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.

Exercising with Diastasis Recti - Four Tips for Moms

The physical changes to your body during pregnancy don't immediately disappear postpartum. One common change is diastasis recti abdominis (DRA), also known as abdominal separation. While this might sound intimidating, it's essential to recognize that DRA is a natural part of pregnancy in order to make room for your growing baby. It's also important to note that if you have abdominal separation, with the right guidance, you can regain core strength and confidence, and return to physical activity and exercise.

Understanding Diastasis Recti:

Diastasis recti, or abdominal separation, occurs as the linea alba (the connective tissue that runs vertically in the middle of your abs) widens and weakens to accommodate your growing baby. This caused your rectus abdominis (six-pack abs) to separate from each other. For some moms, the linea alba naturally tightens post-birth, bringing your rectus abdominis muscles closer together again. For others, the separation can persist, leaving a gap. The opinion about diastasis recti has shifted to such that rehabilitation is less about closing the gap, and more about being able to create tension so that your core can act as the stabilizer that it is designed to be.

Pelvic Floor Physical Therapy/Women’s Health PT

Many moms will look toward physical therapists for support. During your treatment, you'll focus on core muscle activation and breathing. This may result in your gap closing, but even if it doesn't you'll learn to have a strong and functional core so that your DRA doesn't impact your quality of life. It’s important to trust the process even if the exercises feel too basic. The basics are what create a strong fitness foundation so that you can progress and reach your postpartum fitness goals.

Exercise After Physical Therapy

After you've focused on core muscle coordination and have regained some strength, you'll be discharged from PT. You may then wonder what's next and still have questions about what exercises are safe. The key here is to realize that there is no one-size-fits-all approach. It's about personalizing your fitness program and performing exercises that allow you to have core strength and control. I've worked with many postpartum moms returning to exercise while managing abdominal separation, or after pelvic floor physical therapy and I’m happy to share my insight with you.

Tips & Strategies for Exercising with Diastasis Recti

Note, that it is recommended you work with a qualified postnatal fitness professional or see a pelvic floor physical therapist if you're looking for diagnosis or treatment.

1. Gradual Progression: Start with exercises that focus on activating your deepest core muscle the transverse abdominis. Move to coordinate that muscle activation with breath and pelvic floor. Progress to more complex movements gradually, incorporating resistance, repetitions, and different positions.

2. Manage the pressure you create within your abdominal cavity: Be mindful of everyday activities that increase your intra-abdominal pressure, such as sneezing, coughing, or lifting. Use your transverse abdominis activation strategies and breath to help manage the pressure and force on your healing abdominal wall.

3. Exercise Selection: Choose exercises that align with your core strength and function. There isn’t a definitive list of “bad exercises” or “exercises to avoid if you have diastasis recti”. Rather it should be based on your personal ability. If you can lift 20 pounds fairly easily without having to bear down or hold your breath, then that exercise may be appropriate. However if someone else goes to bench press 20 pounds and struggles and grunts and has to create a lot of pressure in the abdomen to perform the movement, then that exercise should be avoided until the core is stronger and the tissue is more healed. Most people will void high-impact or heavy-lifting activities initially. 

4. Muscle Recruitment: Pay attention to recruiting the right muscles at the right time. For example, many people think of the chest, shoulders and arms for a push-up and don’t realize that it is very much a core exercise. To stabilize the spine during a push-up your core muscles should engage. Ensure your deep abs activate for stability before movement.

Avoid back pain and incontinence

Although more research needs to be done when it comes to diastasis recti impacting pain and incontinence, many moms that I work with who are concerned about abdominal separation are also concerned about incontinence and back pain. Both of those conditions are common during and after pregnancy so their concerns are valid. Rather than fearing these conditions, I created a free 5-day program to empower you and educate you on how to have a strong and functional core in order to reduce your risk of pain and leaking when you sneeze or cough. By understanding your body and following a tailored fitness approach, you can confidently navigate your fitness journey with diastasis recti or any other condition resulting from pregnancy. 

Ready for more tips? Download 5 Tips for a Stronger Core After Pregnancy.