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.

5 Things Your Prenatal Fitness Trainer Should be Doing

Trying to navigate prenatal exercise classes and advice can feel overwhelming. Figuring out what is best for your changing body can create feelings of fear, uncertainty and doubt. Information on the internet is often contradictory, and if even you understand the prenatal exercise guidelines, you may not feel confident in implementing them. Whether you’ve worked with a personal trainer before or not, pregnancy is a great time to enlist the additional support you need. In fact, the newest guidelines from the American College of Sports Medicine recommend an individualized program during pregnancy. If you have the access and means to do so, working with a qualified prenatal fitness professional can ensure your program is safe and effective. As a prenatal fitness expert myself, I know the role comes with a lot of responsibility and take that very seriously. So how do you know if the fitness professional you choose is prepared to coach you through pregnancy?

Here are 5 things your prenatal fitness trainer should be doing

1. Assessment: Assessment refers to establishing a baseline in strength, aerobic capacity, and mobility. However, it also includes exercise history, preferences, needs, and injuries. The benefit of working with a personal trainer is customized programming, so at the very minimum, the fitness professional you work with should perform a thorough assessment. As you progress through pregnancy, they should continue to note and evaluate changes in your core function, workout recovery, and daily discomforts.

2. Understand trimester trends: Reading online or scrolling Instagram would make it seem that there are “bad” and “good” exercises for each trimester. This is not the case. Everyone’s needs and abilities during pregnancy vary. The professional you work with should never program exercises based only on your current trimester, nor should they make assumptions about what you’re capable of. However, there are trends during each trimester that they should be aware of, including the fear and fatigue you might feel during the first trimester, or the disturbed sleep or pelvic pressure you might experience in the third trimester. These factors can all influence the workouts they design.

3. Pregnancy continuing education: Hopefully you’ll do your due diligence and select a personal trainer well-trained in exercise science, and one that has taken the extra courses to provide them with prenatal exercise credentials. However, someone working with pregnant people should also have a good, general understanding of pregnancy overall. Heartburn may seem unrelated to exercise, but a professional with an understanding that this is common during pregnancy can coach you on the timing of your meals, or avoid exercises in a position that worsens your reflux.

4. Providing referrals: Prenatal personal trainers or prenatal exercise instructors should be well-trained in prenatal exercise design. They should demonstrate knowledge about the abdominal wall and pelvic floor muscles. However, if you demonstrate any dysfunction or pain they should refer you to the appropriate health professional. This doesn’t mean they shouldn’t work with you, but no matter how knowledgeable they are, it is outside of their scope to diagnose or come up with a treatment plan. They may be certain that your symptoms indicate symphysis pubis dysfunction, but the only support they are qualified to provide is making sure that your exercise program does not exacerbate symptoms, and can help you strengthen and lengthen the muscles that may help you experience less pain. It’s a bonus if they can work in collaboration with the physical therapist you’re referred to so that you receive the most thorough care.

5. Avoiding Promises: If your personal trainer uses words like “fit pregnancy” “bounce back after baby” or “easy delivery”…run! A qualified professional will be focused not on how “toned” your muscles are, but rather how you feel and move so that you can continue to be strong and active through 40 weeks of pregnancy. A qualified professional will design a program that you can stay consistent with and that strengthens/lengthens the muscles most impacted by pregnancy…thus decreasing the chance of delivery complications and possibly reducing the duration of labor. However, they shouldn’t make you any promises about the ease or length of your labor and delivery. Your personal trainer should understand that prenatal exercise can lead to better postpartum recovery, but should never suggest that you’ll “snap back” because the science tells us that tissues take a while to heal and in no way just bounce back.

Beyond those 5 things your personal trainer should be doing there are other factors that you should consider in selecting one to work with, such as convenience, relatability, ability to share information, and trust. The last thing to note is that there is a benefit to working with a personal trainer you’ve worked with before, or working with the same person throughout your entire pregnancy. This leads to a better understanding of the intensity you’re capable of, and someone who knows your ability will probably be less conservative when designing your program. However, you shouldn’t just assume that a personal trainer that you have worked with pre-pregnancy is the most beneficial to you during pregnancy, or the most qualified.

You deserve to feel strong and empowered during pregnancy. Choose someone who will help you use exercise as a tool to be healthy and feel good as you await your baby.

Happy Training! PS. Download 5 Free Tips for a Stronger Core During Pregnancy

When to Start Prenatal Exercise

The short answer: Right away!

But this also depends on what you consider prenatal exercise. Gone are the days when it has to be gentle stretching (although it could be if that’s what you need). In fact, if you watch this video from Nike, you’ll probably feel pretty badass and realize prenatal exercise is going to prepare you for the athletic event that is pregnancy and labor and delivery….a marathon combined with intense sprints.

Prenatal exercise means your training program is designed for the pregnant body. You don’t have to follow a specific set of rules for each trimester. Exercise selection isn’t dictated by the number of weeks you are. A really good prenatal program, simply means you’re going to attempt to put your body in the best position to deal with the demands of pregnancy and motherhood.

Very early in your pregnancy, you may find that prenatal exercise means:

• less intensity because you’re extremely fatigued

• learning how to engage deep abdominal while it's still fairly easy to feel them

• beginning to strengthen pelvic floor muscles

• finding a prenatal exercise specialist to keep you motivated through every trimester

• addressing muscle weakness or tightness that might become an issue later in pregnancy

Later in your pregnancy, prenatal exercise might mean:

• finding new ways to strengthen the core without creating too much abdominal pressure

• reducing impact exercise because it's uncomfortable or your pelvic floor can withstand the load

• calming exercise to help keep your stress low

• making adjustments like switching from pull-ups to rows or floor push-ups to wall push-ups

The above are just examples. Your prenatal program should be based on how you’re feeling, your current fitness level and what you enjoy doing. The earlier you can prep your body for the sport of motherhood, the better.

If you’re ready to start with something simple, download 5 Tips to a Stronger Core During Pregnancy.