Sciatica in pregnancy
About 30 percent of women suffer at some point sciatica in pregnancy, which manifests with pain in the lower back, the gluteus, and can even go down to the leg in the form of cramp or numbness . Although the pain of sciatica in pregnancy can appear to both legs, it is more common to be on one side only.
It is more frequent that this pain appears from the second trimester of pregnancy, when the weight begins to be higher, some women suffer from the first weeks of pregnancy, due in these cases to hormonal reasons.
Why is the sciatic nerve compressed?
The sciatic nerve is formed from several nerve endings that come out between the lumbar and sacral vertebrae. These terminations come together and form a thicker muscle cord that goes to the gluteus and, from the back of the leg down to the sole of the foot. In its journey it gives rise to other smaller nerves, which could resemble the tributaries that a river receives. This set of nerves is responsible for receiving sensitivity and send orders of movement to some muscles of the legs (especially those in the back).
The increase in weight as the pregnancy progresses, causes a change in the body scheme of the woman. The center of gravity moves forward, and the musculature of the back part of the body must react to stop the fall forward. At a more localized level, the weight of the uterus is placed on the upper part of the pelvis, which will have a direct impact on the position of the skeleton of the pelvis, increasing the tension of the ligaments and muscles of this area.
In the posterior part of the pelvis, the pyramidal muscle is located, below which the sciatic nerve passes. Often, this muscle is responsible for the compression of the sciatic nerve. Although there are other causes by which the sciatic nerve can be compressed, compression due to excess tension of the pyramidal muscle of the most frequent, and is what is called Pyramidal Syndrome.
The sciatic nerve is a mixed nerve, which means that they travel information of two types: sensitivity and movement. That is, it receives information about the sensitivity of the skin, muscles and joints that travels to the central nervous system, and carries the orders of movement from the central nervous system to the muscles. This implies that, when the sciatic nerve is compressed, sensitivity can be altered (ranging from a slight tingling to an intense burning sensation), and in some cases the movement (inability to move the foot throughout its range). .
What can Physiotherapy do in sciatica during pregnancy?
From the point of view of the treatment of Physiotherapy, it should be noted that, in cases in which the pyramidal muscle is compressing the sciatic nerve, the pyramidal tension is secondary to other muscular tensions. Therefore, the treatment should never be initiated in the pyramidal muscle, but previously the tensions of other muscle groups should be normalized. This point can be a source of surprise in many patients, since such stress normalization can begin in remote areas of the body, such as the neck or feet. But it is important that the treatment is done in a global way since the tension of the pyramidal is always a consequence of other blockages (hip, spine, etc.), which if not treated previously, will not allow the pyramidal muscle to stop compressing to the sciatic nerve.
To prevent an increase in excessive tension of the posterior muscles of the legs and lower back, it is recommended to stretch the muscles.
Lorena Gutiérrez, physiotherapist specialized in pregnancy, postpartum and pelvic floor.
FisioByM "Physiotherapy for Babies and Moms"
