True sciatica is rare during pregnancy UNLESS there has been previous history of it before pregnancy.  Often SIJ is mistaken for sciatica because it presents itself with similar sharp pain in the buttock radiating down the thigh and in similar areas. If someone comes to class with this issue its helpful to ask how it it was diagnosed was it a health professional by xray etc or is it a presumption.  It can often also be a muscular issue so ruling out these things help.

Possible causes of Lumbar issues in pregnancy are-

• SIJ instability-the pelvis is well supported but they soften in pregnancy and insatiability is a side affect its often over looked as a cause of pain
• SPD mainly pubic in location so easy to diagnose
• Sciatica if its true sciatica it can be caused by disc issue of priformus muscles
• Muscle strain of quadratus lumborum or erector spinae easier to treat as muscles can repair well having good blood supply
• ligament pain (intervertebral joint pain) difficult to treat low blood and longer healing times.

With true disc pain – extension of lumbar spine a gentle back bend is a position of ease and forward flexion will aggravates it.  Where the cushion like structure between the lumbar is compromised.  It bulges placing pressure on the nerves and ligaments which causes pain.

With ligament or joint pain – flexion forward bending brings relief and extension aggravates it.  You will find people struggle to straighten from a seated position.   In classes its important we can find positions to relieve the pain!  Gently incorporate into class the postilions of ease.  Lumbar issues can  increase with aggregation the further on they get in the pregnancy.  Your aim should be to do no harm.  Warning signs of Lumbar issues include: loss of bladder control or bowel control, progressive weakness of any kind, severe constant pain which you can usually see in their faces.

It is important to recognise the lumbar lower back doesn’t operate by itself.  The lower back operates as a cylinder.  We know this as the cylinder of control.  The muscles responsible for supporting the lumbar spine which are of the cylinder are:

• Erector spinae-three long muscles running parallel to spine create extension in spine and keep us right.  The erector spinae is then supported around the lumbar spine by the multifidus and quadratus lumborum which sits beneath the lowest rib and the pelvis on the left and right sides these help us in back bends in the lower spine (back wall)
• Respiratory diaphragm (top/lid cylinder control)  On the inhale the muscles draws down and increases the lordorsis (lumbar curve)  slightly and on the exhale the lumbar curve flattens. Pregnancy puts upward pressure on the diaphragm which stops the action of the decent
•  4 abdominals (front wall) The deepest layer is the transverse abdominis-like an air bag drawing the navel to the spine, this is then supported by the internal abdominal oblique and then the external abdominal oblique both these muscles help with rotation of the spine (side flexion and opposite arm to leg action) The final layer is the rectus abdominis its the 6 pack muscle containing bands of fascia which segment it.  it the muscle Diastasis Recti where it separates due to the goring uterus.  All of these muscles get stretched and become weak in pregnancy.  These all support the lumbar spine by 50%.
• Pelvic floor (bottom/seal) Small but many muscles create integrity in base of body.
• Pelvic stability and reinforcement – iliopsoas and adductors, gluteals, piriformis

Iliopsoas is another supporting muscle of the spine pelvis and thigh bones.  Its two muscles the illiacus (between pelvis and inserts into femur) and the soas (lumbar spine origin and inserts into femur) this muscle is responsible for drawing the knee to chest and truck to thighs in forward bends.   This muscle can be tight because of sitting.

Gluteus maximus, medius and minimus are the buttocks muscles and crucial for stability around pelvis. The maximus is the largest muscle reinforcement in the sacroiliac joint area.  This muscle extends the hip.  Often the muscle can be over active and then this creates pressure on the sacrial area.  in a class situation remind mum’s to be to activate thighs and not tense the buttocks so much.  A block between the knees can help train the maximus to support the area. Adductors are the muscles of the inner thigh which run on the inside seam of trouser leg up to the pubic bone.  There are 5 muscles which hold the femur bones parallel and stabilise the bones in relation to the pelvis they can get tight if we don’t do wide leg stretches. These muscles can have a direct effect on SPD as connect to the pubic bone