Back Pain Post-Epidural! Now What!?

The epidural can be a helpful aid during a long tough labor, but unfortunately many women suffer from low back pain after receiving an epidural. This pain can last for weeks, months, or years after delivery. 

Complaints may include:

  •  Intense pain at the site of the injection
  • Pain and/or numbness to touch the back
  • Pain and difficulty with rotational movements
  • Weak core
  • Unstable hips and/or back
  • Sharp pains with sitting or standing for long periods 
Figure 1: the epidural introduces pain medication into the membrane space surrounding the spine. this picture fails to show the surrounding muscles and ligaments that are in the area. 

Figure 1:
the epidural introduces pain medication into the membrane space surrounding the spine. this picture fails to show the surrounding muscles and ligaments that are in the area. 

The relationship between an epidural and back pain is controversial and not well studied. As many as 1/3 of women have reported back pain following an epidural. After scouring through research databases (pubmed/NCBI, Mantis, Cochrane) I discovered that it is not clear what mechanism causes this lasting pain, but with such a small area there is a possibility that other surrounding structures get nicked or damaged with the injection.

Pregnancy and labor also take a toll on the numerous structures in a females pelvis and low back, which can cause your lingering pain. There are physical changes that occur from the uterus expanding, which weaken the abdominal muscles and alter posture. Additionally the extra weight puts strain on the muscles and stresses the joints in the back. Your hormones change causing the ligaments and joints that connect your pelvis and spine to loosen. This looseness causes pain when you sit, stand, walk, bend. Your back pain can also stem from a difficult or long labor, which will lead to epidural use. During labor you use muscles you've never had to use and these muscle strains have trouble healing. 

 

Treatment In Office
Dr. Heppe will perform a through evaluation, which includes neurological examination, orthopedic examination, and McKenzie testing to determine what area is most affected from the delivery. This includes looking at the bones, joints, muscles, and ligaments. She will look for lumbopelvic instability and soft-tissues muscle irritation.

  •  Cox Flexion- Distraction Adjustments: This focuses on the areas surrounding the spinal canal and improves the functional mobility of the joints around the spine (there are >50 joints along your spine).
  • Myofasical Release: This will reduce soft tissue, fascial, and muscle irritation of the areas surrounding the injection site of the epidural.
  • Instrument Assisted Soft Tissue Massage (IASTM): This breaks up scar tissue, that is located deep in the body. This is used for women who have been suffering with this pain for >6 months. 
  • Home Stability Exercises: A few core and pelvic stability exercises, no more than 10min, a day will greatly improve the strength of smaller muscles injured during the delivery process. These areas have difficulty healing after delivery, because most of your time is spent caring for a newborn instead of yourself.
 

What To Do At Home: 
Dr. Heppe will provide exercises tailored to your exact condition after your first appointment. She will also go over these 3 exercises more in detail at your appointment. 

Figure 2 McGIll BIG 3 Exercises: Click on the picture for the in-depth explanation

Figure 2
McGIll BIG 3 Exercises: Click on the picture for the in-depth explanation

figure 3: McKenzie extension exercises

figure 3:
McKenzie extension exercises

  1. McGill Big 3 Exercises: This will help increase your core stability
     
  2. Ice: Use ice at night for 20min
     
  3. McKenzie Extension Exercises: So much of life is spent hunched forward after delivery- nursing, bending to pick up a child, holding your newborn, etc. These exercises (Figure 3 ) will help stretch and strengthen your back.