与妊娠有关的腰痛

在孕期保健一个长期存在的争论是腰背痛或腰痛是一个必然的过程，并允许自发地解决或者是可以预防的。本文回顾了怀孕患者在临床表现，实用的治疗和管理策略腰痛。

腰背痛（LBP）和后盆腔疼痛（PPP）以前被认为是相同的。过去的研究分为这两个条件的一个分类下的“腰痛。”然而，他们最近已经被离散described-and-measured.It现在很明显，他们需要诊断和管理单独审议。

腰背痛代表怀孕的约为50％，9个月的患病率一个共同的病理生理过程。尽管有丰富的文献资料，在怀孕期间遗骸腰痛知之甚少。目前的治疗方法往往是无效的，留下困惑如何管理病人的症状医生。

总的想法是，没有什么可以做短母亲完成怀孕的解决这些问题，并简单地允许这些症状可以自行缓解。但仔细诊断，适当的治疗是可能的。

Clinical Presentation

孕期腰痛的特点是最大的疼痛强度和疼痛的位置的时间。怀孕有关LBP相比，非孕期LBP的功能会有所不同。相比于普通人群的23.6％，那存严重LBP，所有孕妇的三分之一形容自己在怀孕期间严重LBP一段时间。地幔等所指示的第二和早期第三个三个月是周期时背痛是最普遍的。一些研究还报道说，晚上的时间显然比天的休息更痛苦。孕妇大约有67％来自夜间不适或背痛和36％患有夜间有腰酸很严厉它唤醒他们的睡眠。

疼痛强度或位置的图案在确定的背部疼痛的来源是至关重要的。Ostgaard等分化成LBP疼痛源自后部骨盆区域 - PP（远侧和横向至L5）或下腰部区域（LP）。据报道，发生PPP 2至4倍更频繁然后腰部类型。PPP不像LP已经直接关系到双方的疼痛强度和病假，因此被认为是更致残。虽然妇女与LP疼痛通常全妊娠期保持不变，购买力平价的增加在怀孕中期及后期的流行。

体格检查/标志

怀孕期间LBP的评估包括视觉模拟评分和身体图表/疼痛的图，但它们可以在腰部和后部骨盆疼痛之间进行区分是不够的。神经系统检查通常是不起眼的两种类型的疼痛与负硬膜紧张现象，其中包括直腿抬高。

腰椎疼痛（LP）在怀孕期间相似，患者的临床表现没有怀孕，是比较容易比盆腔疼痛（PPP）来诊断。LP更趋于慢性和激烈产后。疼痛椎旁肌，hypomobility和弱点在腰椎背部肌肉意味着不足的触诊。有可能还与疼痛腰椎前屈再现被腰椎的运动范围减小，。

PPP典型的LP介绍不同，往往是急性的，妊娠，和不常见的非孕妇人群。没有额外的创伤或色料，轻度PPP通常可解决产后3个月。在临床上，患者目前背痛和“深，枯燥的，边界不清的疼痛是局部的不良”和向下的后外侧大腿至于小牛辐射。Sturesson等人建议，大神经支配的骶髂关节（L4-S1）有助于由孕妇经历的称为疼痛。虽然有用于评估骶髂关节病理学无数次试验，研究表明3次测试的具有优异的灵敏度和功效;“帕特里克Fabere测试，Menell的测试，和后盆腔疼痛激发试验。”

鉴别诊断

Pregnancy-related LBP can be defined as any type of idiopathic pain arising between the 12th rib and the gluteal folds during the course of the pregnancy. As such, this does not include any situation in which the pain can be attributed to a specific pathological condition, such as a disk herniation that arises either before or during the pregnancy. It is important to consider other disease pathologies, some of which are listed in Table 1, that mimic the symptoms of “primary” LBP associated with pregnancy.
As previously stated, LBP with radiation into the buttocks and legs is a common problem during pregnancy. However, LBP must be carefully differentiated from radicular and other neurologic symptoms. True sciatica is rarely diagnosed in the pregnant population. Posterior facet syndrome can present with pain radiation down the posterior thigh and mimic radicular pain. Another type of radiculopathy, meralgia paresthetica, follows the distribution of the lateral femoral cutaneous nerve and may be confused with referred pain symptoms experienced with LBP. Meralgia paresthetica is associated with severe pain, numbness, tingling, hypesthesia, or burning sensation down the anterolateral aspect of the thigh.

Management/Treatment

对于LBP常见的治疗干预措施包括物理治疗和练习。乐动体育汇Ostgaard等研究病假和产前回到教育和培训类之间的关系。他们发现，在孕妇中的病假时间降低12％的个性化回的教育和培训计划，PPP和LP疼痛类型的患者。作为预防措施，理疗程序应设计和妇女的健康理乐动体育汇疗，或卫生保健提供者谁专注于女性健康监测。这是因为特殊人群，如待产孕妇与PPP的管理不当可能导致病情恶化。例如，PPP受害者应该从爬楼梯避免，在该过载骨盆臀部和背部，和其它位置单腿站立，极端运动。那些既腰目前谁后盆腔疼痛症状时，应避免背部，加强锻炼，直到骨盆后症状缓解;如果腰部加强锻炼执行这些症状可能会加重。

除了理疗，演习以缓解轻度LBP乐动体育汇可以包括步行，游泳或骑自行车在低到中等强度。深腹色调建议产生于背部肌肉压力较小，但仰卧起坐和举腿试验是禁忌。还应该注意的是，运动的怀孕期间的目标是提高或维持肌肉，而不是控制体重增加或以正确的姿势。高血压，糖尿病，早产史，前置胎盘，先兆流产在怀孕期间都禁忌锻炼。

其他辅助疗法也可用于女性盆腔疼痛，并可能减少对药物的需求。Berg等报道的患者遭受严重LBP经历了一些救济粗隆带，提供支持，以骨盆带71％，但这一带可压迫腹部而引起不适。骶髂皮带，相反，不压缩，腹部和女性后盆腔疼痛的82％，报告了这些带一些缓解疼痛。

预防

预防of LBP is often associated to how one manages her pregnancy during this period. Maximum working capacity is expected during pregnancy in some career environments, and ignoring the additional responsibility of pregnancy by employers or the employees themselves only exacerbates the symptoms. Pain intensity during pregnancy has been positively associated with duration of pain postpartum. Women who did not take breaks at work report experiencing back pain symptoms 6 years postpartum. Wergeland and Strand found that women felt more at ease during pregnancy if they controlled their own work pace.

Prepartum physiotherapy management and exercises have also been considered a component of LBP prevention. Women who are more physically fit prepartum appear to have a reduced risk of developing LP and PPP during pregnancy. Exercise regimens as little as 45 total minutes per week have been correlated with reduced lumbar pain symptoms. Expectant women with history of PPP and/or LP felt more positive and less fearful of their pregnancy when they know that help and support is available from qualified physiotherapists in the event that symptoms flare up.

Conclusion

Pregnancy, for good reason, is considered by many a fragile time of a woman’s life. Health care providers use special precautionary measures to ensure the health of the growing fetus and the mother. For this reason, they are often hesitant to address the symptoms of LBP, which are widespread and often debilitating. But if unaddressed, these symptoms can persist during pregnancy and severely affect the lifestyle and health of the patient postpartum. It is therefore vital that health care providers and patients understand the underlying issues of LBP, including appropriate prevention and treatment options, to allow for a pain-free and stress-free pregnancy.

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