospitals and
       physicians suggest a small pillow, warm water bottle or donut
       shaped pad for relief of pressure on the coccyx if a woman must
       lie on her back. In cases of severe pain, injections of pain
       relieving medications are prescribed. Cortisone injections have
       also been used to alleviate pain in this area. In most cases the
       pain subsides and the damage is not permanent.

       In rare cases, systemic disorders have been found in pregnant
       women who complain of lower back pain. Osteomalacia is vaguely
       related to osteoporosis which was discussed in an earlier
       chapter. In simplest forms it is a vitamin deficiency. The
       normal treatment is to administer additional amounts of both
       calcium and vitamin D. In a sense, this disease is an obscure
       form of adult rickets. It affects primarily the bones of the
       pelvis and lumbar area. In severe cases the weakened bones of
       the pelvis may indicate Caesarian section delivery of the baby
       since the malformed or twisted bones of the pelvis do not permit
       easy passage of the fetus during birth. This disease, largely a
       dietary deficiency, is rare among American women whose diets are
       reasonably balanced.

       Osteitis condensans is another unusual disease which can
       sometimes affect pregnant women. It is unusual since its primary
       manifestations may be aggravated by pregnancy. The changes
       brought about by this disease are seen in the sides of the
       pelvis within the two bones of the ilia which become hard and
       thickened with calcium buildup. The normal porus matrix
       structure of the ilia is dramatically altered and the bones
       become firm and dense. Cause and cure are largely unknown at
       this time. Pain medications are at present the only relief. The
       excessive buildup of calcium seems to accelerate with each
       pregnancy and in some cases of this condition, caesarian section
       may be the preferred method of delivery. Back pain can be a
       manifestation of this condition which is relatively rare for
       most pregnant women.

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                                 BIRTH DEFECTS
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       A variety of other conditions can also give rise to back pain.
       Congenital and developmental problems, while rare, can occur
       before or after a child is born and in specific instances can
       increase the risk of backache and back pain for the child.

       Spondylolysis is a unique developmental defect of the back which
       involves the upper and lower articular facets of the vertebrae.
       In simplest terms this junction between two vertebrae must
       precisely match for smooth motion and good structural stability.
       In this condition a section of the articular facets may be
       missing and thus poorly aligned. Gradually a gap forms and the
       empty space is filled with a type of soft cartilage. The site of
       the defect is frequently in the area of the sacrum and fifth
       lumbar vertebra - a classic candidate for backache.

       Since the tissue which fills this missing gap is softer than
       bone, the misalignment can be significant enough to give rise to
       a secondary condition termed spondylolyisthesis which refers to
       the actual movement or slippage of the vertebrae out of proper
       alignment. The fifth lumbar vertebrae is most frequently
       affected by this condition which is not purely congenital
       (present at birth) but probably begins after a child is born.
       The condition usually deteriorates during the teenage and adult
       years as the fifth lumbar vertebra slips out from the support of
       the sacrum below. The disc between these two bones becomes
       stretched and in time the sciatic nerve may also become involved
       leading to a sharp pain radiating into the legs. Surgical
       correction via fusion of the fifth vertebra and sacrum is
       sometimes attempted in severe cases of this condition.
       Fortunately this condition, like many congenital and
       developmental conditions is relatively rare.

       Spina bifida describes a congenital defect in the development of
       the fetus growing within the mother's womb. You will recall that
       the bones of the vertebrae enclose the spinal cord like a
       protective shell. During embryonic development the rear or
       posterior portion of the vertebral bones are the last to form
       and surround the spinal cord. If closure is incomplete during
       the final stages of spinal development, sections of the delicate
       spinal cord may remain outside the protective vertebrae along
       with its covering membrane shroud known as the meninges. A
       protrusion or sac may form around this nerve tissue and extend
       directly through the skin of the back and be visible at birth.
       The exposed portion may be relatively short or long. When
       extensive portions are exposed, nerve function may be lost in
       the lower limbs, bowel or bladder. Obviously surgery and
       substantial medical care is required in cases of spina bifida
       involving substantial spinal cord damage or exposure.

       Spina bifida can also be present as smaller defects which do not
       cause exterior swelling and are relatively minor. In many cases
       an individual may go through life not realizing that a portion
       of vertebrae does not completely enclose the spinal cord. The
       structural integrity of the spine is nonetheless compromised and
       potential instability is present which may lead to eventual
       backaches and pain.

       Typically the lumbar and sacral portions of the spine are most
       commonly affected in cases of spina bifida. A minor defect may
       not be apparent even upon X ray examination of a child under the
       age of six or seven years old. After this age, the defect is
       more easily diagnosed by X ray or NMR (nuclear magnetic
       resonance) examination. Occasionally a small pimple or darkened
       hairy wart may appear at the base of the spine on the skin to
       mark to defect. Eventually, as the child grows, the structural
       instability of the spine in this area may lead to backache or
       pain. Surgery to fuse or repair the defect may be attempted to
       restore function and reduce pain in cases where spina bifida
       leads to chronic back pain or potential nerve damage. Some
       medical journals report that the undetected occurrence of small
       spina bifida defects in the general population may be as high as
       14%.

       Congenital defects can occur in other ways as well. Normally the
       lumbar area of the spine consists of five vertebrae. Sometimes
       the vertebrae develop but do not properly separate, thus leading
       to congenital vertebral fusion. In other instances only four
       vertebra develop. Medical literature has also reported six and
       even seven lumbar vertebrae developing. Finally the articular
       facets, the bony "projections" or "arms" which extend from the
       sides of the oval vertebrae may develop poorly and protrude from
       the vertebrae at unusual angles. Back pain and backaches may
       thus arise and in some cases surgical intervention may be
       required.

       This tutorial is merely a starting point! For further
       information on back care and back pain, be sure to register this
       software ($25.00) which brings by prompt postal delivery a
       printed, illustrated guide to back pain written by a physician
       plus two software disks. From the main menu select "Print
       Registration Form." Or from the DOS prompt type the command
       ORDER. Mail to Seattle Scientific Photography (Dept. BRN), PO
       Box 1506, Mercer Island, WA 98040. If you cannot print the order
       form, send $25.00 to the above address and a short letter
       requesting these materials. End of chapter.