Preggo With Back Pain?
A friend who is pregnant with twins recently approached me and asked if physical therapy could help the back pain she was experiencing. The short answer was, “Absolutely!” While back pain is one of the most common discomforts women have during pregnancy, pain at any time is not normal. It is the body’s way of telling us something is not quite right. Because of the changes that occur in the body during pregnancy, expecting mothers are at an increased risk of developing aches and pains. Fortunately, there are some simple steps moms-to-be can take to ease discomfort or even prevent pain from occurring.
The Causes
During pregnancy, there are many changes that occur in the body. These include stretching of muscles, softening of ligaments, and loosening of joints. All of these changes are essential to make room inside of mom for the baby and to help with the birth process.
Posture Issues ~ During pregnancy, the baby, uterus, and breasts all grow or enlarge. This shifts mom’s center of gravity forward. To respond to these changes, mom will often times lean backward causing her upper and lower back muscles to work harder.
Weight Gain ~ Weight gain during pregnancy is normal but it does mean more work for the muscles and increased stress on the joints.
Pregnancy Hormones ~ There are several different hormones released during pregnancy that allow ligaments and other tissues to soften and become looser. This loosening allows weight-bearing joints in the pelvis to shift and move too much during pregnancy. Ligaments that normally support the back no longer offer the same support.
Muscle Imbalances ~ Weakness of the abdominal (belly) muscles may also cause back pain. These muscles normally support the spine and play an important role in keeping the trunk stable. When they are stretched during pregnancy, these muscles may weaken and offer less support than they did previously.
Stress ~ Let’s face it…pregnancy can be stressful. While the link between stress and pain is not clearly understood, several resources list stress as a possible cause of pain during pregnancy. One way to look at pain and stress is to view pain as the “TV” and stress as the “volume control” – when stress increases, the pain gets louder and louder.
Avoiding the Pain
Exercise ~ Exercise during pregnancy can help strengthen the muscles that support the back and joints of the pelvis. Stretching is also an important part of any good exercise program. Exercises should be approved by your health care provider and should be performed in a way to avoid strain on your joints.
Posture Correction ~ Standing and sitting up straight can be difficult during pregnancy due to the body changes discussed above. An easy trick to remember is “shoulder under ear, tuck in the rear.” When the ears are in line with the shoulders, forward head is often corrected. Because the belly is pulling mom forward, “tucking in the rear” corrects the increased curve that develops in the low back. Remember to take breaks from prolonged positions and take frequent, short walks as able.
Wise Shoe Choice ~ Avoid high heels during pregnancy as much as possible. Choose a comfortable, low-heeled (but not flat) shoe that has a good arch support.
Proper Lifting ~ Always bend from the knees and squat to lift items instead of bending over. Also avoid twisting, lifting heavy objects, and reaching overhead repetitively. Dividing the weight of the objects being carried into smaller bags held in each hand is also much better than carrying one heavy bag on either side.
Good Sleep Position ~ Side sleeping with a pillow between the legs is the position of choice when it comes to pregnancy. A small pillow or wedge placed under the belly is helpful to the support the abdomen in the later stages of pregnancy. Listen to your doctor if he/she advises sleeping on one side opposed to the other or avoiding sleeping on the back. Also, take care when rolling in bed or getting in/out of bed – it is best to perform a slight knee squeeze when rolling to the side and then using the arms to push to a sitting position with the lower legs dangled over the side of the bed.
Rest ~ Every expecting mom should get plenty of rest. Rest is vital for the body to repair and function and moms-to-be should avoid getting fatigued.
Help Me Now!
Some of the actions listed above to avoid low back pain may also be used to treat current back pain. Other management options include physical therapy, massage, relaxation techniques, heat/ice applied to the affected area and braces or supports. I always recommend patients talk with their doctor and ask for a referral to a qualified physical therapist who has been trained to treat obstetric patients. There are precautions that need to be taken to protect mom and baby so you want to make sure you ask your physical therapist if they have had advanced training. Our practice avoids any type of high force movement of the joints but instead uses the muscles to help gently align and correct dysfunctions. Our therapists also address soft tissue pain with hands-on techniques and offer LOTS of education!
Doctor, Doctor!
Experiencing back pain is usually not a reason to call your obstetrician this minute (although it would be something to mention during your next appointment). There are situations when contacting your doctor is necessary.
- Severe back pain or loss of sensation/feeling in the legs, buttocks, groin, genitals, bladder, or anus; feelings of weakness or being uncoordinated
- Sudden onset of low back pain or increasingly severe pain – especially if this pain is in the late second or third trimester OR if there is no history of back pain
- Pain in the low back or side just under the rib cage – especially if this pain is accompanied by fever, nausea, or blood in the urine