Causes and Treatments of Back Pain During Pregnancy

Dear Dr. Bell, I’m in my second trimester and I’ve started experiencing bad back pain. Do you have any exercises or stretches you would recommend to help with the pain?

My eldest daughter is going through her first-time pregnancy and has recently started experiencing low back pain as well. It is very common for pregnant women to experience back pain at some point during their pregnancy. I will give you some of the same advice I gave her!

Causes

First, the causes of Back Pain are most often a result of poor posture, weight gain, hormonal changes, loosening joints, and the expanding uterus. As your center of gravity shifts, your posture will adjust as well. It is important to avoid slouching and ensure you maintain good posture. Physical Therapists will tell you this is often the cause of much of the back pain you will experience throughout your pregnancy. While you can’t really control the other factors, this is one you can impact. 

While it might feel like a promising idea to curl up on the couch all day, this is counterintuitive. You are at higher risk for back pain if you engage in a sedentary lifestyle. Strength Training and stretching are important to maintain throughout pregnancy if approved by your Doctor. 

Treatment

Walking, biking, and swimming are all highly recommended and are considered safe during pregnancy. You should be able to carry on a conversation while performing these activities. That is the best way to gauge your intensity level while you exercise.

If you were already consistently weightlifting before getting pregnant, you can perform variations of these exercises (again make sure you have approval from your doctor).

• Sumo Squats, Box Squats, and even Wall Squats are all great variations depending on your fitness level prior to becoming pregnant, as well as where you are in your pregnancy.
• Pelvic Tilts 
• Hip Circles on a Stability Ball, 
• Supine Glute Bridge. You can start with the standard Supine Glute Bridge then add marching, and/or Leg Extensions.
• Planks, as you progress through pregnancy as your stomach expands you can use a countertop for more assistance. Lateral Planks are a good variation to add to your routine as well.
• Supine Lower Truck Rotations
• Quadruped with legs (AKA Bird Dog Exercises), or with legs and arms (depending on your fitness level) are exercises that will strengthen your abs, lower back, glutes, and hip flexors.

Stretching is also a fantastic way to prevent/relieve back pain throughout pregnancy. Remember these Key Teaching Points for stretching

• Always complete a proper warm-up
• Never bounce while stretching
• Hold each stretch for 30 seconds, then go into a slightly increased "Developmental Stretch” free of discomfort...NO PAIN...for an additional 30 seconds.
• Never hold your breath while stretching. Slow deep breathing is key.
• NEVER STRETCH TO THE POINT OF PAIN! Go to a point of "Tight" and hold.

Many stretches you performed pre-pregnancy can be modified with a stability ball, chair, or bed for additional support. 

• A Modified Child’s Pose (or Prayer Stretch) with a Stability Ball is a great stretch for your back. Make sure to spread your legs further apart, as you progress through your pregnancy.
• Cat/Camel Stretch
• Standing Hip Flexor stretch placing foot on a chair.
• Seated Single Leg Hamstring Stretch
• Standing Quad Stretch
• Glute and Hip Stretch (make sure hips are squarely facing the bed and the bed height is roughly hip height, bring right leg up to bed height, knee bent 90 degrees, and externally rotated so that calf is parallel to hips. Place hands on the bed for balance. Lean gently into position and hold.)
• A Modified Half Pigeon Stretch can be performed while sitting in a chair, this stretch targets your piriformis, spine, and glutes. 
• The Bridge stretch can be performed on a yoga mat. This stretch targets your gluteus maximus, hamstrings, quadriceps, rectus abdominis, and hip flexors. 
• A Bound Angle Pose is performed seated on a yoga mat and will stretch your inner thighs, hips, and back.

Along with these stretches, to take it a step further, Prenatal Yoga is becoming very popular. Prenatal Yoga will improve both strength and flexibility in your muscles, ligaments, tendons, fascia, and joints.

Some other helpful tips 

• Whether it’s your home, office space, etc. reorganize items to make life easier. As you progress throughout your pregnancy, you should not be reaching high for items or bending low to pick items off the ground. Of course, there will be times when this cannot be avoided, but make your life easier by reorganizing items that have you reaching on your tippy toes, or constantly bending down.
• As previously mentioned, sitting for extended periods of time will only add to your discomfort. Make sure you are getting up and moving around often, even if it is only for a minute to alleviate postural stress. 
• If you haven’t already, I would highly recommend investing in a pregnancy pillow. These pillows provide additional support and can greatly assist with back pain.
• Wear comfortable, supportive shoes (no high heels)
• There are also diverse types of Maternity Support available online and in stores. The Sacroiliac Joint “SI” Belt is a favorite of many Physical Therapists. Having additional support can greatly assist with back pain.
• Heat and Cold therapy 
• Acupuncture is the Bell Family cure-all! 
• Foam Rolling can ease pressure in joints.
• Pre-Natal Massages
• If you are having unbearable back pain, seeing a Physical Therapist might be the best thing for you to do!

Overall, each person is different, as is each pregnancy. What worked for your mom, best friend, sister, etc., might not work for you. Also, what worked in your last pregnancy, might not produce the same results this time around. I would recommend trying out some of these tips and figuring out what works for you. Always listen to your body, and always check with your Doctor before making any drastic changes! I also recommend you wait 2.5-3 years between pregnancies to allow your body complete recovery. See your doctor for details.

While the aches and pains are not a fun part of the process….what an exciting time for you! Congratulations on your pregnancy. Wishing you all the best with your new arrival!

Dr. Jim Bell,

CEO of the IFPA