Improving maternal health by reducing pregnancy-related low back pain

Rehabilitation research scientist Nina Goossens, AXA Research Fund Women Health Fellowship Grantee, felt that this situation was very unjust and decided to explore, in a biopsychosocial framework, the factors that could lead to pregnancy-related lumbopelvic pain and its persistence after childbirth. Dr Goossens’ objectives were twofold: to find out whether having less control over one’s body while standing can cause lumbopelvic pain during pregnancy and postpartum; and to find out the reasons for this impaired control. These include changes in how the women perceived their own bodies (body perception), how they use proprioceptive signals (signals indicating the position and movement of our body) to control standing and psychological factors, such as being afraid of moving in the “wrong” way. 

Dr. Goossens and her colleagues found that women with pregnancy-related lumbopelvic pain (PLPP) during the final weeks of their pregnancy indeed showed a more disturbed body perception of their lower back compared to pain-free pregnant women. For example, they were unaware of how their lower back was moving during daily activities or reported that their back felt bigger, smaller or crooked. The same applied to women with PLPP in the first weeks after childbirth (1). In a related study, they found that women with impaired proprioception stood in a different, less optimal strategy to maintain a stable posture compared to non-pregnant women.  

The AXA project was a longitudinal, observational cohort study, meaning that Dr. Goossens’ team followed a group of pregnant women over time – from the first trimester to six months after childbirth. 

The results from the project help advance our knowledge on predictors of PLPP during pregnancy and after childbirth. They allow to change current unhelpful biomedical beliefs and increase awareness of PLPP, permitting healthcare providers to take women’s pain complaints more seriously and encourage them to seek aid rather than minimizing their pain as something that they should “just put up with”. The findings can also be a stepping stone to improving screening procedures and prevention and treatment strategies. This could help prevent lumbopelvic pain from becoming chronic and recurring after giving birth, in later pregnancies and indeed later in life. Novel interventions could, for instance, include exercise therapy to improve how women sense their bodies, while reducing inflammation (known to play an important role in musculoskeletal disorders in general), and cognitive interventions to help reduce their fear of moving. 

(1) Goossens N, Geraerts I, Vandenplas L, Van Veldhoven Z, Asnong A, Janssens L. Body perception disturbances in women with pregnancy-related lumbopelvic pain and their role in the persistence of pain postpartum. BMC Pregnancy Childbirth. 2021 Mar 18;21(1):219.