How To Relieve Back Pain In Pregnancy
Pregnancy back pain typically happens where the pelvis meets your spine, at the sacroiliac joint or SIJ, in the joints of the lumbar spine or at the joint between the two halves of the pelvic rim known as the pubic symphysis. Between 50-80% of women experience some form of back pain in pregnancy.
Common Causes:
Hormonal changes — during pregnancy your body makes hormones called relaxin and oestrogen that allow ligaments in the pelvic area to relax so then the joints become looser in preparation for birth. These same hormones though can cause ligaments that support the spine to loosen, leading to instability and pain.
Muscle Separation — as the uterus expands, two parallel sheets of muscles called your rectus abdominus (6-pack muscles), which run from the rib cage to the pubic bone, may separate along the centre seam. This separation causes weakness of the abdominal muscles and can contribute to back pain.
Posture changes — pregnancy shifts your centre of gravity. As a result, you may gradually (even without noticing) adjust your posture and the way you move. This may result in back pain.
Weight gain — during a healthy pregnancy, women typically gain weight. The spine has to support that weight which can lead to lower back pain. The weight of the growing uterus also puts pressure on the blood vessels and nerves in the pelvis and back.
Stress — emotional stress can cause muscle tension in the back, which may be felt as back pain or back spasms.
The good news is, there are many things you can do to ease and treat your back pain in pregnancy.
How to relieve back pain in pregnancy —
1. Do Your Pelvic Floor Exercises — you know the ones!
Your pelvic floor is the band of muscles that stretches across the bottom of your abdomen, from your tailbone to your pubic bone. These muscles support the pelvic organs, which include your uterus, bladder and bowel. Think of your pelvic floor like a hammock on which these organs rest. The pelvic floor muscles also help stabilise the spine. Exercising these muscles before and during pregnancy can decrease the damage done to the muscles by the strain of carrying a growing baby, decrease the risk of injury during a vaginal birth and speed up recovery afterwards. A strong supportive pelvic floor will also help prevent lower back pain and pelvic girdle pain in pregnancy. To exercise the pelvic floor, lie on your back (or side) with your knees bent up and try to envision pulling the muscles of the vaginal area up and in towards your baby. You should not feel your buttocks, thighs or abdominals tightening as you do this. Hold for 5-10 seconds and repeat 10 times (you may need to build up to this). Always stop when fatigued. For more information refer back to my previous journal post “The Importance of Keeping Your Pelvic Floor Strong With Physiotherapy.”
2. Do Your Stretches
Stretching is a great way to ease some of the aches and pains you may be experiencing. Because of the hormones present in your body, which lubricate and loosen the joints and ligaments during pregnancy, it’s really important that you don’t overstretch as this can cause injury. Don’t go deeper in stretches than you could prior to your pregnancy and they should always be done GENTLY and SLOWLY. Here is a link to a short program of stretches perfect for pregnancy “Pregnancy Yoga Stretches for Back, Hips, and Legs.”
3. Start Or Keep Exercising
Regular exercise in pregnancy (at the right intensity) can help reduce back pain, improve or maintain muscle tone, reduce leg cramps, swelling and constipation and improve sleep patterns. Women who exercise also often feel better about themselves and their changing body during pregnancy.
In fact, the latest guidelines on exercise during pregnancy say women should be aiming for between 150 and 300 minutes of “moderate intensity” activity a week. That means you should feel you’re exercising “somewhat hard” for around half an hour a day, most days of the week. If you’re not used to doing any exercise when you fall pregnant, you should start slowly and work your way up, then continue exercising through the pregnancy until it becomes uncomfortable.
“There used to be a misconception that exercising to any degree of intensity was dangerous for the pregnancy… We now know that’s not true. Exercise helps your body during the pregnancy and also during the recovery following your pregnancy. If you have better fitness and tone during the pregnancy, you recover more quickly.”
My favourite exercises in pregnancy are —
Clinical pilates with a physiotherapist
Pilates is a great exercise for maintaining muscle tone and strength. Supervised Pilates with a physiotherapist can be extremely beneficial in helping with any issues such as pelvic instability or back pain.
Walking
Walking, at a brisk pace, is a good form of cardio during pregnancy. It will help you keep fit and control your weight gain. It’s safe and simple, and can be easily fitted into a daily routine.
Swimming
Swimming has all the usual benefits of cardio, plus the big advantage of making pregnant women feel lighter as the water will support your increased weight. Some local swimming pools provide aqua aerobic classes with qualified instructors.
“It can take pressure off, especially in the third trimester when a woman’s weight is making it more difficult. If women have any issue with their pelvis, knees or ankles during the latter stages of their pregnancy, exercise in water can be an effective way of maintaining some level of fitness.”
Exercise tips when you’re pregnant —
Always warm up before exercising, and cool down afterwards.
Try to keep active on a daily basis; 30 minutes of walking each day can be enough, but if you can’t manage that, any amount is better than nothing. If you haven’t been active or are overweight, start with 3-4 days spread across the week.
Avoid any strenuous exercise in hot or humid weather.
Drink plenty of water and other fluids.
If you go to exercise classes, make sure your teacher is properly qualified, and knows that you’re pregnant and how many weeks pregnant you are.
4. Improve Posture
Much of the back pain experienced in pregnancy is related to the strain on your back from the weight of your growing baby. Using proper posture can help prevent and even relieve some of the pain. As your beautiful bump grows, your lower spine will curve inwards to support your baby’s weight and the top of your spine will curve slightly outwards to support the growth of your breasts. When your body is in alignment (when you use proper posture) — you can imagine a straight line running from your ears to your shoulders, and to your hips and knees. Keeping your chin tucked in slightly, lengthen through the crown of your head, draw your shoulders gently back and down and tuck in or tilt your pelvis gently forward to keep your lower back from arching in a swayback position (you should feel you lower abdominals gently activate as you do this). Refer to the image above for clarification.
Some other tips to help you use good posture —
Avoid standing for long periods of time. Try to vary your position often. When you do have to stand, keep your feet slightly apart and avoid locking your knees. Remember to keep your pelvis tucked in.
If you have to stand in one place for a long time, place one foot on a small step stool. This takes some of the weight off your lower back (a great tip is when you are washing the dishes, open the cupboard under the sink and place one foot up on the ledge).
When getting out of bed, roll to the side first and then use your arms and hands to push yourself up into sitting.
It’s best to avoid lying on your back, especially in late pregnancy, when the weight of the heavy uterus can press on the large blood vessels in your belly.
It’s also really important to support your pelvis by trying to keep your knees together as much as possible. For example when getting out of the car, rolling over in bed and avoiding using too many stairs.
Sleeping on your side with a pillow between your knees can also provide great comfort and support in pregnancy (sometimes adding them behind your back and under your belly works well too).
Keep your body in alignment while sitting, and try not to slump or slouch. Use a sturdy chair with low-back support and tilt your pelvis forward to avoid the swayback position. Your knees should be slightly lower than your hips and your feet should touch the floor.
5. Use A Heat Pack Or Get A Gentle Massage
Heat packs alleviate back pain by improving blood flow to your aching muscles which encourages them to relax. Simply apply the heat pack for approximately 15-20 mins to your sore back every 3-4 hours. Be careful not to overheat your body though — heat packs shouldn’t be hot but feel comfortably warm against your body. You can also ask your partner to rub your back or indulge in a pregnancy massage with an experienced practitioner.
6. Start Meditating
Pregnancy is the perfect time to learn meditation, after all, you are now meditating for two! Relaxation and calmness are vital at this precious time. Recent studies suggest that excessive stress, whether physical or emotional, can cause the body to produce hormones that may increase the likelihood of difficulties during pregnancy and birth. Stress and anxiety can also have a negative impact on the fetus and may have long term effects on the child. The Vedic Meditation technique I teach is my meditation of choice as it reduces stress, tension and fatigue and balances emotions overall. It can also be practised anywhere you can have your back supported (ie. when breastfeeding, sitting in the passenger seat of the car while your partner is driving, while your child plays next to you, in a chair beside the cot as you are patting your baby to sleep, in a stationary car when your baby has fallen asleep or in the car park before school pick up). I also design a special mother’s program for anyone with a newborn or if you are suffering from sleep deprivation in any way. This meditation practice reduces the stress of new motherhood, balances emotions, curbs anxiety and depression and is said to be the equivalent of 3-4 hours sleep! Making meditation a part of being a mother ensures that you are nurturing yourself so you can better care for your baby and family. (If you want to start meditating today, and can’t get to one of my three day live courses, a great place to begin is to download the app ‘Insight Timer’ where you can search ‘pregnancy meditation’ and receive a load of beginner options to try).
7. Use A Pelvic Support Belt
A pelvic support belt may be required to support the pelvis during pregnancy and can be fitted by a physiotherapist. They work by taking some of the belly’s weight and helping to stabilize the body. It is vital that if these are worn, they are still used in conjunction with a range of strengthening exercises for the hip, pelvic floor and abdominal muscles which will be given to you by your treating women’s health physiotherapist.
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Trying a few of these suggestions and seeking the help of a women’s health physiotherapist, can greatly improve pain and allow you to enjoy your pregnancy to the fullest.
With love
Nat x