Pregnancy is 9-month long period that causes abrupt changes in the physiology, biochemistry and anatomy of maternal body. According to a report published in the scientific journal Spine (1), the prevalence of lower back pain after 30 weeks of gestation is 71%. Healthcare providers suggests that pregnancy back pain is a physiological complaint among pregnant women but still needs attention to optimize pregnancy, labor and post-delivery maternal health.
This is mainly because poorly managed or untreated lower back pain may lead to complications in the pregnancy and may compromise the health of mother, the baby or both. Due to extremely high prevalence of back pain during pregnancy and associated mechanics, it is pretty safe to assume that almost every pregnant female is at risk of developing lower back pain.
What causes lower back pain during pregnancy?
Pregnancy marks the beginning of hormonal and mechanical changes in the body of a female. There are several factors that may contribute to lower back pain; such as:
- Significant weight gain
The spinal column support and stabilize the entire weight of the body. However, during a 9-month pregnancy, an average woman can gain up to 25 to 45 pounds. The sudden increase in body weight affects the inherent equilibrium of the body and increases the risk of wear and tear changes in the spine leading to backache and discomfort.
- Shift in the center of gravity
A leading cause of backache during pregnancy is a shift in the center of gravity due to expanding uterus. Loss of equilibrium and balance affects the spinal integrity and may lead to stress and strain on spinal ligaments.
- Posture changes of pregnancy
As the baby continues to grow (in terms of development and size), the center of gravity of maternal body further shifts forward. In order to oppose the forward acting forces, most pregnant mother unintentionally try to compensate by leaning on the back that increases the pressure on lower back muscles and leads to backache during pregnancy.
- Hormonal influence on the pelvic ligaments
In a non-pregnant female, uterus is a pelvic organ. However, in later stages of pregnancy, uterus ascends and becomes an abdominal organ. Additionally, pregnancy hormones prepare the pelvis for childbirth for which pelvic ligaments that support pelvic floor loosens in order to accommodate the fetal head at the time of delivery.
Certain risk factors that may lead to backache during pregnancy are:
- History of lower back pain in prior pregnancies
- A higher than recommended weight gain (or high body mass index (BMI)
- Younger age at conception
- History of depression
- Low sleep
How To Ease Lower Back Pain During Pregnancy
There are several methods that can be employed to ease pregnancy back pain in females. Some are trivial like maintaining a good posture and nutritious diet; while other strategies involve goal directed and target oriented exercises and physical activity. Here are some preventive strategies to minimize the risk of developing pregnancy related back pain:
- Exercise during pregnancy
According to latest guidelines, pregnant females should exercise at least 3 times a week (for up to 20-30 minutes at moderate intensity) to monitor weight gain and physical strength. Yet research conducted by Kristin Gjestland (2) and associates suggested that only 14.2% pregnant females currently follows this regimen. Report further suggested that pregnant females who follow a regular pattern and frequency of exercise during pregnancy are less likely to experience severe low back pain during pregnancy. There are several other benefits of maintaining exercise regimen during pregnancy such as:
- Maintenance of optimal blood flow and circulation to all parts of the body (especially the fetus) to ensure optimal development
- Lower risk of cesarean section and higher chances of an uneventful normal vaginal delivery
- Lower risk of post-pregnancy weight gain, joint issues and chronic lower back pain
- Exercise improves glucose metabolism in the body and thereby decreases hypertension, diabetes and other metabolic disorders during pregnancy
Maintaining a regular regimen for physical activities regularly can keep the back of pregnant woman strong and it also give relief from back pain in her pregnancy. It is important to take advise of health care provider about doing gentle activities including water exercise and walking.
- Practice good posture
Here are a few tips to alleviate back pain during pregnancy by posture maintenance.
- Make sure to stand erect and straight
- Embrace the chest higher while standing
- Support your back with cushions while sitting or lying (especially if you are maintaining this posture for long hours)
- Perform shoulder stretching exercises
- Avoid locking the knees while sitting (that supposedly increases pelvis pressure)
While standing always maintain a comfortable posture that support the entire body weight. If your job responsibilities require you to stand for long hours, try to take frequent breaks.
It is important to keep good posture while sitting as well. If your job or work related responsibilities requires you to sit for long hours, use stool with low step height to prevent excessive pressure on spine and lower back. Select a chair that can adequately support your back. Placing a small pillow to support lower back and propping your feet while sitting is also fairly helpful in easing back pain.
- Use the right gear
Avoid wearing high heels and opt for flat and comfortable shoes that provide excellent arch support. Otherwise, you can also wear maternity support belts. Several researchers concluded the effectiveness of maternity support belts in managing lower back pain and a lot of women consumers also reported that the belt is an effective help in managing pregnancy back pain.
Research report by Jan M.A. Mens (6) suggested that the use of pelvic belts helps in reducing the mobility of sacroiliac joint. Men also suggested that knowing the precise position at which the belt is applied often helps in achieving promising results. Study conducted on 25 pregnant females with lower back pain suggested that belts tied just below the waist (at the level of anterior superior iliac spine) are far more supportive than belts tied at pubic region.
- Lift properly
For an uneventful and healthy pregnancy, it is recommended to pregnant women to avoid excessive weight lifting and vigorous physical activity. While lifting objects from ground, squat down and then lift with your back full supported. Avoid bending at waist or twisting your back. It is better to have help from any family member if needed (5).
Some practical strategies to ease back pain during pregnancy are:
- Sleep on the side
Try to sleep on your side, instead of sleeping on your back. Keeping one or both knees bent can be helpful in alleviating sub-acute episodes of pain. Placing support or pregnancy pillows between the bent knees, behind the back and under the abdomen are other possible options.
Moreover, use of comfortable mattress and pillows also helps in decreasing the spinal pressure. Research report published in peer reviewed journal The Lancet (7) suggested that mattresses with medium firmness are far more effective at alleviating back pain in pregnant mothers as suggested by mult-icenter case-control study in 313 individuals.
- Try heat, cold therapy or hydrotherapy
If you are experiencing moderate back pain, you can also use heating pads on back to ease your discomfort. Besides heat and warmth, application of cold compresses or ice pack also helps by numbing the pain. Likewise, back massage also helps to reduce the pain intensity.
Another recently popular modality for therapeutic back pain relief is hydrotherapy that is now frequently suggested by healthcare professionals and midwives. Hydrotherapy improves the movement of limbs under water that allow pregnant females to move her stiff limbs and muscles without experiencing pain or discomfort (due to buoyant effect of water).
Moreover, by warming the water slightly, the soothing relief can be further enhanced. Sergio R Cavalcante (8) conducted a study on 71 sedentary pregnant females with the complaint of back pain. Results suggested that hydrotherapy, water aerobics or any type of physical activity under water is safe and highly effective for an uneventful pregnancy. Investigators also identified that the use of hydrotherapy during pregnancy is not associated with any complications like low birth-weight baby, pre-term delivery or complications in labor.
- Stretching exercises for back pain
Stretching the lower back is also helpful in easing pain. Rest the body on knees and hands and place the head in column with back. Now pull the stomach and slightly round the back. Hold in this position for some seconds then relaxes the back and stomach. Try to keep the back as flat as you can. Start with 5 repetitions and then add gradually to 10 repetitions. Consult with health care provider for doing different stretching exercises.
- Consider holistic care for pain management
One of the biggest limitations of pharmacological interventions during pregnancy is the risk of exposing the fetus to toxins and hazardous chemicals that may culminate in potential complications. Most healthcare provides advice holistic methods of care to manage lower back pain and other pregnancy related ailments to prevent complications.
For example, various researches proved that exposure to non-steroidal anti-inflammatory drugs during pregnancy can lead to placental insufficiency (compromised blood circulation to developing baby). According to some researches, acupuncture helps in reducing the intensity of back pain during pregnancy. Other holistic interventions include chiropractic care. However, before going through these therapies it is better to take advice from your health care provider.
Research conducted by Christopher Oswald (3) suggested that manual therapies (including spinal manipulation) for the relief of back pain are extremely safe during pregnancy. The spinal manipulation helps in the management of lumbar lordosis (a key cause of gestational back pain). According to Midwifery Today (4), complementary or alternative care is advised to 57.3% of American pregnant population (chiropractic care being the third most common treatment option for pregnancy back pain).
When to consult your doctor for pregnancy back pain?
- If you are experiencing severe back pain that is interfering with your quality of life (physical activities, diet and sleep) it is highly recommended to seek medical help for pain management.
- If moderately severe back pain lasts more than 2 weeks or causing neurological symptoms (interfering with bladder control), you should contact your healthcare provider as it may be a sign of nerve impingement that can significantly interfere with normal childbirth.
- It is important to keep this in mind that back pain during pregnancy can also be a sign of preterm labor. During pregnancy if you experience back pain accompanied with fever, vaginal bleeding or burning while passing urine then this is a serious problem and require prompt attention therefore urgently seek medical help or consult with your doctor right away.
Your doctor may suggest medications like acetaminophen (Tylenol) to alleviate pregnancy back pain or may advise other specific treatments to restore health and well-being.
1. Kovacs, F. M., Garcia, E., Royuela, A., González, L., Abraira, V., & Spanish Back Pain Research Network. (2012). Prevalence and factors associated with low back pain and pelvic girdle pain during pregnancy: a multicenter study conducted in the Spanish National Health Service. Spine, 37(17), 1516-1533.
2. Gjestland, K., Bø, K., Owe, K. M., & Eberhard-Gran, M. (2013). Do pregnant women follow exercise guidelines? Prevalence data among 3482 women, and prediction of low-back pain, pelvic girdle pain and depression. British Journal of Sports Medicine, 47(8), 515-520.
3. Oswald, C., Higgins, C. C., & Assimakopoulos, D. (2013). Optimizing pain relief during pregnancy using manual therapy. Canadian Family Physician, 59(8), 841-842.
4. Zerdecki L, Passmore S. Chiropractic evaluation and management of the pregnant patient: an update from recent literature. Midwifery Today Int Midwife 2008;(87):28-9, 67-8
5. Vermani, E., Mittal, R., & Weeks, A. (2010). Pelvic girdle pain and low back pain in pregnancy: a review. Pain Practice, 10(1), 60-71.
6. Mens, J., Damen, L., Snijders, C. J., & Stam, H. J. (2006). The mechanical effect of a pelvic belt in patients with pregnancy-related pelvic pain. Clinical Biomechanics, 21(2), 122-127.
7. Kovacs, F. M., Abraira, V., Peña, A., Martín-Rodríguez, J. G., Sánchez-Vera, M., Ferrer, E., … & Mufraggi, N. (2003). Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial. The Lancet, 362(9396), 1599-1604
8. Cavalcante, S. R., Cecatti, J. G., Pereira, R. I., Baciuk, E. P., Bernardo, A. L., & Silveira, C. (2009). Water aerobics II: maternal body composition and perinatal outcomes after a program for low risk pregnant women. Reprod Health, 6(1), 19126239.