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 the prenatal exercise guidelines feel overwhelming and you’re not sure where to begin, schedule an Active Mom Fitness tele or in-person signature prenatal consultation.

3 Holiday Fit Tips

As if your to-do list wasn’t long enough already, now add maintaining the holiday gathering calendar, planning/prepping more meals, and making sure your kids experience family traditions...phew, it’s no wonder our perspective on fitness changes a bit this time of year. Here are a few reminders as we approach the holiday season.

1. January is not your start date: From November through December life gets busy and fitness might be a lower priority, but do yourself a favor and don’t see these last two months of the year as pointless when it comes to workouts. Sure it’s easier to ramp up fitness in January, but you don’t want to enter 2022 feeling like you’re starting over or that you’re “getting back on track”. If you know the end of 2021 will mean less consistency with exercise, instead look at it as your off-season; a chance to maintain what you’ve built, try different types of exercise, enjoy shorter movement sessions, and prepare your body for a surge in a couple of months.

2. Embrace the dark (and cold): whether you work out early in the morning or in the evening, chances are it’s going to be dark and cold. Acknowledge the challenge, but don’t let it become an excuse. Brighten up your home workout area, enlist an accountability partner, lay out your clothes the night before...whatever it takes to embrace the change of season and not let it sabotage your goal to stay active.

3. Exercise is not an exchange for indulging: During the holidays meals tend to be heavier and alcohol might be more frequent. Indulging a bit more is often part of tradition and good times with friends and family. If you’re choosing to indulge, it’s important to be OK with it and not fill yourself with guilt and stress. Don’t fall into the thinking that exercise is there to make up for eating more than usual. Continue to fuel your workouts with good nutrition and if you’re making the choice to have that extra dessert or glass of wine, accept it and enjoy it, knowing that your healthy habits over long periods of time will help you maintain your baseline.

As you can see, for your fitness routine to survive the holidays, it takes a little bit of a mental shift and recognizing that this is a temporary time period and adjustments should be made. So enjoy the family traditions, acknowledge the challenges, and change your perspective on what fitness means to you during this time. If you’d like some guidance with your holiday fitness plans or want to set yourself up for success in the New Year, schedule your personal exercise consult.

3 Ways to Incorporate Pelvic Floor Training into Your Strength Routine

Your pelvic floor muscles can be considered the basement of your core and play a key role in managing intra-abdominal pressure (pressure within your abdominal cavity that helps stabilize your spine). When your pelvic floor muscles work with the rest of the core to manage the pressure, you'll feel stable and strong. When one area of your core is weak, your ability to manage and create pressure for stability changes. During pregnancy breathing, abdominal muscles/wall, and pelvic floor are impacted by the changes to your body-which is why training each of them properly is so important.

Pelvic floor muscles also play important roles in sexual function, organ support, and sphincteric control (holding urine, gas and poop). During the natal period (pregnancy and postpartum), weakness or overactivity of these muscles can impact your core strength and function, as well as cause conditions such as urinary and fecal incontinence, or pain with intercourse. By now most of us have heard of kegels, and some of you may even manage to fit in a few sets while brushing your teeth or driving. However, like most muscles in our body, pelvic floor muscles need to be functional during movement and not just at rest. The best way to do this is to coordinate the activation of your pelvic floor muscles with other core muscles during movement. Here are some ways to train those muscles with common exercises:

1. During squats: As you descend into a squat this is when your pelvic floor muscles should relax. During this lowering movement, you will inhale. As you ascend up to standing with an exhale, this is when you can contract your pelvic floor muscles (think of trying to tighten your vagina around a tampon). Additionally press through your heels to activate glutes, and draw in your belly button (to hit your transverse muscles).

2. During a front dumbbell raise: As you lift the dumbbell exhale and draw in your belly button (to hit your transverse muscles), while at the same time visualizing your pelvic floor rising along with your arm toward your belly button. As you lower the dumbbell, gently release your abdominal contraction and relax your pelvic floor.

3. Wall sit: While you're holding your wall sit (back against the wall, knees bent at 90 degrees with your knees over your ankles), challenge yourself for endurance pelvic floor contractions-one set of three 8-12 seconds long holds (make sure you’re not holding your breath, just the pelvic floor lift). And then follow that with a wall sit of quick pelvic floor contractions-strong flickers of your muscles for 10-15 reps. Think quick “contract, relax, contract, relax”. (similar to an orgasm)

For most pregnant people, pelvic floor training is recommended and will help you maintain a strong and functional core. Remember to always relax between contractions...you don’t want a tight pelvic floor during delivery.

It can be helpful for everyone to get a pelvic floor assessment postpartum, as many people will need to retrain the muscles, and although common, pelvic floor dysfunction is not normal. Weakness is not the only concern, sometimes birth trauma can lead to overactive or spasmed muscles...so don’t just jump back into kegels.

Happy training! If you’d like a strength program that incorporates pelvic floor, get started with Active Mom Fitness!

Advice on Prenatal Exercise: 3 Tips to Achieve 40 Weeks of Workouts

I’ve collaborated with two mamas-to-be to provide you with their advice on exercise during pregnancy. I’ve worked with both Shannon and Jen for 40 weeks of prenatal workouts. So consider these 3 tips you approach exercise each trimester.

Tip 1 from Shannon: Consistency is key. Consistent exercise feels better physically, but just as important, consistency will help you overcome that guilty pressure of needing to “get back on track”. Even if you can’t do much, do something to stay consistent. This could be a 40 minute workout, it could be a 5 minute walk. Either way check that box and get it done.

Jen and Shannon

Tip 2 from Jen: Build a relationship with your trainer. This is a great point. Any fitness professional experienced in prenatal exercise will do their due diligence to ask you about your experience, complications, history, etc. You don’t want to have to catch every new instructor up, or worse, not have them understand your strengths and weaknesses. You’ll receive better workouts and your trainer will feel more confident challenging you if you’ve built a relationship. Jen adds, “I have a constant connection with Ashley so I am more aware of how hard to push myself and/or to know what to look out for! Ashley keeps me updated as to what to watch out for if certain pains pop up. This enables me to continue my training with confidence.

Tip 3 from Shannon: Be kind to yourself. “You never know what kind of day you are going to have. Energy flow fluctuates so much throughout different trimesters, and can change daily. At a certain point, your body just grows and changes and things you used to be able to do, you just can’t do. I’ve also cut back slightly on how frequently I workout as I get closer to the end, which is okay. I’m still making the time as my body feels it can. I agree with Shannon. For some the hardest part of prenatal exercise is mental. You want to challenge yourself, but you don’t want to be rigid in your goals. With hormones shifting and your body physically changing, your mentally have to be flexible and try to be OK with adapting as needed.

If you’re pregnant and ready to get started, check out this Free prenatal exercise 101 series for tips to get started or enroll in the Free Trial of the Prenatal Core, Function & Fitness online membership.

Ashley Reid is an exercise physiologist with the only strength-based studio for moms and moms-to-be in Philadelphia.