On an average day seeing patients in the office I hear about many types of discomfort experienced by pregnant women. Heartburn, frequent urination, difficulty sleeping and numbness in the hands and feet are just a few of the common complaints.
By far the most common, however, is back pain.
It’s a problem that often takes women by surprise, especially those who have never dealt with back pain before pregnancy.
The main cause of back pain in pregnancy is muscle strain. One look at a woman late in her pregnancy tells the tale: The heavy uterus, now way out in front of the torso, forces the mother to arch backward just to remain upright. That arching is called lordosis. Her center of gravity, once in the central torso, is now several inches forward.
I often see pregnant women supporting their lower back with both hands as they walk or stand, which exaggerates the pregnant woman’s “waddle” as she walks. Deep core muscles the women never even knew they had are now being recruited just so they can stay upright, and they often overcompensate with a dramatic lordosis. The result: strained back muscles.
The abdominal muscles are also an important component of spine support. In pregnancy the abdominal muscles are stretched out and can weaken. Those changes increase the risk of injury, strain, soreness and stiffness in the back during and after exercise.
The icing on the cake is the effect of hormones on connective tissue during pregnancy. To prepare the pelvis for the passage of the baby through the birth canal, a hormone called relaxin literally relaxes the ligaments in the joints of the pelvis. That loosening allows the joints to become more flexible, but it can also lead to back pain if the joints are too mobile.
What can you do to prevent back pain during pregnancy?
For starters, be aware of how you stand, sit and move.
Also, I would strongly recommend orthotics in both shoes. Arch supports will change the geometry of standing and relieve the lower back.
Another tip is to invest in a firm mattress, which provides more support during pregnancy and will also improve sleep patterns. Perhaps the most effective treatment that never fails to improve back pain is to sleep on your side with one or two pillows between your legs to prevent the hips from collapsing.
A general rule is to sit in chairs with good back support so you can lean back and, if necessary, use a small pillow behind the low part of your back while sitting. A device called a lumbar support, which can be purchased from medical supply stores, is helpful. And do not bend over from the waist to pick things up: Squat, bend your knees and keep your back straight.
The role of exercise in prevention and treatment of back pain during pregnancy cannot be overemphasized. Regular exercise strengthens and stretches the muscles that support your legs and back while promoting good posture. Exercise will not only ease back pain but also help prepare for labor and childbirth.
What kind of exercise is recommended for back pain during pregnancy?
In general, exercise that strengthens and stretches the muscles that support your back and legs while promoting good posture are key. A great place to start is to stretch the hamstrings and hip flexors. Simply stretching those muscles will release tension in the lower back. Also, exercises such as Pilates will improve core strength, which also helps release and relax deep core muscles throughout the back.
I also recommend prenatal yoga to virtually all of my patients. Prenatal yoga improves circulation, stretches the appropriate muscles, builds strength and keeps the body flexible, which is also important to preparing for labor and delivery. Most yoga studios offer classes in prenatal yoga with an instructor familiar and trained to work with pregnant patients. For patients who are unable to attend a class, prenatal yoga is also available online. Local prenatal yoga instructors can be found teaching classes online at YogaToday.com, where you can do prenatal yoga in the privacy of your home and at any time.
In addition to easing back pain, yoga provides a powerful stress-management tool with rhythmic breathing. The meditative aspect of yoga also can bring a great sense of calm and peace to a pregnant woman as her life and body go through tremendous changes. The awareness of the perineum that occurs through yoga practice will also help with the labor, delivery and postpartum experience.
Other tools to help with back pain during pregnancy include prenatal massage and physical therapy. Generally I recommend patients pursue exercise with stretching, prenatal yoga and Pilates, supported sleep with firm mattress or bolsters or pillows, followed by regular prenatal massage. Women who see only minimal improvement from these steps may need to be referred to an experienced physical therapist.
If your back pain is worsening or if it persists for more than a few weeks, your prenatal provider should be contacted. We would want to make sure that other causes of pain, such as preterm labor and urinary tract infection, are not present. Fortunately these scenarios are uncommon, and ultimately back pain resolves with delivery of the baby.
This column first appeared in the Aug. 5, 2015, News&Guide. — Eds.