There are a lot of chemical changes in a woman’s body throughout pregnancy and some of those changes linger for quite some time after delivery and throughout the breastfeeding year(s). There’s a very good reason for all of those changes and ligamentous laxity – a loosening of all the connective tissues of the body is one of those changes. It’s an essential feature to help facilitate the mechanics of childbirth and depending on each woman’s individual chemical constitution and genetic make-up, this can sometimes linger long after the child is born.
Do you remember Charlene and her mid back pain and spasm? It made a lot of sense to me when I saw how much her newly no-longer-pregnant lower back was rounding and collapsing forward compared to when she was pregnant (which is precisely what set her up for mid back failure as we saw briefly in this previous post “when being limber becomes too much…” ). No matter that this makes sense to me from a functional anatomy point of view, Charlene is left extremely frustrated that a simple and necessary movement like reaching into the car to get her son out of the car seat – could have triggered this amount of alarming pain and who can blame her? She’s been putting her infant son in and out of the car for 3 months now without a problem like this. I explain to her that in addition to less than perfect bio-mechanics (rounding her lower back while reaching and bending into the car – not to mention her son’s increasing size), her body in particular, is more vulnerable and therefore more unpredictably reactive. It’s because of the excessive mobility in her spine firstly due to her life-long work with yoga and dance but now especially that her body is post-pregnancy and still breastfeeding; her ligaments are even more lax than before she became pregnant.
At the end of this first visit to my office for her mid back sprain, I learn that just last month, Charlene unexpectedly started having her period again for the first time since giving birth and is possibly due to start her period again in the next week. This was yet one other factor stacking against her during that instant when simply reaching into the back seat of the car for her son resulted in unexpected sharp pain. It’s been shown that in leading up to the period part of the menstrual cycle, necessary changes in our hormones cause inflammation[iii] and ligament laxity. The ligaments are one of the main things holding our bones together and when they get loose and wobbly because of an injury or chemical changes from pregnancy, the muscles are left in charge of holding things in the “right” place. Without the usual stability of the ligaments, the muscles often will overreact by grabbing on and clamping down creating a sensation of tightness and knotted muscles over time. Add inflammation to this mix and you have a bucket of pain brimming to the top and ready to overflow at the next slightest stress. So, even though Charlene is a limber, fit young woman with a high degree of tissue elasticity, who would normally not have had to think twice about reaching into a car to get her son out of his car seat, that particular day in addition to some reasonable but repetitive mechanical stressors, she had a number of chemical factors working against her as well.
Not only was this routine activity of putting her son in the stroller from the car seat, reaching it’s mechanical limit, but with the added inflammation from her impending next menstrual period, plus the ligament laxity that commonly lingers in the body this soon after pregnancy (and for some women until they stop breastfeeding), poor Charlene had no chance against the ensuing mid back and rib sprain that brought her into my office.
If you’ve noticed this connection between premenstrual time and inflammation, ligament laxity or injury please share your thoughts or story with me here.
Real Everyday Stories are based on actual patient cases. Names and some details have been changed to protect their privacy.
The information provided in this blog is in no way intended to and should not be used to substitute for individualized medical advice.
Please consult a health care provider for the proper treatment of your pain.
“Every Body's Guide to Everyday Pain,” “Return to Health,” “Return to Health Press,” and accompanying logos and domain names are trademarks of Return to Health, P.S. and Dr. Ya-Ling J. Liou.
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