Lower Back Pain in Women: Causes & Treatment
Lower back pain in the lumbar region is among the most common conditions for which patients seek chiropractic care, especially when it is caused by spinal stenosis or a herniated lumbar disc. Lower back pain is defined as pain, muscle tension, or stiffness, with or without leg pain, caused by strain on the sciatic nerve and resulting in neurologic symptoms. Chronic lower back pain can begin in childhood and continue to plague the patient throughout their life. This pain is often caused by issues in the lumbar spine, which consists of five vertebrae that protect the spinal cord. It is a disorder with many possible causes and many explanations and occurs throughout various sectors of the population.
Research indicates that more than 80% of all people experience lumbar pain during their lifetime, with its prevalence being slightly more common in females than males across all age groups. This pain can be caused by arthritis, muscle strain, or issues with the spine. Women with osteoporosis may experience increased lower back pain, especially during their menstrual cycle or at the time of ovulation. This pain can be attributed to lumbar issues and may also be exacerbated by arthritis symptoms. The inflammation and cramping associated with uterine issues can cause an increase in intra-abdominal pressure, which may exacerbate symptoms of lumbar arthritis.
Age Influences Back Pain
Lower back pain in women increases significantly with age. A 2019 article in the Journal of Mid-Life Health reported an increased incidence of lower back pain symptoms in females with osteoporosis and arthritis during menopause, particularly in the lumbar region. Women suffering from osteoporosis, a common condition in menopausal patients, may experience low back pain as one of the symptoms. A synthetic literature review in 2016 demonstrated that female patients had a higher prevalence of low back pain across all age groups, including those with osteoporosis. This female vs. male difference was highest for school-age children.
Pregnancy and Back Pain
Pregnant women may experience symptoms such as weight gain of 20 to 25 pounds, a shift in their center of gravity, and hormonal and anatomical changes. Patients may notice these changes during pregnancy. These necessary alterations increase stresses and loads on the lower spine and pelvis, leading to back pain symptoms in patients. Additionally, these changes can also contribute to infection in the affected area. The paraspinal muscles, which support and stabilize the spine and help alleviate pain in patients, shorten and become unbalanced by the excessive stretching of the abdominal muscles in the front. This can lead to complications such as infection. As the abdomen presses outward, the connective tissue that joins the two sides of the rectus abdominis muscle begins to thin and widen, making the muscles less effective at contracting. This can contribute to low back pain in patients, particularly those with spine issues or infection. The widening of the connective tissue in patients with low back pain is called a “diastasis recti,” which is a normal response to the expanding belly during pregnancy and can lead to infection in the spine.
The growing uterus may cause increasing lower back pain in female patients due to changes in the spine. The expanding uterus may shift a woman's center of gravity, causing pain and strain on her spine. This can stretch and weaken her abdominal muscles, altering her posture. The extra weight that pregnant patients carry may cause low back pain, increased stress on the spine, and flattening of the three arches under each foot.
A tenfold increase in the hormone relaxin may loosen the ligaments in the joints of the pelvis, causing low back pain in patients. This makes patients more flexible, so they may experience low back pain. It also makes the abdominal muscles more flexible and relaxes blood vessels to accommodate the increase in blood volume during pregnancy. Relaxin may also help to relax the pelvis and prepare low back pain patients for the baby's passage through the birth canal. Low back pain (LBP), sacroiliac joint pain, and pain at the pubic bones may occur if low back joints become too flexible in patients.
Patients may experience low back pain as the facet joints in the lumbar spine are also under duress during the entire pregnancy process. Patients with low back pain may experience strained or injured muscles that can become stiff, locked, and inflamed. The growing uterus and increased curvature of the lower spine exert additional mechanical loads on the lower back, causing pain in patients and altering their spinal posture. This altered posture increases stress on the lumbar facet joints and lumbar spinal discs, leading to low back pain.
After pregnancy, a woman's core musculature is weakened, leading to low back pain. There is impaired load transfer during activities, which can result in an overload of stress on the pelvic ligaments. Thus, the pelvis tends to tip forward or anteriorly. This pelvic position further adds to the female's low back pain issues during her pregnancy. As a result, low back pain, hip impingement, instability, tears in the labrum, and potential early osteoarthritis of the hip joint can occur.
Menopause and back pain
About 70% of perimenopausal women experience symptoms related to estrogen deficiency, including sleep disorders, decreased bone mineral density, and musculoskeletal pain, particularly in the low back. This pain is reported by more than half of perimenopausal women. Most studies show that women with a higher menopause symptom burden may be the most vulnerable to chronic back pain.
Female sex hormones play an essential role in the etiology and pathophysiology of various musculoskeletal degenerative diseases, including low back pain. Postmenopausal women experience accelerated disc degeneration, which can lead to back pain, due to relative estrogen deficiency. Research studies indicate that in the United States, about 25% of women will experience vertebral compression fractures, leading to back pain, of the middle to lower spine throughout their lifetime. The condition of back pain occurs more frequently with age, reaching a prevalence of 40% at age 80. These can cause significant disability and limit function.
The National Institute on Aging reports that osteoporosis is the most common cause of compression fractures, which can lead to back pain. Approximately 20% of women over 50 experience this condition. Postmenopausal women have an increased risk of osteoporosis and back pain due to hormonal changes that decrease bone mineral density, predisposing bones to fracture.
Women in the Work Force
Women in the workplace are also obtaining more physically demanding jobs, which can lead to an increased risk of back pain. According to the United States Department of Labor and Statistics, the top five positions for women in the labor force are back pain.
- Registered nurses
- Elementary and middle school teachers
- Secretaries and administrative assistants
- Customer service representatives.
In 2020, a cross-sectional study based on a population survey of 600 individuals showed an overall prevalence of back pain at 60.9% in women. The measured associated factors in women for back pain were occupational activities that involved heavy lifting, standing posture leaning forward, sitting posture leaning forward, and sitting at the computer three or more days per week.
A Solid Chiropractic Care Plan
Whether they have monthly, cyclic lower back pain, are at any stage of pregnancy, or are engaging in a job/activity that is stressful, women’s bodies benefit from chiropractic. Specific adjustments to align the pelvis, sacroiliac, hips, and alleviate back pain are key. Equally important is to examine the 26 bones of each foot and adjust the excessive pronation or supination patterns they exhibit, which can contribute to back pain.
Utilize custom, three-arch, flexible orthotics for the pedal foundation to alleviate back pain. Supporting the three arches of the feet will provide symmetrical balance from the ground up, relieving back pain. With a supported kinetic chain, the body's joints will be less stressed, reducing pain and preventing back problems.
When women are expecting, the pain in their back gets worse and worse throughout their pregnancies. The force onto the three arches also increases. If the patient is experiencing back pain during pregnancy, appropriate orthotic support can be provided from the first trimester through all stages of the pregnancy and postpartum. This will minimize the damaging effects on the plantar fascia, soft tissue, and bones of the feet from the pain and back effects of pregnancy.
Core Stabilization Exercises
In general, but especially for pregnant and postpartum females, core training exercises, including those that target the pelvic floor, are essential for alleviating back pain. The types and frequency of back exercises will depend on the state of the patient's pain. An exercise regimen for a woman with general back pain (LBP) who is not pregnant or in the early stages will look different than for a postpartum female.
If a woman has given birth, most OBGYNs suggest waiting until the 6-week check-up before starting core/pelvic floor work to avoid back pain. Whether they had a cesarean section or a vaginal delivery is important as that helps determine the timeline for back pain before they can
begin exercising and how long it may take to return stability and strength to the core. Typically, the focus is on the rectus abdominis, the transversus abdominis, and the internal and external abdominal oblique muscles to alleviate back pain. Abdominal bracing with variations, pelvic tilts, and kegels are great examples of safe, effective exercises for back pain relief.