Pain in the low back and pelvis areas in not uncommon during pregnancy, in fact, roughly 45% of women who are pregnant and 25% of women who have given birth experience some form of pain in these areas. Pain in the low back /pelvis can be very debilitating and can prevent you from participating in everyday activities. For this reason it is good to see your physical therapist whenever you have pain in these areas that last for longer than 1-2 weeks.
The main causes for back pain during pregnancy are outlined below:
- The additional weight of the baby has a tendency to pull the mother’s body forward. The natural reaction is to arch the back in order to keep the head straight up. This forces the muscles of the low back to work harder which makes them tired and more prone to injury.
- Formation of trigger points – Trigger points are basically knots in muscle tissue that form from the muscles being over active and compensating for other weak muscles in surrounding areas. Trigger points in the muscles of the low back and pelvis can form from working overtime carrying the extra weight of the new baby. These “knots” in the muscle tissue can compress nerves and blood vessels and can be very painful.
- Hormones – Hormones are released during pregnancy in order to allow for added movement of the ligaments in the pelvic area by making them relax to prepare for birth. Ligaments are structures that connect bones together and are supposed to be tight to prevent unwanted motion. The increased laxity in the ligaments makes the bones of the pelvis slide on one another in excess which can create feelings of pain in the low back/pelvic areas.
- Posture – Poor posture, standing for too long, or bending over while pregnant can cause, or if you already have it, increased pain in the low back. It is important to know that proper posture is difficult to maintain during pregnancy because of increased stress on the muscles from the added weight of the baby pulling on the low back muscles and stretching the stomach muscles in the front of the body.
Again it is recommended to see you physical therapist if you have pain in the low back or pelvis for more than 1-2 weeks. When you are pregnant, if your pain is sudden and severe and/or have feelings of cramping that come and go, see your physician as these may be signs of labor.
Here are some things you can do at home to alleviate some low back pain associated with pregnancy at home:
- A heating pad and rest can go a long way. Using a heating pad and lying down to rest can take away some of the pressure on the low back that occurs when you are standing. The heating pad can help to loosen up the muscles of the low back and rest can take pressure off of your joints to help decrease pain.
- Add an extra pillow. Sleeping with a pillow between your legs when you are lying on your side can help decrease pain by making sure your hips maintain alignment which will decrease stresses on the low back and hips.
- When getting in and out of bed try keeping your knees close together, lift both legs at the same time and lie on your side to limit the amount of stress on the low back.
- Try to avoid sitting on chairs or couches that are positioned too low or that are too soft as it will increase the amount of stress on the back when trying to stand up.
- Try not to bend or twist as these motions can cause increased stresses on the low back in addition to the added weight of the new baby. If something is needed off of the floor and you do not have help squat down to pick it up rather than bend at the waist.
- Take breaks. If you are tired and feel the need to take a break, listen to your body. Taking some time out to reduce the stresses on your low back will be beneficial in the long run and will ultimately make it easier to cope with the added stresses throughout the day.
When you see your physical therapist, they will go through an examination/evaluation with you that may include a brief medical and social history, some strength testing, range of motion testing, and other special tests to find out what structures are being affected by pregnancy and are causing the increased pain. After their assessment, they will prescribe a treatment plan that is tailored to the individual. Treatments can include the use of modalities like hot/cold packs, ultrasound, electrical stimulation, and superficial massage techniques to help decrease pain, and promote healing to stressed tissues. An exercise and stretching program will be prescribed in order to help increase strength and endurance of the weakened muscles and/or help improve their flexibility. Posture education will also be provided as well as techniques to make moving while pregnant a little more efficient for the mother in certain aspects of daily living.
Another key goal after the start of treatment is looking ahead towards prevention of another injury happening again. It is recommended that you continue seeing a physical therapist routinely to alter and progress your exercise prescription. Continuing treatment after pregnancy should also be discussed with your physical therapist as pain can persist for many months even after delivery of the baby when the added weight is no longer stressing the body. Pain in the low back can have a huge negative impact on your quality of life by preventing you from performing basic everyday activities. The sooner you see your physical therapist for a diagnosis and treatment, the better the outcome will be.
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2. Norén L, Ӧstgaard S, Johansson G, Ӧstgaard HC. Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. European Spine Journal. 2002;11:267-271. doi: 10.1007/s00586-001-0357-7.
3. American Pregnancy Association. Back Pain. American Pregnancy Association. http://www.americanpregnancy.org/pregnancyhealth/backpain.html. Updated March 2007. Accessed December 18, 2012.