Curr Rev Musculoskelet Med (2008) 1:137–141 Back pain can also be caused by all of the normal factors associated with back pain in the non-pregnant population. Factors such as degenerative disc disease, malignancy, and infection are all potential causes. Pregnancy related prob- lems may also develop such as preterm labor and pregnancy induced osteoporosis. These causes present a more serious problem that can signiﬁcantly endanger the health of the mother and fetus if not dealt with quickly. Diagnosis Diagnosis of low back pain is usually based on symptoms because there are few tests available to aid in diagnosis because of fear of harming the fetus. Evaluation of low back pain during pregnancy is difﬁcult because the pain is subjective and usually the result of a combination of problems. Pain is most often measured on a horizontal visual analogue scale from 1 to 100 with anchors at ‘no pain’ and worst pain imaginable. Classic mobility models cannot be applied to pregnant women because their mobility pattern and expectations are different from the general population. Disability as the result of pain is often measured using the Quebec back pain disability scale. While this scale is used primarily to measure disability from nondescript low back pain not related to pregnancy, it can be adapted to use for pregnancy related pain [21–23]. Several studies have attempted to develop a system to evaluate the extent and effect of pain speciﬁcally during and after pregnancy. Van De Pol et al. developed the Pregnancy Mobility Index (PMI) to assess the ability to do normal household activities on a scale from ‘no problems performing this task’ to ‘performing this task is impossible or only possible with the aid of others.’ The PMI was found to be a valid assessment of mobility during and after pregnancy [24]. Physical exam can distinguish posterior pelvic pain from lumbar pain by several maneuvers. The posterior pelvic pain provoking test, standing on one leg, and Patrick Fabere test elicit pelvic pain. Each test manipulates the patients’ legs to put pressure on the pelvic joints. Palpation over soft tissue of the sacroiliac, pubic symphysis, and gluteal regions distinguish pelvic pain from tenderness over the back above the waist. Studies show that both methods are effective in diagnosing posterior pelvic pain and distinguishing among the various causative syndromes; although pain provocation tests are more reliable than topography/palpation tests [25]. When the source of the problem is difﬁcult to determine by history and physical alone, imaging techniques are available for consideration. The amount of radiation or Grays depends on the type of imaging technique used and the area of the mother exposed. The effect of absorbed 139 radiation depends on gestational age of the fetus. At 2– 8 weeks, a dose of less than 10 cGy poses no increased risk of abnormalities, while the risk of anomalies increases 1% per 10 cGy increase [26]. From 9 to 15 weeks, risks are similar and increase with dose. After 15 weeks there is a measurable increase in the risk of cancer with an exposure as low as 1 cGy [27]. The fetus is exposed to virtually no radiation when radiographs of the extremities, head, or chest are done with proper shielding. However, the fetus does absorb a mod- erate to high amount of radiation when imaging the lumbar spine. The mean fetal exposure for a conventional lumbar spine radiograph is 1.7 mGy with a maximum dose of 10 mGy while the mean and maximum dose for computed tomography is 2.4 and 8.6, respectively [26]. Magnetic resonance imaging is the preferred technique for severe low back pain that is not relieved with more conservative therapy during pregnancy. Uroradiologic procedure occa- sionally preformed for hydronephrosis in pregnant women result in a mean uterine dose of .4 mGy [28]. Treatment Most women consider back discomfort as an inevitable part of pregnancy and do not seek treatment from a health care professional. Only about 50% of women visit a physician for low back or pelvic pain. Women who rate their pain higher on a VAS are more likely to see a physician. Of the women who saw a physician, 70% were treated. The majority of women treated report more than one type of treatment [8]. The majority of treatment strategies center on preven- tion because treatment late into the pregnancy is often difﬁcult to implement. When treatment is sought; conser- vative management of low back pain is preferred during pregnancy for obvious reasons, although such treatments typically do not have a high incidence of success. Treat- ment options include physiotherapy, transcutaneous nerve stimulation, pharmacological treatment, acupuncture or chiropractic treatment, and stabilization belts. Proper pos- ture is essential for the relief of low back pain. While instruction may be enough to alleviate the pain, braces are available to insure proper body positioning. Exercise before and early in pregnancy can strengthen abdominal, back, and pelvic muscles, which improves posture and allows increased weight bearing ability. Low intensity exercise can also alleviate pain once it develops. Exercise during the second half of pregnancy signiﬁcantly decreases pain following a three time a week 12 week program [29]. Pelvic tilts are particularly effective in relieving lumbar pain. Knee pull, straight leg raising, curl up, lateral straight leg raising, and the Kegel exercises are