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.

Stages of Being an Active Mom

You care about being an active role model for your family. You see exercise as a tool for both physical and mental health. You recognize that a mom's body needs to be trained differently, and that strength and core training is important. You also understand the need to be flexible, stay committed, and get creative when it comes to finding time for fitness and family. Your goal to be an Active Mom might not waiver, but how you attain this vision looks different at various stages of motherhood.

Based on my personal experience, as well as many of yours, here's what I've come up with as a quick guide for all stages.

Pre-conception/Get Healthy Stage: You’re assessing whether your physical health will support fertility and pregnancy. You might be considering your weight and stress levels. You have a desire to “be in shape” for pregnancy.

What exercise could look like: Start by meeting the physical activity guidelines. Use exercise as a tool to decrease mental stress. Using resistance training and aerobic exercise to achieve a healthy weight. Make sure your calorie intake supports your activity so as to not impact your menstrual cycle.

Prenatal/Pregnant Stage: Your doctor is recommending exercise. Your energy levels fluctuate. You’re adjusting to the changes in your body. You may experience aches and pains.

What exercise could look like: Aim to meet the physical activity guidelines for pregnant people. Enlist the help of a prenatal exercise specialist. Prioritize muscle groups impacted by pregnancy such as the pelvic floor, core, glutes, and upper back. Consider whether a shift to low-impact aerobic activity is right for you. Include mobility work in your routine. Adjust exercise intensity according to your energy level. Ensure you eat a snack before activity to maintain energy and blood sugar levels.

Newborn/Fourth Trimester: Your newborn baby is your priority. Your schedule is completely unpredictable. You feel disconnected from your body (even if you were active during pregnancy). Your tissue is healing. You are sleep-deprived.

What exercise could look like: Recovery is your priority. If you’ve had a c-section or any vaginal delivery complications, healing before increasing activity is key. When you’re ready, begin with stretching and activation of your deeper core muscles through breath. Try to reconnect with pelvic floor muscles (see a pelvic floor PT). Take short walks with the baby in the stroller. Walking is a great form of exercise early on in addition to your short 5-10 minute bouts of core strengthening. Gradually increase the duration of your walks and add bodyweight strength exercises. Focus on posture and stretching.

Baby’s first year/Postpartum: You’re still tired, but you’re feeling motivated to start to feel like yourself again. You have very little time for yourself and your schedule is dictated by baby/work/family. You may be feeling the overuse aches in your feet, wrists, and back from taking care of the baby. Hormones may still be shifting. You may have weight loss goals. Your abs are different and the pelvic floor may be giving you trouble.

What exercise could look like: Enlist the help of a postnatal exercise specialist. Walking is still one of the best modes of exercise because it can be conveniently worked into your day, outdoors can boost your mood/energy, and your baby can join you. Gradually progress in your core exercises, but still prioritize deep abdominal muscles and pelvic floor through breathing. You can begin to incorporate more strength training, with a focus on movement patterns (squats, deadlifts, lunges), core, and muscles to help with aches like upper back and glutes. You’ll have the most success with short 10-15 minute bouts of exercise each day.

Toddler years/Pre-Conception: You still may be juggling an inconsistent schedule with naps and nighttime sleep habits, but you’re less sleep-deprived. Your energy is challenged by keeping up with a toddler. You’re starting to feel like yourself again, but may not be completely pleased with your inconsistent exercise routine. You might be motivated by the fact you’re going to try for another baby, or the idea that your body won’t endure another pregnancy…either way, you want to ramp up your fitness routine. You appreciate the role of physical activity in your mental health, but also the fact you now have to role model healthy behaviors for your family.

What exercise could look like: Assuming you’ve rebuilt your core strength and have a fitness foundation, you have many options for exercise. Strength training should still play a major role in helping you meet the demands of motherhood, and continue to build the body you aesthetically want (aim for a minimum of two times per week, more if you’re really aiming for muscle definition or weight loss). Aerobic activity can vary according to your likes. Consider home workouts not just for convenience, but to begin to model exercise to your children as a habit and priority. Your child will most likely try to interrupt. Try to remain patient, but also firm in letting them know it’s important to you. Ask them to join. Thirty-minute workouts are probably the most feasible, sneaking in longer ones when you can/if you want. Outside of structured workouts, walks, hiking, and playground activity are great ways to be active with the family, and encourage your child to love activity too.

School-age years/perimenopause: Just when you think you’ll get some time back, your child starts to have their own activity calendar. Your energy and time balancing fitness and family is manageable but has to be intentional. You’ve learned that mornings might be your most reliable time for exercise. You might be back to some of your old activities or taken up new ones. Your postpartum hormones are stable, but you might be experiencing minor symptoms of menopause, finding that your body fat distribution is changing/feeling like your metabolism isn’t functioning like it used to. You might be experiencing more anxiety or depression.

What exercise could look like: Exercise is a great tool during this stage to manage stress, promote mental well-being, spend time with your older child, prepare your body for the changes associated with age/menopause, and as a social activity with your friends. Strength training should still be a major component. This will be the key to protecting your bones as you get older and maintaining the physique you’ve grown to love. This stage is an opportunity to start exploring new activities with your child like hiking, ice skating, tennis, or biking. Aiming to exercise at least 30 minutes most days of the week is your goal. Strength training at least 2-3 times per week is ideal and will help maintain lean body mass. It’s basically the stage you’ve been working so hard for….you get to be a healthy and active mom, enjoying physical activity by yourself and with your family!

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.