Sciatica During Pregnancy: 5 Ways To Relieve The Pain
Blog post written by Dr. Marnie Hansen, DC, for Salt Lake Spine & Pelvis
Pregnancy can be a beautiful and magical time. Yet, it can also make you wonder why it feels like a lightning bolt is shooting through your butt. Welcome to the world of sciatica during pregnancy. It might be common, but it does not have to be the norm if you know what to do.
Also common: hip, back, pelvis, and leg pain. As your body shifts and changes to accommodate a growing babe, aches and pains can naturally arise. Just know that there is a lot you can do, and you don't have to just grin and bear it until delivery.
With that being said, let's have a candid chat about what is actually happening with sciatica during pregnancy, and what you can do about it!
First: is it actually sciatica?
It is helpful to know what you are dealing with so you know the right steps to take.
Technically, sciatica isn't an actual diagnosis, but a description of nerve pain referral down the back of the leg that travels past the knee and toward the foot. Other definitions include numbness, tingling, and weakness in the leg.
For the anatomy and diagnosis nerds, some related diagnoses include: lumbar radiculopathy or symptoms of lumbosacral radicular syndrome. In short: "pinched or irritated nerves."
Breaking it down further, sciatica specifically describes pain or symptoms involving the pathway of the sciatic nerve, or the nerve roots that exit the spine and eventually form the sciatic nerve.
It's a whole bundle of fun!
These nerve roots begin at the lower spine and sacrum and travel through the pelvis, glutes, and buttocks, and continue down the leg.
True symptoms of sciatica can include:
Sharp or electric pain down one leg
Burning or tingling
Numbness
Pain into the calf or foot
Occasionally weakness
But it's important to remember that not everything that hurts in your butt during pregnancy is sciatica. I will see many pregnancy patients with pain radiating from the sacroiliac joints, pelvic floor, deep hip muscles, round ligament stress, glute muscles, or trigger points in the low back or pelvis that refer pain into the rear end or legs.
In other words, sciatic pain might come with a few accomplices :)
Why does sciatica get stirred up in pregnancy?
Your body is innately intelligent and is doing something incredible during this process: it's rebuilding and remodeling itself in real time. Your belly shifts your weight forward, your center of gravity shifts, and your pelvis adapts to it all. Your rib cage opens and expands, and your walking pattern changes to accommodate the center of gravity shift of it all.
That's a lot of work!
On top of it all, your spine has to figure out how to keep up and manage it all as it, too, shifts and changes. As women enter their second or third trimester of pregnancy, many will naturally see the curvature of their low back increase, or the position of their pelvis shift and tilt to balance out a growing belly. Meanwhile, the muscles that support the low back, hips, and pelvis are moving alongside these changes and are working overtime.
Add in different sleeping positions, decreased exercise for some, more sitting for others, previous back injuries, old disc problems, or a sacroiliac (SI) joint that was already feisty to begin with, and you start hearing some very loud opinions coming from your back side!
Don't Forget the Pelvic Floor
Not to be forgotten: the pelvic floor. The back and the pelvic floor work wonderfully together, and this is why I love working with pregnancy. There is a lot you can accomplish by working from core to floor.
Your abdominal wall, diaphragm, and spinal stabilizing muscles all work with the pelvic floor to manage the pressure system in your trunk (abdomen). Think of it like this: when you inhale, your diaphragm naturally descends, and the pelvic floor responds by doing the same. On the exhale, both the diaphragm and pelvic floor work in sync, subtly rebounding upward.
This pressure system changes dramatically with pregnancy, as the diaphragm and pelvic girdle don't have the same wiggle room they had before. The body has to now manage this change in pressure a little differently. This is why I usually don't prescribe hundreds of Kegels to my pregnancy patients. Sometimes, yes, the pelvic floor does need strength. And other times it needs to deeply relax. The pelvic floor can benefit from better coordination with breathing, posture, hips, and core function in most cases.
So what's a person to do?
1. Keep moving
Movement is life, and there are a lot of moving parts with pregnancy and sciatic pain. Unless your OBGYN has recommended activity restrictions, pregnancy usually isn't the time to completely stop moving. Gentle walks, guided strength training, swimming, prenatal yoga, mobility work (like cat-cows or pelvic tilts), and other comfortable methods of exercise can help your body train the right way for labor. It can also help you maintain strength and movement as your body shifts and changes.
The American College of Obstetricians and Gynecologists strongly recommends maintaining regular physical exercise during uncomplicated pregnancies. The key is to keep it appropriate and reasonable for you. Go gently when you need to; your third trimester workouts don't need to be a copy of your pre-pregnancy workout. Your body is already doing a ton of good work!
2. Try the "90/90" breathing position
This is one of my faves, and it is so easy to do.
Start by shifting slowly to the floor and lying comfortably on your back with your legs up on a chair, couch, or even the wall. Slightly bend the hips and knees if you can. If you are in your third trimester and lying flat is not comfortable, try lying on your side or in an elevated position with pillows propped up behind your back.
Then, slowly and deeply breathe into your ribs, belly, side body, back, and pelvic floor. Let it all relax. Then gently exhale. No need to force or do any breath-holding or aggressive Kegels.
Just breathe.
Take five minutes to just to check in with your breath and your body, and do this twice a day! It can be a nice little reset, and a great time to unwind the back and pelvis after working hard all day long. (There has been a lot of research on breathwork and back pain... check it out!)
3. Give your glutes some love
Your glutes work hard to support and stabilize the pelvis, and pregnancy gives them plenty of work to do. Depending on what stage of pregnancy you are in and your comfort levels, checking out some legit YouTube videos on proper clamshells, side steps, supported squats, and modified bridges can do the glutes a lot of good!
These exercises help maintain pelvic strength and train appropriately for the big day! The goal is definitely not to overwork your glutes at the gym, but to build the proper support for the pelvis and the low back.
In my office, I screen for glute engagement and how it affects posture. It can be a wonderful tool for women who are wondering how their posture is holding up with it all, and what their glutes are doing about it. This quick check often gives a lot of insight to women on how to shift or manage their glute and pelvic care.
Because those glutes need a lot of love during this time!
4. Avoid sitting like a curled-up shrimp, please :)
And many thanks from your local chiropractor! This will make their jobs so much easier. (I bet you knew the posture talk was coming, huh?)
Posture indeed plays a huge role in the pregnancy equation.
If you work at a computer all day, your baby sits right there with you. Unfortunately, pregnancy doesn't magically make eight hours in a chair better for your back... making sure to change positions frequently does! Set a timer on your watch or phone to get up and move around. Bring your screen toward you instead of leaning your head forward to see your screen. Support your back and feet, and try not to spend hours perched up on one hip or with your back curled up into the back of the couch.
Your best posture is your next posture. It's posture in motion... and movement wins! Your back will thank you for this.
5. Get the right help
If you are experiencing sciatica with pregnancy, or if low back, pelvic, glute, or leg pain is limiting your sleep, work, exercise, or even how you walk, save yourself days of backache or sciatica and get it checked!
A chiropractor, pelvic floor therapist, or other physical medicine practitioner experienced with the aches and pains of pregnancy will likely evaluate more than just the painful spot. For example, when I'm evaluating pregnancy-related back, pelvic, or sciatic pain, I am looking at the whole body. And I ask:
How is the low back and pelvis moving?
What are the SI joints doing?
Is the pelvic floor involved?
How is breathing?
How are the hips functioning?
What does posture look like?
Is there muscle guarding with areas that aren't moving too well?
Are there symptoms in the glutes, hips, legs, or feet?
And if so... what can we do about it?
This is where gentle treatments like chiropractic care, soft tissue therapies, pelvic floor work, breathing, mobility, yoga, and exercises can really help provide great relief to the mama-to-be!
One last thought...
Pregnancy can change your body, but it doesn't mean you are falling apart. Far from it. Pain is great information, and that information the body offers during pregnancy allows us to get to the bottom of where you could use more support and care.
I love addressing movement and functional issues before baby arrives, as it helps prepare for better ease with labor, delivery, feeding, rocking, carrying baby and carriers, lifting car seats, and all the nine million diaper changes that come up next!
By building a mobile, strong, and coordinated spine and pelvis now, you are proactively preparing for all the fun stuff to come. And that could be one of the best investments you make for your postpartum recovery!
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