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.

Taking Care of Your Pelvic Floor During Exercise

You may not have known anything about pelvic floor muscles until pregnancy or after having a baby. Most likely, you’ve heard two things 1) you should do kegels to strengthen them, and 2) problems with these muscles can cause incontinence. 

Those two things are a good start, but I’d love to provide you with a bit more education so that you feel empowered to care for these muscles and/or continue to exercise if you’re dealing with pelvic floor muscle dysfunction. In this post, we’ll talk about where the pelvic floor muscles are located and their function, common problems that can occur, and four ways to engage and protect them during your workout routine.

What are pelvic floor muscles?

Your pelvic floor muscles form a hammock-like layer across the base of your pelvis. They stretch from your pubic bone in the front to your tailbone in the back. I’ve also heard them referred to as a trampoline, which should be taught and durable. Here are a few things to know about their function:

• When these muscles contract, they lift up and support your pelvic organs. 

• When you bear down, like when sneezing or lifting something heavy, the pelvic floor stretches and lengthens to accommodate the pressure created in your abdomen.

• Additionally, your pelvic floor muscles play a role in sexual function. When these muscles are too tight you might experience painful intercourse. Strong functioning pelvic floor muscles can help you achieve greater sensation during orgasms.  

• Pelvic floor muscles play a role in continence, allowing you to have control over elimination, including passing gas. 

• Lastly, they play a role in spinal and pelvic stability as a member of the core muscle-stabilizing team. 

Common Pelvic Floor Issues in Moms

Factors like pregnancy, childbirth, and aging can impact the function of these muscles. They may weaken due to the weight of the uterus, or they may become too tight due to the birthing process. Either way, if they’re not functioning as they should, it can lead to incontinence, prolapse, and impact your core strength. 

Most of you are probably aware of the connection between pelvic floor muscle function and incontinence. Did you know that there are two types of incontinence? 

• Stress incontinence causes leaking of urine when you cough, laugh, sneeze, or during exercises that involve impact, breath holding, or bearing down.  

• Urge incontinence is when you have the sudden urge to urinate and may not be able to hold it. An example often given is that you know you have to use the bathroom and right before you get to the toilet the urge gets stronger and you can’t prevent urinating.

The majority of incontinence for moms is stress urinary incontinence, however, some moms will also struggle with fecal incontinence which is the inability to control bowels. This can happen due to trauma during the delivery process.

Another condition that involves the pelvic floor muscles is pelvic organ prolapse. Because the pelvic floor muscles support your organs, if there is a dysfunction this can cause organs like your uterus or bladder to drop into the vaginal wall. Picture a hammock or trampoline that can’t support the weight of the person on it…it begins to sag toward the ground. In some cases, the organs can extend outside of the vagina.

The good news is that pelvic floor physical therapy is more widely available and we’re learning more about lifestyle changes and exercise that can treat, improve, or help you cope with these conditions. Additionally, qualified exercise professionals should be able to prescribe exercises that support your efforts to improve pelvic floor function.

Four Ways to Engage, Strengthen, and Protect Your Pelvic Floor During Exercise

As I mentioned, either while you’re in pelvic floor physical therapy, or after you’ve been discharged, a qualified exercise professional can help you engage, strengthen, and protect your pelvic floor during strength workouts. Here are a few strategies you can implement during your workouts:

1. Coordinate your breath: Your pelvic floor muscles are the basement of your core, where the diaphragm is the ceiling. The cylinder which is your core will function optimally when both of those muscles work in synergy. When you exhale your pelvic floor muscles are lifted and when you let the breath out your pelvic floor relaxes. The diaphragm should move in the same direction, descending on your inhale and rising on your exhale. Coordination of these two muscles isn’t always easy, especially when movement is involved. However, it’s important enough to master so that you’re not putting excessive pressure on the pelvic floor muscles. 

2. “Close the holes” or "Blow before you go”: I can’t take credit for these terms as I’ve heard them from several pelvic floor physical therapists. The strategy is to engage the pelvic floor muscles right before you’re about to lift something heavy. Imagine closing your anus as if you’re trying to not pass gas. This will activate your pelvic floor right before there is increased abdominal pressure. You can also try “blow before you go”, which means that right before you’re going to lift, you begin the exhale. Again this can help manage pressure pushing down on the pelvic floor muscles.

3. Avoid impact exercises postpartum until you’ve dedicated time to resistance training: The postpartum running guidelines suggest a minimum of 12 weeks of progressive exercise, including resistance training. However, if you’re having symptoms of pelvic floor muscle dysfunction, this may take longer. When you’re ready to add higher impact activities, start with fewer reps and shorter duration. Take your time to progress and build up. You wouldn’t go from lifting a 5-pound dumbbell straight to 50 pounds, would you? It’s worth mentioning that there aren’t prenatal running guidelines and plenty of moms do run during pregnancy, but if you’re noticing symptoms, that may mean your pelvic floor muscles can’t handle the impact and it’s probably best to move to low impact options. 

4. Remember that pelvic floor muscles are muscles: We all understand the concept of challenging a muscle in order to make it stronger and stretching muscles to relax and lengthen. The same goes for pelvic floor muscles. If you have a weak pelvic floor, you don’t want to avoid core training altogether because it’s going to need the challenge of the exercise to get stronger. If you’re not having symptoms, it’s also important to learn how to contract and relax those muscles. The easiest way to do this is by focusing on breath and core stabilization during strength training. If your core muscles are working together, your pelvic floor muscles will maintain/gain strength. If you prefer isolated exercises, you can throw in kegels of different durations (long contractions and quick contractions). 

Education should be empowering. As you learn more about your body, don’t let it cause fear. Research around core stability exercises benefiting the pelvic floor muscles is increasing, which is an incredibly positive thing. So whether you’re experiencing any of the named conditions, or if you’re concerned about atrophy as you age, or if you just want a well-rounded core program, take the time to become familiar with your pelvic floor muscles. 

If you’re ready to put core training to reduce your risk of incontinence and back pain into practice, consider my free 5-day core course.

Happy training!