Why are there a number of back pain issues to - which women are more susceptible?
There are also some factors which mean women or people with a uterus may be more susceptible to back pain becoming a chronic condition.
Some conditions are exclusive to women or persons with a uterus. And a great many problems typically begin to appear post-menopause. Read on to find out which ones and why.
In this article we will be discussing some of the most common causes of back pain in women, the reasons why they occur and some of the tools women can use to manage and prevent chronic back pain.
If you have been listening to the series I have been doing on back pain you will be familiar with the idea that multiple factors affect our experience of pain. This includes our biology and genetics, social conditions, exercise and information processing in the brain.
And for women, there are a number of other things to consider which are hormones, puberty, reproductive status and menstrual cycle which also affect pain threshold and perception.
Conditions which primarily affect women and why:
Piriformis syndrome
This is a painful condition caused by irritation or compression of the sciatic nerve near the piriformis muscle. The nerve and the muscle travel through the same opening side by side in the pelvis, their proximity to one another being why the issue might arise. It is also rare but not unheard of that the nerve might actually travel through the muscle.
Why?
This condition is more common in women but the answer is not really clear as to why.
Typically we hear people complain of "sciatica" — which is usually described as a, sharp, severe, radiating pain from the lower back or buttock down the back of the leg and into the thigh, calf, and foot.
Symptoms:
pain or numbness radiating from the sacrum to the bum and down the back of the leg.
pain improves with movement- and gets worse with prolonged sitting.
sciatica-type pain when the hip is moved and rotated outward against resistance.
If you suspect you might have piriformis syndrome visit a musculoskeletal expert to get is properly assessed and then begin to rehabilitate.
Sacroiliac joint disfunction
50-80% of women experience back pain during pregnancy and dysfunction of the SI joint is a common cause of that pain.
The sacroiliac joint is where the sacrum, the large, triangular bone at the bottom of the spine, meets the ilium, the largest elephant ear shaped bones, the uppermost part of the hipbone. This joint is held together by strong ligaments that allow just a small amount of movement.
Women are 8-10 times more likely to experience sacroiliac joint disfunction then men, due to anatomical factors as well as body chemistry.
Why?
Women have one fewer sacral segments than men to lock into the pelvis and stabilise it. This gives more space enabling persons with a uterus to birth children.
Women have wider hips than men, which increases torque across the SI joint when walking or running. This, too, is related to having children.
The sacroiliac joint surfaces are shallower than men’s, which also diminishes the stability of the joint.
Hormonal changes during menstruation, pregnancy and lactation can all make ligaments more flexible this is so that...you guessed it, people with a uterus can bear children. This can leave the SI joint very mobile, and when joints are overly mobile it causes surrounding muscles to tighten up in order to compensate which can cause pain and inflammation.
Symptoms:
A sharp, stabbing pain that radiates from your hips and pelvis up to the lower back and down to the thighs.
Sometimes it may feel numb or tingly, or as if your legs are about to buckle.
Spinal osteoarthritis
Women are more likely than men to develop osteoarthritis in the lumbar spine. This difference is particularly noticeable after age 50. Evidence suggests that the drop in women’s oestrogen levels during menopause may have a negative effect on the health of women’s facet joints.
Osteoarthritis affects each person differently. For some people, osteoarthritis is relatively mild and does not affect day-to-day activities. For others, it causes significant pain. As the damage to soft tissues in the joint gets worse, pain, swelling, and loss of joint motion starts to set in. When we are in pain, we may be less active, and this can lead to muscle weakness, which may cause more stress on the joint.
Symptoms:
Pain while using the joint which may improve with rest. Joint pain in the morning or after a rest. Swelling in and around the joint. Changes in the mobility of the joint.
A diagnosis from your GP is so important for treatment. As in an exercise programme specifically designed for supporting your bones.
Degenerative spondylolisthesis
Spondylolisthesis which always catches me in the pronunciation (spon-di-loh-lis-thee-sis) is a condition where one vertebra has slipped forward over another one below it. Degenerative spondylolisthesis as the name suggests is usually a symptom of the ageing process of the bones, joints and ligaments. They become less able to maintain the alignment of the spine. Spondylolisthesis is most common in the spinal vertebra of L4-L5. But it can occur elsewhere as well.
Your GP will test your movement and balance and take a case history and then perhaps a CT scan, x-ray or MRI to determine the diagnosis.
Symptoms:
Low back pain, sciatic type symptoms, an aching pain in the hip, buttocks, and lower back that radiates (spreads) into the back of the thigh and leg.
And weakness in the legs.
Remember this is similar to piriformis pain dysfunction and SI joint.
Your GP will recommend:
physical therapy and strengthening exercises, rest and a restriction of physical activity.
Coccydinia (tailbone pain)
Another condition which has a higher instance in women is tailbone pain. Women are 5 times more likely to develop coccydynia than men. The tail bone is small but important, as it works with the ischial tuberosities to be a stabilising structure while we are seated.
A backwards fall may cause damage to the coccyx. Or the location of the coccyx makes it particularly susceptible to injury during childbirth, especially if it is a difficult labour or instruments have been used during delivery.
Treating tailbone pain is best approached from a multi layered system of treatment with movement therapy, ergonomic adaptations and possibly psychotherapy.
Symptoms:
Localised pain over the area of the tailbone.
Endometriosis
A condition only in people with a uterus, it is caused by the growth of tissue (which normally lines your uterus, called the endometrium) outside of your uterus, usually around the region of your pelvis.
If the endometriosis has spread to other organs it can cause pain with bowel motions, pain with a full bladder or during urination, lower back and leg pain.
Symptoms:
Abnormally painful periods,
pain during intercourse,
excessive bleeding during menstruation,
fatigue, diarrhoea, constipation, bloating or nausea, especially during menstrual periods.
Spinal osteoporosis fractures
Osteoporosis is essentially the loss of bone density. Spinal compression fractures that occur as a result of osteoporosis are actually quite common.
Why?
Osteoporosis is especially common in postmenopausal women, approximately four times as many women have low bone mass or osteoporosis as men.
Symptoms:
Many people experience some kind of back pain but some people may not notice any pain at all. Things to look out for are sudden severe back pain, pain that gets worse when standing or walking, trouble bending or twisting your body.
Your GP will send you for an MRI to assess whether there is a fracture. The best way to prevent a fracture is to prevent osteoporosis. If you already have been diagnosed, you can take steps to keep it from getting worse. Eat a diet rich in calcium and vitamin D, (you can read more on the 5 best foods to eat for spine health) and get regular exercise especially the weight-bearing and muscle strengthening kind.
Knowledge is power!
These conditions can all be managed and treated; - however if the pain we experience becomes a persistent untreated issue it can cause a woman's entire life to be affected contributing to depressive symptoms, restlessness and fatigue. Education around pain and mindset can help us take control and power back.
Evidence from recent studies reveals that females are more susceptible to clinical pain conditions, especially postoperative and procedural pain.
The rise in the prevalence of chronic pain in women mainly originates from the combination of developmental and family issues. The studies are not conclusive but some research has suggested that as we get older we become more sensitive to pain. And some studies have even suggested that society expects women to report more pain. Hereditary factors may also have an impact on creating variations in pain tolerance and analgesic response. Ultimately, racial and cultural disparities are as well recognised as creating cultural perspectives that strongly determine the perceptual experience of pain.
How can we manage pain in women?
A multi-dimensional approach is required in the treatment of pain. Health care professionals and complementary therapist understand this multi-layered approach more and more.
Psychological approaches for chronic pain management developed as a consequence of our more complex understanding of pain, help us to recognise the contribution of psychosocial and physiological processes that occur in the perception of pain. And that in turn allows us to understand the importance of this puzzle piece in the treatment of pain (Roditi & Robinson, 2011).
Mindfulness-based interventions (MBIs) have emerged as a means to treat several chronic conditions (e.g. chronic pain, depression, anxiety, stress, insomnia. ((Roditi & Robinson, 2011).
CBT (Cognitive behavioural therapy) Studies by Hoffman et al. (2007) document the success of cognitive therapy in managing chronic low back pain by significantly eliminating the physical and psychosocial independence. It primarily focuses on psychoeducation about pain and behavioural components related to the syndrome. This is a teacher – student model. The learners are given relevant knowledge and skills to manage the pain. The main goal of therapists is to increase understanding of pain and put in management efforts to enhance life.
Tips for coping with chronic pain:
Physical exercise: physical exercise promotes a sense of fortitude, resilience and strength. Fear avoidance mechanisms related to pain affect people negatively. It means we might reduce or stop being active for fear of causing more pain. We should strive to remain active and engage in everyday movement activities which bring us joy. Even if it begins with gentle movement.
Setting desired goals: pain management requires realistic goals developed from personal motivation. Learning to befriend your body, meeting yourself where you are at every day and recognising that this changes on a regular basis allows us to see our limitations but to not let them limit us.
Distracting pain: instead of allowing ourselves to be pulled into a spiral of thinking constantly about the pain, finding ways to engage the mind through social and movement - based practices creates pleasant feelings which help in pain management.
Your social support system: Social support is an important factor for chronic pain. Being with people who care for us and listen decreases instances of depression and anxiety through talking and sharing experiences.
In conclusion, chronic pain in women is influenced by a combination of biological, psychological and societal factors. As of yet, most of the treatment interventions we have available to us do not eliminate pain entirely. But we can learn to be compassionate towards ourselves, not to become our pain and to learn self-management skills that can have a huge impact on our mental health and quality of life.
With special thanks to Trudy Payne (editor)