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Pregnancy: Causes of Back Pain

Updated on September 14, 2009

Back pain is a common symptom of pregnancy that as many as 50% to 70% of pregnant women experience. While it most commonly occurs in the later stages of pregnancy as the baby bump grows larger, back pain can also be one of the early signs of pregnancy.  Back pain during pregnancy can range from a mild discomfort to severe debilitating pain that prevents women from carrying out their regular daily activities.  Back pain has been reported to be the most frequent cause for sick leave taken during pregnancy.

It has been found that women most at risk for developing back pain are those who are overweight or have a history of back pain prior to becoming pregnant. There are two types of back pain that can occur during pregnancy - lumbar pain (lower back pain) and posterior pelvic pain (which is felt below the waistline). Lumbar back pain is generally similar to lower back pain experienced by individuals who are not pregnant.  There are several causes of lower back pain during pregnancy.

1. Weight Gain

Weight gain is a common cause of back pain in regular individuals - not just pregnant women. However, in pregnant women, the weight gain can be quite significant over a relatively short period of time. Based on the recommended guidelines, a pregnant woman gains anywhere between 12 to 18kgs over nine months. Some women may gain more, some less. For women who are overweight at the beginning of their pregnancy, their risk of developing back pain is even higher.

Additionally, weight gain for pregnant women is largely in the area of the belly. This throws the back out of alignment and adds strain to the back due to the increased weight it is required to support. The increased weight gain may also lead to spinal nerve compression which also causes back pain.

To a certain extent, it is possible to control back pain caused by excessive weight gain. This can be done by limiting pregnancy weight gain to the recommended amount according to pregnancy guidelines.

2. Weakened Abdominal Muscles

As the belly expands to accommodate the growing uterus and baby, the abdominal muscles become stretched and are weakened.  In this expanded state, they are less able to support the back.  If the muscles were weak at the beginning of the pregnancy, they will only get worse as the pregnancy progresses. 

Ordinarily, the abdominals can help to stabilise the pelvis.  During pregnancy, the back muscles and spine are required to take up the additional burden of supporting the added weight and changes in the center of gravity.

Ideally, to avoid back pain due to weakened abdominal muscles, it is recommended that women build up their abdominal strength before getting pregnant.  Although there are exercises that can be performed during pregnancy, the effectiveness of these are limited due to the fact that the abdominals are already stretched.  The type of abdominal exercises that can be performed during pregnancy are also limited.

That said, there are appropriate exercises that pregnant women can engage in to help to strengthen the back and supporting abdominal muscles. Exercises like Pilates help to strengthen the core muscles and reduce back pain during pregnancy, though it may not completely alleviate the problem.

Before commencing any new exercise programs, it is important to consult your medical practitioner.  Women with high risk pregnancies need to take extra care not to engage in activities that may endanger their pregnancy.  If it is safe for you to begin a Pilates exercise program, make sure that the classes you do are conducted by certified instructors who know the limitations of pregnant women and can make suggestions for modified exercises in the event that you suffer from specific pregnancy-related issues.

3. Hormonal Changes

During pregnancy, the body releases a hormone called relaxin which causes the ligaments in the pelvic area to loosen. This occurs in preparation for child birth to facilitate the passing of the baby through the birth canal. The changes in the joints and loosening of the ligaments in the pelvic area can also affect the back.

Additionally, relaxin doesn't only act on ligaments in the pelvic area, it also loosens other ligaments in the body - including those along the spine. Loosening of ligaments in the back decreases the stability of the lower back leading to a reduction in support at a time when extra support for the back critical.

Though there is not much that can be done for back pain caused by hormonal changes, it usually resolves itself shortly after delivery.

4. Changes in Center of Gravity

As the baby bump grows larger, a woman's center of gravity will gradually move forwards, causing a change in posture to balance the increasing bump size. Changes in posture and the increasing weight of the bump places strain on the ligaments, which can lead to back pain or worsen existing back pain.

Although changes in center of gravity during pregnancy cannot be prevented, measures can be taken to lessen the effects of back pain caused by it. For instance, wearing a support belt under the baby bump can help to reduce back pain.

5. Posture and Activities

Poor posture aggravates back pain because it adds stress to the spine. Having poor posture when picking up objects can also exacerbate back pain. Other activities that can escalate back pain include standing for long periods and carrying heavy objects in front, for instance, an older child.

To minimise back pain caused by activities, it is recommended that pregnant women avoid engaging in unnecessary activities that add strain to the back. For instance, avoid standing for long periods, ask for help to carry heavy objects, put off housework, and rest! Additionally, try to maintain a neutral posture at all times.

6. Stress

There is a strong link between stress and lower back pain. During pregnancy, stress can be increased which may also contribute to lower back pain. Pregnant women should take pains to relax as much as possible during their pregnancy. Remember that the pregnancy itself adds stress to the body, therefore eliminate as many external stress factors as possible.

Be sure to get plenty of R&R and engage in activities that help generate a feeling of well-being, for instance, sleeping early and getting back massages from a spouse.

There are many causes of lower back pain during pregnancy - all or some of which may be contributing factors. Most of the causes of lower back pain are the same as those causing lower back pain in regular back pain sufferers - increase weight, weak muscles, stress, and poor posture. Although some of these causes cannot be avoided, there are still many things that can be done to reduce the experience of back pain during pregnancy.


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