懷孕期間腰痠痛！該如何是好？How to deal with pregnancy low back pain?
腰部痠痛是孕婦常見的問題，根據過去的統計，兩位孕婦中可能有一位飽受腰痛的困擾。甚至產後一年內還會有50％的新手媽媽們感到腰部不適。懷孕導致的腰部痠痛常在懷孕第四個月，也就是第二孕期的時候發生。這是因為生理上的變化導致，此篇文章是來讓媽媽們更認識懷孕引發腰痛的原因以及可以做哪些運動舒緩身體不適。
Low back pain (LBP) is common during pregnancy. According to previous studies, the prevalence of low back pain is up to 50%, and half of these moms continue to suffer from back pain 1 year postpartum. LBP during pregnancy usually occurs in the second and third trimester. This article is to discuss about the etiology of pregnancy LBP and what exercises we can do to relieve it.
腰部痠痛原因 Etiologies of pregnancy LBP
賀爾蒙 Hormones
懷孕賀爾蒙 — 鬆弛素使全身關節韌帶與肌肉的鬆弛，使得腰椎周圍不穩定或肌肉失衡導致腰部酸痛。孕婦可能有的僵硬困擾，常常是因為關節韌帶太鬆弛而引發的肌肉僵硬。此賀爾蒙會在懷孕第三個月時達濃度高峰，直到產後濃度一直維持不變。因此大約懷孕三個月後腰痛的狀況會趨近明顯。適度的放鬆腰部肌肉可以達到症狀舒緩的效果，但由於鬆弛素的影響，在放鬆或拉筋時必須要注意不要伸展過頭以免受傷。
Relaxin, peak at the end of the first trimester and remain elevated till labor, loosen muscles, tendons and ligaments throughout the whole body. The pelvic and spine would therefore be loose and unstable, causing unwanted shear force to your joints. Muscles in your low back may become stiff to help decrease spine instability. Massaging and slow stretches are great ways to relieve back pain.
胎兒的重量 The weight of the baby
懷孕賀爾蒙使骨盆周圍骨骼肌肉以及韌帶鬆弛，外加上胎兒的重量，骨盆連同子宮會比較向前傾斜，身體的重心也會隨之前移。隨著懷孕週數的增長，寶寶重量增加，前移（傾）的程度也會變多。如此的變化，施於骨盆後方的薦髂關節以及腰椎壓力提升，導致腰部酸痛，嚴重甚至出現麻痛。
An enlarging gravid uterus gradually shifts the center of gravity anteriorly throughout the gestational weeks. This creates unwanted moment and loading on the lumbopelvic area, sacroiliac joints and ligaments. The incidence of LBP increases as more weight put on the uterus. In more severe situations, pregnant moms may feel numbness around the low back or lower limbs.
肌肉力量 Muscle weakness
隨著日益漸增的肚子重量以及大小，腹肌與核心肌群形變的程度增加。原本保護著腰部與骨盆帶的肌群在長期的變形下，會越來越無力。加上鬆弛素讓原本就已被拉長的肌肉肌腱等變得更鬆弛，形成惡性循環。如此會使得腰部、腹部以及骨盆帶支撐性下降，會因為突來動作或姿勢不良的關係讓腰酸（痛）加劇。
Loss of abdominal (core) muscle tone and strength is common in pregnant women. This is due to increased size of the uterus that lengthens the muscles. Weak abdominal (core) muscles do not function normally, resulting increased strain and instability in the lumbopelvic area. If the abdominal (core) muscles are not controlled or tightened during exercise or daily activities, injuries may happen.
要怎麼做才能預防或緩解腰痠背痛？
What should we do to prevent or decrease LBP?
運動改善腰痠 Exercises to relieve pain
綜合以上造成懷孕時腰部酸痛的原因都會帶來腰部或骨盆帶不穩定以及肌肉鬆弛無力。但別擔心，這是可以靠運動改善的。以下是幾個可以在整個懷孕過程都可以做的運動，使腰部疼痛緩解。
LBP is a result of weak and unstable muscle, spine and pelvis, which can be improved by specific exercises. Muscle strengthening and mild low back stretching is useful to relieve pain.
骨盆後傾運動 Pelvic rotation exercise
可採躺姿、坐姿，背靠地板或椅背。膝蓋彎曲90度，以骨盆為軸心，進行向後旋轉（後傾）的動作，同時感覺腰部伏貼地或貼椅背，尾椎翹起。此動作可以搭配夾臀及小腹輕輕收縮的感覺。動作越輕柔越好，並且保持自然呼吸。維持骨盆後傾5秒後放鬆。
Begin with hook lying with arms and neck relaxed, slightly draw in your belly and tighten your glutes to posterior rotate your pelvis. You may slightly feel a lift on your sacrum area. This exercise should be done in a gentle manner, keeping your breath flow as smooth as possible. Hold for 5 seconds and relax. This exercise can also be done in sitting position with back support.
腰部活動 Lumbar rotation exercise
正躺且大腿抬起，膝蓋彎曲90度，使小腿與地面平行。雙手放置身體兩旁，感受腰部貼地。在頭部及上半身不動的狀況下，緩慢左右晃動骨盆，感受兩側腰部輪流貼地。左右各10下。若到懷孕後期抬腳變得較為吃力，可以在膝蓋彎起腳踩地的姿勢下執行。若做此運動時大腿特別酸，可以將次數減少，休息時間拉長。
Lie on your back with knees bent 90 degrees in the air, hands put aside you. Feel your low back flatten on the ground while your knees are in the air. Rock your pelvis side to side in a comfortable range without any movement in your shoulder and head. Try 10 times. If you feel strenuous lifting your knees, try this exercise in hook lying.
腰部伸展運動 Low back stretching exercise
採四足跪姿，手腳與肩同寬。掌心放置肩膀正下方，膝蓋彎曲90度，身體與頸部保持一直線。緩緩將眼睛看向肚臍的位置，腰背部向上拱起，同時將臀部輕輕夾住。維持此姿勢5秒鐘後回正。若手部撐地不舒服，可以將手掌墊高或握拳。
Start with a quadruped position with your head inline with your body. Curl your chin toward your navel and arch your back. You may feel a slight stretch on the low back. Remain in an arched position for 5 seconds and return to the starting position. Repeat for several times until the tightness is relieved. If you feel uncomfortable in your wist, try making a fist or elevate your palms.
執行運動以前請與您的婦產科醫師確認是否可以運動。Be sure to acquire the doctor’s approval before exercising.
若有興趣，歡迎參考之前的文章
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懷孕期間可以 運動嗎？物理治療師提供幾招小撇步讓孕媽咪動起來！
Physiotherapist’s guide on exercise do and don’ts during pregnancy懷孕時我的身體會如何變化，運動會不會有風險？
How does my body change during pregnancy?懷孕媽媽體態大解析
Pregnancy and posture alterationsReference: Casagrande D, Gugala Z, Clark SM, Lindsey RW. Low Back Pain and Pelvic Girdle Pain in Pregnancy. J Am Acad Orthop Surg. 2015 Sep;23(9):539–49. doi: 10.5435/JAAOS-D-14–00248.
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