Pregnancy Back Pain Explained

It’s estimated that on average 50% of expecting moms suffer from back pain during pregnancy, but some studies show this number as high as 90%. It tends to be highest during the third trimester. This condition might be referred to as pregnancy-related low back pain or pregnancy-related pelvic girdle pain. In this article, I want to explain the causes of pregnancy back pain, provide you with suggestions for relief, and encourage you to use core and strength training as a tool to prevent or reduce back pain as you move through each trimester. Many of the moms I work with keep waiting for back pain to kick in, but with proper preparation and awareness, it never does!

What causes back pain during pregnancy?

• Pregnancy Hormones: During pregnancy, a hormone produced by the placenta called relaxin helps your body relax and stretch. This includes muscles and ligaments around the pelvis to prevent pre-termis uterine contractions and allow your baby to pass through the birth canal during delivery. The relaxation of these ligaments in the pelvis may impact the stability of your spine and pelvis, causing pain. 

• Pregnancy Posture: As your uterus and baby grow, your center of gravity shifts, and you develop more of a curve in your lower back as your pelvis tilts forward. This change of posture called lordosis can increase the stress on the spine and cause back pain.

• Pregnancy Weight Gain: The additional weight gained during pregnancy puts more strain on the muscles and joints, which can result in discomfort, especially at the end of a long day.

Can you prevent back pain during pregnancy?

Based on my personal experience working with moms, it’s a definite yes! Although we can’t control your hormones, we can use strength training and mobility exercises to help your body adapt to the anatomical changes during pregnancy, improve posture, and handle the additional weight/stress. Research shows that core stabilizing exercises can help reduce the risk of lower back pain. During pregnancy your “six-pack abs” called the rectus abdominis lengthen as your belly grows, however, those muscles are not your primary stabilizers. Muscles like your multifidus and transverse abdominis, as well as your glutes, play a major role in core stability, and they can still be strengthened during pregnancy! 

By building body awareness and strengthening key muscle groups, many moms find great relief and even avoid back pain altogether. Keep in mind that your ability to do certain exercises will change as you move through pregnancy so this is not a one size fits all list.

Strengthen

• Transverse abdominis: these muscles act as a corset around your waist. You can activate and strengthen them with exercises like plank variations (wall, shoulder taps, up-downs, etc.), Pilates moves (hundred, side lying leg kick, corkscrew, etc.), or one of my favorites when going against gravity isn’t advised is pallof variations (press, shuffle, etc.)

• Multifidus: This muscle runs along your spine. Exercises like a side hip lift, side plank, bird dog, and bridge march are great ways to activate and strengthen those spinal stabilizers.

• Glutes: This is an oversimplified explanation, but glutes support the stability of your spine and pelvis. Many moms I work with tend to be quad-dominant (front thigh muscle) when doing exercises like lunges and squats. During pregnancy, if your body is constantly being front-loaded and your back and core muscles are being overworked, it is essential to have the assistance of muscles in the back of your body like your glutes. Research tells us that glute exercises combined with back stabilizing exercises are more effective than back stabilizing exercises alone in decreasing back pain. Because the glutes move the hips in different directions and include three different muscles, it’s important to use a variety of exercises. Some of my favorites include side leg lifts using a pilates ball under the hip/rib area to stabilize the pelvis, hip thrusts, seated abduction, and Romanian deadlifts.

Mobilize

It may seem counterintuitive to talk about relaxin AND the need to work on mobility during pregnancy, but as your body changes you’ll need to keep joints mobile and muscles flexible. If you’re experiencing back discomfort, stretches like cat/cow, wagging the tail, pelvic tilts on a stability/yoga ball, and a side stretch can feel good. 

You’ll also want to focus on joints and muscles that aren’t directly involved in the pain area. Because your spine is segmented, tightness and immobility above and below your lower back can impact your level of discomfort, specifically immobility in your thoracic spine (mid back) and hips. 

1. You can use foam rolling to increase mobility in your upper and mid-back. 

2. Try the figure four stretch, hamstring stretches, and a kneeling hip flexor stretch to target the hip area.

A note on lifestyle modifications

Although we’ve focused on the exercise component of reducing your risk of pregnancy back pain, lifestyle modifications can also help prevent discomfort. 

• Ensure you have a supportive bra to support your growing breasts. Supportive shoes are also important, especially if your feet begin to flatten. 

• When you’re sitting, use a lumbar support and try to keep your feet flat on the floor, with knees at hip height. When standing, aim to keep your ribcage stacked over your hips, while also aligning your ears over your shoulders. 

• You’ve heard the term “lift with your legs” to avoid injuring your back. Most people think of squatting in order to do this. However, when you’re pregnant, a squat may not always be comfortable, in which case you can hinge at your hips mimicking the deadlift. This will call on your glutes and hamstrings to support your back.

To close this article, the main takeaway is that although back pain is common, many pregnant moms can prevent it by staying consistent with exercise and being aware of daily life factors. As we continue to learn more about prenatal exercise, specifically strength and core training, I hope the notion that pregnancy has to be miserable begins to fade. Happy training!

If you’re looking for a few more core tips, check out this free download which provides you with 5 strategies for core training during pregnancy.

If you already are experiencing back pain or leaking, consider this FREE 5-day course to gain a better understanding of how to reduce your risk for pain and incontinence.

Mobility vs. Flexibility: What do Moms Need More?

At some point during or after your pregnancy, you’ve probably complained about a muscle feeling tight or if you feel restricted in a movement, your response may have been that you need to stretch more…or maybe you’ve convinced yourself that you’ve always been inflexible. However, it’s quite possible that you’re plenty flexible and that it’s an issue of mobility. So what’s the difference?

Generally, mobility refers to the ability of a joint to move through its full range of motion. It encompasses flexibility, strength, stability, and motor control. Optimal mobility will allow you to perform movements without limitation. Most definitions refer to mobility as an “active” action.

Generally, Flexibility is a component of mobility that describes the ability of a muscle or tissue to lengthen. It primarily focuses on stretching the muscles. Most definitions refer to flexibility as a “passive” action. During and after pregnancy the hormone relaxin, can increase the laxity in joints, which most people translate to less flexibility, but research usually measures joint movement, so my thoughts are that it should be looked at in more totality and it may be more of a mobility issue. After a c-section or tearing, scar tissue can decrease a tissue’s flexibility, which is why scar tissue massage is important.

Because I believe that being functional and being strong in all the major movement patterns is what keeps moms active during pregnancy, and return safely to exercise after having a baby, I always include mobility work in my sessions with clients. Flexibility is a part of that. So the title of this post may have been slightly misleading. What I want you to understand is that flexibility is a piece of mobility and, therefore not enough. Moms should look for opportunities to enhance their overall mobility.

So what are the benefits of improving your mobility as a mom?

So you can actually follow the suggestions:
Pregnant moms are told to squat as a way to prep for childbirth, however, it’s incredibly hard to do this appropriately if your ankles or hips are immobile. You might have been told to use breathing as a way to strengthen your core postpartum, but this will be difficult if your thoracic spine is immobile. Mobility exercises can remove the limitations of performing these movements that are good for your pregnant and postpartum body.
Injury Prevention and Pain Management:
Discomforts such as back pain, pelvic pain, and joint pain are not uncommon for moms due to the stress of pregnancy and caring for a child. When you have mobility, you’re less likely to compensate and overuse the wrong muscles. Without mobility, poor posture and improper alignment can cause pain and even injury.
Greater Functional Ability:
Mobility exercises are specifically designed to replicate the demands put on your joints in your daily life, such as lifting, bending, and carrying. By incorporating mobility training into your fitness routine, you can develop the functional strength you need to push a stroller, carry your toddler, or reach to the back seat to replace a pacifier for the 10th time. In one study assessing the role of flexibility exercise, and the role of muscle strengthening exercises in the functional daily activity of adults, they found that each improved function. Because mobility is improved with muscle strength training, it is safe to conclude that mobility (which includes stretching), can improve your functional quality of life.
Emotional Health:
Being in a body during and after pregnancy that you feel like you have very little control over can take an emotional toll on you. Mobility exercises can help you move well and regain confidence. Feeling good both in your body and while you perform basic tasks is great for your mental health.

So although I know your time is limited and some weeks you’re lucky to get any workouts in, consider spending more time on your mobility if daily functions are a struggle. Enhance your ability to meet the physical demands of motherhood with training that includes flexibility, stability, and motor control…in addition to your strength and aerobic exercise sessions. Tight hips are often a complaint during pregnancy, check out this video for a. hip mobility flow.

Moms, Stretching Isn't Going to Fix Your Back Pain

When your back feels tight or even painful, the first thing you probably say is “I need to stretch more”. And although stretching and back mobility is one component to back health, it will never be the best or only remedy. Stretching lengthens muscles…in the moment, but it rarely is enough for spasms, and definitely isn’t enough for chronic or recurring pain. Most often, the cause of back pain for moms is feeding posture, carrying, and lifting their baby, weak core. This pain may appear in pregnancy and continue postpartum, or not show up until after the fourth trimester as your baby grows. To truly address your pain, you have to address the cause. The moms I work with have significantly less back pain than most because we focus on range of motion (mobility) of joints like hips, knees, and ankles, we strengthen the muscles involved in mom posture (rounding shoulders), and we strength train for mom movements (lifting, bending).

Here are four muscle groups you can focus on as you begin to address your back pain:

Glutes

Your glutes are important for hip extension and they help with core stability. During the early postpartum period, strong glutes can support your weaker core muscles as you work to rebuild ab strength and function. During pregnancy, your glutes can step up and assist your lower back muscles when they fatigue trying to adapt to the anatomical changes that occur each trimester.

Hamstrings

The hamstrings are responsible for hip extension and knee flexion. They play a crucial role in bending down to pick things up. When they are strong they can share the load with your back muscles to prevent overuse, which reduces your risk for pain. Use your hamstrings to hinge rather than rounding your spine when lifting your baby out of the crib, your back will thank you.

Core muscles

This is probably the most obvious group of muscles when you think of preventing lower back pain. However, you have many core muscles, and not only do you need to keep them strong, but you have to make sure they coordinate and work well together. This is especially important for moms considering your rectus abdominis muscles, diaphragm, and pelvic floor muscles are heavily impacted by pregnancy. But, don’t feel hopeless, I’ve helped hundreds of moms learn how to strengthen their core during and after pregnancy. Research shows back pain is common, but not inevitable with the right core training program.

Upper back muscles

Yes, your upper back muscles can impact your lower back muscles. Muscles like your rhomboids, trapezius, and rear deltoids, help maintain posture and prevent rounding of your shoulders. Moms tend to develop rounded shoulders due to extra frontal weight during pregnancy, and feeding posture postpartum. Strengthening the upper back will keep your body in better alignment reducing your risk for low back pain.

So even though nearly 80% of moms suffer from low back pain, that doesn’t have to be your story. If you recognize that reducing your risk for pain is more than just stretching, and involves joint mobility and muscle strengthening, then you’ll fall into that 20% of moms who can stay active during pregnancy, and take care of their child comfortably. You got this!

Postpartum Back Pain: 3 Changes to Make Now

Low back pain is common for moms but doesn’t have to be accepted. It’s estimated that 68% of women that have pregnancy back pain, continue to suffer postpartum, impacting daily life and even the ability to work. Hormonal shifts, joint laxity, weak core, heavier breasts, frequent lifting/bending, forward-leaning posture, and changes in your feet can all contribute to low back pain so it should go without saying there isn’t one easy fix.

Exercise, specifically core stability and strength training have been proven to improve low back pain., but exercise is only one piece of the puzzle. Here are 3 changes you can make now:

1. Update the gear. Heavier breasts mean a more supportive bra. If you’re breastfeeding you’re probably wanting to avoid compression, but a wide strap, supportive bra is key. If you’ve noticed flatter feet, wider feet, or longer feet…it’s time to update your shoes. Support starts from the ground up, so consider a new pair of shoes, or if you’re walking around barefoot a lot, you may need some supportive house shoes/slippers.

2. Better your body mechanics. We’ve all probably heard lift with your legs to prevent back pain, but the truth is that it isn’t always that simple when you’re performing the same movements day in and day out. Identify the most common movements you do throughout the day and then self-assess if you’re providing your back support with your leg muscles. If not, it’s time to make some changes. If you’re lifting the baby out of the crib, focus on support from your abs, glutes, and hamstrings similar to a deadlift. If you’re holding the baby as you get off the floor, practice standing from a kneeling lunge position. Forward leaning while feeding the baby? Get in the habit of stretching your chest muscles right after.

3. Nourish to Heal. In our superwoman society sometimes we forget that the postpartum period is more than just caring for the baby and beating the sleep deprivation. Your body has been through major changes and your tissues need to heal and hormones need to regulate. It’s important to nourish your body with enough water, sufficient nutrients, and good gut health. If this isn’t a focus, do your back a favor and begin to make simple changes.

I know it may seem overwhelming to care for your children and yourself, but healing and core function will impact your quality of life for years to come. Your child is only going to get heavier, and the physical demands of being a mom aren’t going anywhere. Let’s tackle this low back pain now. If you have access to a pelvic floor physical therapist or a postnatal fitness trainer, their support will be invaluable. You deserve to feel good, mama! If you need more guidance, try the FREE 5-Day Program to Reduce Your Risk of Back Pain.