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Persistent Back Pain in Women and What You Can Do about It
by Tara Galles, MS, OTR
Shirley suffered back pain for over 10 years. She bought a Tempur-Pedic® mattress, orthopedic shoes, and faithfully did her physical therapy exercises. She periodically saw a chiropractor and got a massage when she could afford it. Shirley resented the fact that she needed pain medication every now and then. As a teacher, she was still able to manage normal workdays, but had a setback from a back spasm that occurred after sitting for an entire day of continuing education.
Shirley suffered back pain for over 10 years. She bought a Tempur-Pedic® mattress, orthopedic shoes, and faithfully did her physical therapy exercises. She periodically saw a chiropractor and got a massage when she could afford it. Shirley resented the fact that she needed pain medication every now and then. As a teacher, she was still able to manage normal workdays, but had a setback from a back spasm that occurred after sitting for an entire day of continuing education.
She finally talked to her doctor about the back pain again after realizing she was unable to pick up her young grandchildren.
Back pain is the single leading cause of disability in America [source]. Like Shirley, it prevents many people from engaging in work as well as other everyday activities. Certain causes of back pain are unique to women and frequently go undiagnosed. This is why Shirley’s back pain was never quite resolved with prior physical therapy.
Women’s bodies are different than men’s and their back pain should be evaluated with those differences in mind. If you are a woman whose back pain has not been resolved, here a few women specific causes that may have been overlooked:
HORMONES
Decreased estrogen can lead to osteoporosis in women; a medical condition in which the bones lose tissue and become fragile. Spinal compression fractures from osteoporosis will cause sudden and severe back pain that hurts the most when standing. Compression fractures may be misdiagnosed as a muscle spasm if the fracture does not appear on the x-ray (yes, that happens somewhat frequently). It is estimated that only 1/3 of vertebral compression fractures that occur in the U.S. each year are diagnosed [source].
Women diagnosed with a compression fracture of the spine have a 15% higher mortality rate than those who do not experience fractures; therefore, preventing and treating osteoporosis is important [source].
Estrogen therapy and hormone therapy are valid treatments for osteoporosis as well as modifying nutrition and physical therapy. However, physical therapy protocols are specific for women who experience pain from osteoporosis, which makes it important to get an accurate diagnosis and not just treat the pain. Elevated prostaglandins can also cause back pain in women during menstruation, which I will discuss next.
MENSTRUATION
Nearly 85% of women report menstrual pain and one in four women report absenteeism due to menstrual pain [source]. Menstrual cramping is essentially caused by muscular overactivity of the uterine wall, which aggravates hypertonic back and pelvic floor muscles. This muscular pain, also known as dysmenorrhea, can be triggered by exercise or bloating, thus explaining why some women experience “cramps” at random times throughout their cycle.
Multiple women have told me I am the first medical person to seriously explain or address their back pain with menstruation, outside of the referring provider.
Once again, therapy protocols are diagnosis specific, and studies confirm that pelvic floor therapy has higher rates of effectiveness to help reduce menstrual pain. Women who experience dysmenorrhea, or pain with menstruation, should seek out a therapist who specializes in pelvic floor rehabilitation.
PELVIC ORGAN PROLAPSES
Prolapses occur when a pelvic organ falls into the space of the vagina. It is estimated that 50% of women who have had children have some sort of prolapse [source]. Postpartum female athletes are especially at high risk for prolapse.
Pelvic organs are suspended by ligaments that attach into the pelvic bones. When a pelvic organ is displaced, there is increased tension to these suspensory ligaments. This can also place a painful torque on bone alignment.
Many women are unaware they have prolapsed or just chalk the “falling out” feeling to bearing children or their age. Back pain from prolapse is often accompanied by a sensation of heavy pressure. Most women with prolapse are unaware of any shifting of their internal pelvic organs. This is why it is important to ask your provider to check for prolapse when having a pelvic exam, since evaluating for prolapse isn’t standard.
Unfamiliarity with this diagnosis among medical providers, along with nonspecific symptoms, often leads to a delayed or missed diagnosis for patients.
PREGNANCY
If you’ve been pregnant, you likely experienced back pain to some degree. Around half of all pregnant women experience back pain [source]. Symptoms can range from a dull ache to stabbing or radiating pain with peak episodes related to activity or time of day. Pain will often interfere with work, sleep, caring for other children, sexual activity, and more. Approximately 25% of women who experience back pain in pregnancy will continue to have back pain after pregnancy, and 8% of them will experience severe disability [source].Pregnancy related back pain affects women’s lives dramatically. Low back pain is the most common cause of sick leave after delivery, not staying home with a sick baby. It can be debilitating and have lifetime disabling effects if not properly treated [source].
CESAREAN OR VAGINAL CHILD DELIVERY
Back pain can be a complication from both vaginal and cesarean child delivery. Tail bone pain (coccydynia) and muscle tears are common causes of back pain from vaginal delivery.
Women who had emergency cesarean deliveries can also experience coccydynia from the prolonged labor. Labor will migrate the pelvic bones to an open birthing position. I find that with postpartum patients, even 20 years postpartum, the pelvis can retain this open-birthing position.
Many women have severe lumbopelvic pain from scar conditions caused by cesarean deliveries. They wind up in physical therapy, but don’t get much relief if the scar isn’t considered and treated. Scarring from cesarean delivery also tends to pull the uterus anteriorly, so the position of the uterus needs to be considered.
Complications from episiotomies also cause lumbopelvic pain as this procedure destabilizes the pelvic floor. Side effects from epidurals can also cause back pain. There are many injuries that can occur from child delivery that lead to back pain. The sooner they are treated, the sooner a woman can be relieved of pain.
ENDOMETRIOSIS
Endometriosis occurs when tissue that should line the inside of the uterus forms on the ovaries, fallopian tubes, and other areas outside of the uterus. It affects up to 15% of women of reproductive age, and the severity of symptoms can vary greatly. When endometrial tissue moves into the spine, it can cause back pain [source].
HIGH HEELS AND BRAS
Before I delve into my loathing of bras, I’ll explain high heels. High heels create a structural imbalance and can cause a jamming effect of the lumbar facet joints, causing facet syndrome that will in turn create low back pain. I like high heels and have more than I can wear in any given year because they are only practical for me to wear on the weekends. A quality orthopedic shoe can do wonders towards reducing any back pain, so we recommend wearing those and saving the high heels for weekends.
Unfortunately, we are unable to do the same for bras unless you work at home. Bras redistribute the force angle of the breast tissue on the spine. While this can sometimes relieve pain, it most often creates it. Additionally, if a bra is too tight, it can create thoracic or middle back pain. Bras can also restrict respiratory mobility as well. Last year, I came across a shapewear camisole that doubles as a bra, and it changed my life. I loved it so much that I contacted the company and became a distributor.
IN CONCLUSION
Back pain in women most often presents the same or similar symptoms and causes found in men. In other words, back pain is biomechanical, meaning not caused by serious conditions such as inflammatory arthritis, infection, fracture, or cancer. It can be caused by strains, arthritis, disc herniation, degenerative disc disease, stenosis, facet syndrome, etc.
Causes of back pain specific to women are often overlooked, resulting in an incomplete diagnosis. While an accurate diagnosis won’t make the pain go away, it does provide the information needed to identify the optimum treatment.
Shirley, like many women who come to my clinic, was skeptical because she had been through therapy previously for degenerative disc disease. Her back pain was diagnosed this time as facet syndrome, and we treated it accordingly.
It wasn’t until Shirley was educated about causes of back pain specific to women that we discovered her pain was not going away because of sacral iliac misalignment, caused by prolapse. After adjusting her treatment plan to address the prolapse, Shirley started having some relief. We worked with urogynecology to address the prolapse and were able to reduce her pain from a ten to a one or two. She learned how to keep her sacroiliac joint in alignment and reported that she felt better than she had in years. Shirley no longer needed medication for her pain and was able to pick up her grandkids using compensatory methods to support her back.
As mentioned before, women’s bodies are different than men’s and therefore should be evaluated with those differences in mind. These differences may also explain why women experience up to 30% more back pain than men.
We specialize in comprehensive rehabilitation for women including physical and occupational therapy provided by women at You’re In CONTROL! Our mission is to move women to Take CONTROL! of their bodies. We believe that this is best done one-to-one with a registered therapist. This is why our therapists do not utilize aides or see multiple patients simultaneously. If you are a woman who has not gotten rid of back pain, decide to Take CONTROL! Talk about therapy with your provider and call us at 765.319.8420 to make an appointment.
Tara Galles, MS, OTR
Tara Galles, MS, OTR, is owner of You’re in CONTROL! With over 20 years of clinical experience she compassionately moves each woman to take CONTROL! of their body and rehabilitates them to feel like a natural woman again. As a mother of four children she also understands what it’s like to be a pelvic rehab patient. You may contact Tara about your pelvic issue at (765) 319-8420, or make an appointment using the button at the top of the page.