Pregnancy: How to Relieve Back Pain

Back pain is a common symptom experienced by as many as 50-70% of women during pregnancy.  Although it can develop at any time during pregnancy, it most commonly occurs towards the later stages of pregnancy as the baby bump grows larger.  In general, women who are prone to back pain prior to pregnancy are more likely to develop it during pregnancy. 

Back pain during pregnancy may be caused by the changes in hormones, shift in center of gravity, weight gain, poor posture, stress, and weakened abdominal muscles.  For some women, back pain may be mildly discomforting, while for others, it can be severely debilitating, inhibiting them from carrying out much of their regular daily activities. Thankfully, there is much that can be done to reduce the severity and frequency of back pain. 

There are two types of back pain associated with pregnancy - lumbar pain and posterior pelvic pain.  Lumbar pain is similar to the type of back pain experienced by individuals who are not pregnant and can be managed in much the same way.  Posterior pelvic pain typically occurs below the waist and generally affects pregnant women only.  It is important to distinguish between the two because the treatment for each is different.  Treatments for relieving lumbar back pain may exacerbate posterior pelvic pain.

Lumbar Back Pain

Lumbar back pain occurs above the waist at the center of the back.  It may be associated with pain radiating down to your leg or foot.  Similar to regular back pain experienced by non-pregnant individuals, lumbar back pain can worsen by maintaining certain postures and engaging in specific activities, such as sitting, standing, or lifting.  Here are some tips for relieving lumbar back pain during pregnancy:

  • Posture - As your baby bump grows during pregnancy, your center of gravity will move forward with a concurrent change in your posture to compensate.  The new posture often increases the strain on the muscles and ligaments of your lower back which may lead to back pain.  Try to maintain the principles for maintaining good posture as much as possible - tuck your bottom under, pull your shoulders backwards and downwards, and stand straight and tall.
  • Sitting - When sitting, make sure you elevate your feet slightly.  Either place a small pillow behind your lower back or select a chair that supports your back.  Make sure you change positions regularly.
  • Standing - Avoid standing for long periods.  If you must stand, rest one foot on a low stool and switch feet from time to time.
  • Sleeping - Sleep on your side with one or both knees bent.  Place a pillow under your knee (for one bent knee) and between your knees (if both knees are bent).  Place another pillow under your abdomen.  Alternatively, you can use a full length body pillow (dutch pillows) or a c-shaped pregnancy pillow.  Avoid sleeping on your back as this can aggravate back pain and make sure you are getting enough rest.
  • Lifting - Make sure you lift things appropriate with the correct posture.  Always squat down and lift with your legs rather than bending at the waist.  Don't attempt to lift objects that are too heavy for you - make allowances for your pregnancy.  Get help when necessary.
  • Shoes - Avoid wearing high heels - pregnancy is not the time to be vain.  Opt for low-heeled shoes with good arch support.
  • Support Belt - Wearing pants with a supportive waistband or a maternity support belt can help to reduce back pain.
  • Hot and Cold Packs - A hot water bottle or heat pack can help reduce back pain.  Alternatively, soak in a warm bath.  Alternatively ice packs with a heat pack can also be helpful. 
  • Back Rubs and Massages - Getting a good back rub from a partner can also help to reduce back pain.  Alternatively you can lie on your side or lean over the back of a chair and have your spouse gently massage your back.
  • Stay Fit - If back pain is a problem for you, it is important to make sure you are fit before getting pregnant.  If you are already pregnant, it isn't to late to start.  Just take it easy and start slow.  Maintaining regular exercise during pregnancy can help keep your back strong and relieve pain.  Pilates is great for strengthening back muscles and can be an appropriate exercise for pregnant women to pick up.  Swimming (regular laps or even aquarobics) or riding a recumbent bike are also good exercises to try.
  • Pelvic Tilt Exercises - Commonly referred to as the cat stretch because of its similarity to a cat stretching its back, pelvic tilt exercises can help to relieve pressure in your lower back.  Begin on your hands and knees with your head aligned with your back. Pull in your abdominals and arch your spine upward (imagine a cat stretching). Hold for several seconds, then relax. Repeat the exercise five times, and work your way up to ten times.  You can also check with your health care provider for other stretching exercises that can help.
  • Alternative Therapies and Medication - Some women find chiropractic care or acupuncture to be helpful in relieving back pain, however, it is important to consult your health care practitioner first to eliminate other possible causes of back pain which may have serious underlying consequences.  You can also see an osteopath who may be able to recommend methods to help relieve your pregnancy-induced back pain.  For severe cases of back pain, you may need to speak to your professional healthcare advisor about pain medications you can take that alleviate inflammation.

Posterior Pelvic Pain

This is the more common type of back pain experienced by pregnant women. It is up to four times more common than lumbar pain.  It typically occurs as a deep pain below the waistline on one side and may occur on both sides.  The pain extends down to the bottom and upper part of the back of the thighs.

Unlike lumbar pain, it does not resolve with rest and there may also be stiffness in the morning.  Certain activities can worsen the pain or bring on an episode, such as rolling in bed, climbing stairs, sitting and rising from a seated position, lifting, twisting, bending forward, running and walking.  Also unlike lumbar pain, having a high level of fitness prior to pregnancy does not prevent the problem.

Because posterior pelvic pain is primarily caused by hormonal changes during pregnancy, it cannot be prevented.  However, related muscle pain can be alleviated.  Contrary to the recommendations for lumbar pain, back exercises and any other vigorous exercises are not advised as they will only increase the pain experienced.  Certain activities must be avoided, such as climbing stairs, standing on one leg, extensive walking, standing, heavy lifting, prolonged sitting and extreme ranges of motion of the back and pelvis.  Bed rest is also to be avoided as this weakens the supportive muscles.

Probably the most helpful supportive measure that can be taken to alleviate posterior pelvic pain is to wear a pelvic belt.  This should be worn throughout pregnancy.  There are also some specific exercises that can help.  These exercises focus on the pelvic muscles - the gluteus maximus, gluteus medius, lateral hip rotators, hamstrings, hip adductors, rectus femoris and the quadratus lumbuorum.  It is important to get advice from a health professional who can provide treatments such as neuromuscular therapy and teach side-lying positioning that supports the pelvis during sleep and rest.

Posterior pelvic pain usually resolves itself after birth.  Women who experienced posterior pelvic pain during pregnancy should begin exercising the pelvic muscles before any back exercises.

Back pain during pregnancy is one of the main reasons for taking sick leave among pregnant women.  Although it cannot be prevented or completely eliminated, there are many things that can be done to alleviate the discomfort and make the pregnancy more bearable.

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