What to do back pain during pregnancy
Back Pain During Pregnancy: Causes and Treatments
Written by Mary Anne Dunkin
In this Article
- Causes of Back Pain in Pregnant Women
- Treatments for Back Pain in Pregnancy
- When to Seek Treatment From a Doctor
The good news is, your baby is growing. That's exactly what should be happening -- but it can still be tough on your back.
You've got lots of company -- most pregnant women experience back pain, usually starting in the second half of pregnancy.
You should know that there are things you can do to minimize your back pain. Here's what helps.
Causes of Back Pain in Pregnant Women
Pregnancy back pain typically happens where the pelvis meets your spine, at the sacroiliac joint.
There are many possible reasons why it happens. Here are some of the more likely causes:
- Weight gain. During a healthy pregnancy, women typically gain between 25 and 35 pounds.
The spine has to support that weight. That can cause lower back pain. The weight of the growing baby and uterus also puts pressure on the blood vessels and nerves in the pelvis and back.
- Posture changes. Pregnancy shifts your center of gravity. As a result, you may gradually -- even without noticing -- begin to adjust your posture and the way you move. This may result in back pain or strain.
- Hormone changes. During pregnancy, your body makes a hormone called relaxin that allows ligaments in the pelvic area to relax and the joints to become looser in preparation for the birth process. The same hormone can cause ligaments that support the spine to loosen, leading to instability and pain.
- Muscle separation. As the uterus expands, two parallel sheets of muscles (the rectus abdominis muscles), which run from the rib cage to the pubic bone, may separate along the center seam. This separation may worsen back pain.
- Stress.
Emotional stress can cause muscle tension in the back, which may be felt as back pain or back spasms. You may find that you experience an increase in back pain during stressful periods of your pregnancy.
Treatments for Back Pain in Pregnancy
More good news: Unless you had chronic backaches before you got pregnant, your pain will likely ease gradually before you give birth.
Meanwhile, there are many things you can do to treat low back pain or make it rarer and milder:
- Exercise. Regular exercise strengthens muscles and boosts flexibility. That can ease the stress on your spine. Safe exercises for most pregnant women include walking, swimming, and stationary cycling. Your doctor or physical therapist can recommend exercises to strengthen your back and abdomen.
- Heat and cold. Applying heat and cold to your back may help. If your health care provider agrees, start by putting cold compresses (such as a bag of ice or frozen vegetables wrapped in a towel) on the painful area for up to 20 minutes several times a day.
After two or three days, switch to heat -- put a heating pad or hot water bottle on the painful area. Be careful not to apply heat to your abdomen during pregnancy. - Improve your posture. Slouching strains your spine. So using proper posture when working, sitting, or sleeping is a good move. For example, sleeping on your side with a pillow between the knees will take stress off your back. When sitting at a desk, place a rolled-up towel behind your back for support; rest your feet on a stack of books or stool and sit up straight, with your shoulders back. When standing, pull your hips forward and your shoulders back. You may tend to lean back to compensate for your growing belly. Wearing a support belt may also help.
- Stretch regularly. Look up the "backward stretch," the "low back stretch," and the "standing pelvic tilt." These strengthen your back and pelvic muscles.
- Counseling. If back pain is related to stress, talking to a trusted friend or counselor may be helpful.
- Acupuncture. Acupuncture is a form of Chinese medicine in which thin needles are inserted into your skin at certain locations. Studies have shown that acupuncture can be effective in relieving low back pain during pregnancy. Check with your health care provider if you're interested in trying it.
- Chiropractic. When performed correctly, chiropractic manipulation of the spine can be safe during pregnancy, but consult with your doctor before seeking chiropractic care.
More tips:
- If you need to pick something up from the ground, use your legs to squat rather than bend over.
- Don't wear high-heeled shoes. Choose low-heeled shoes with good arch support. Remember, as hormones loosen joints, you may need to buy a larger shoe size.
- Don't sleep on your back.
If your back pain persists, you may want to consult your doctor to see what else you might try. Be sure to consult your doctor before taking pain medications.
Acetaminophen (Tylenol) is safe for most women to take during pregnancy. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve) are not advised. In some cases, your doctor may recommend other pain medicines or muscle relaxants that are safe during pregnancy.
When to Seek Treatment From a Doctor
Back pain, by itself, usually is not a reason to call your doctor. But you should call your doctor right away if you experience any of the following:
- Severe pain
- Increasingly severe pain or pain that begins abruptly
- Rhythmic cramping pains
- Difficulty urinating or “pins and needles” in your extremities
In rare cases, severe back pain may be related to problems such as pregnancy-associated osteoporosis, vertebral osteoarthritis, or septic arthritis. Rhythmic pains may be a sign of preterm labor. So if you are experiencing any of these problems, it's important to be checked by your doctor.
Health & Pregnancy Guide
- Getting Pregnant
- First Trimester
- Second Trimester
- Third Trimester
- Labor and Delivery
- Pregnancy Complications
- All Guide Topics
Back pain in pregnancy - NHS
It is very common to get backache or back pain during pregnancy, especially in the early stages.
During pregnancy, the ligaments in your body naturally become softer and stretch to prepare you for labour. This can put a strain on the joints of your lower back and pelvis, which can cause back pain.
Avoiding and easing back pain in pregnancy
Try these tips:
- bend your knees and keep your back straight when you lift or pick something up from the floor
- avoid lifting heavy objects
- move your feet when you turn to avoid twisting your spine
- wear flat shoes to evenly distribute your weight
- try to balance the weight between 2 bags when carrying shopping
- keep your back straight and well supported when sitting – look for maternity support pillows
- get enough rest, particularly later in pregnancy
- have a massage or a warm bath
- use a mattress that supports you properly – you can put a piece of hardboard under a soft mattress to make it firmer, if necessary
- go to a group or individual back care class
You can take paracetamol to ease back pain while you are pregnant, unless your GP or midwife says not to.
Always follow the instructions on the packet.
When to get help for back pain in pregnancy
If your backache is very painful, talk to your GP or midwife. They may be able to refer you to an obstetric physiotherapist at your hospital, who can give you advice and may suggest some helpful exercises.
Non-urgent advice: Contact your GP or midwife urgently if:
You have back pain and you:
- are in your second or third trimester – this could be a sign of early labour
- also have a fever, bleeding from your vagina or pain when you pee
- have pain in one or more of your sides (under your ribs)
Immediate action required: Call 999 or go to A&E if:
You have back pain and:
- you lose feeling in one or both of your legs, your bum, or your genitals
Exercises to ease back pain in pregnancy
This gentle exercise helps to strengthen stomach (abdominal) muscles, which can ease back pain in pregnancy:
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1) Start on all fours with knees under hips, hands under shoulders, fingers facing forwards and stomach muscles lifted to keep your back straight.
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2) Pull in your stomach muscles and raise your back up towards the ceiling, letting your head and bum relax downwards gently – do not let your elbows lock and only move your back as far as you comfortably can.
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3) Hold for a few seconds then slowly return to the box position – take care not to hollow your back, it should always return to a straight, neutral position.
4) Do this slowly and rhythmically 10 times, making your muscles work hard and moving your back carefully.
Doing prenatal yoga or aquanatal classes (gentle exercise classes in water) with a qualified instructor can also help build your muscles to better support your back. Ask at your local leisure centre.
Page last reviewed: 15 March 2021
Next review due: 15 March 2024
5 Exercises for Back Pain During Pregnancy - Academic Medical Center (AMC)
During the second half of pregnancy, most women suffer from nagging lower back pain. Most often, it is caused by physiological changes in the body and disappears with a change in body position and the selection of a comfortable posture. Back pain can also be provoked by inflammatory and infectious diseases and exacerbations of chronic pathologies. To determine the cause of discomfort, be sure to consult a doctor.
If no diseases have been identified, and aching pain is the result of an increase in the load on the back muscles, then special physical exercises will help to loosen it.
5 exercises to relax the back
Back twists
Sit on the floor or sofa with your legs crossed. Take your right hand forward and begin to slowly wind it behind your back and turn after it with your whole body. Move until you feel a slight stretch in your muscles. After that, return to the starting position and turn to the other side. When performing the exercise, make sure that your back remains straight.
Child posture
This exercise helps to relax the back muscles. Get on your knees, put your feet shoulder-width apart and rest your palms on the floor. Keeping your palms pressed to the floor, lower your buttocks onto your heels. The stomach should lie between the knees, and the back muscles should stretch.
Cat back
Get on your knees and place your palms on the floor. Gently lift your back up, arching it in a semicircle. Hold this position for 5 seconds, then relax and repeat all over again.
Reverse cat back
Kneel down and place your palms on the floor. Raise your head up and bend your back down. Hold this position for 5 seconds.
Bird Flight
Stand sideways against a wall or back of a sofa so that you can hold on with one hand. Holding on with your left hand, lift your right leg to a horizontal position. Hold this position for 5-10 seconds, then repeat the exercise with the other leg. This exercise strengthens the back muscles, making them stronger.
How to do the exercises?
Before you decide to do exercises to relieve back pain, be sure to consult your doctor. He will assess your condition and determine the acceptable load level.
All exercises must be performed smoothly, avoiding sudden movements and strictly following the execution technique.
Contraindications for gymnastics
Not in all cases, pregnant women are allowed to exercise. They are prohibited with the threat of miscarriage or premature birth, after pregnancy loss, with increased uterine tone, with severe toxicosis, changes in blood pressure, diseases of the spine and cardiovascular system.
How to prevent back pain?
During pregnancy, back pain is the result of increased strain on the back muscles and spine. To reduce stress and prevent pain, wear low heel shoes or shoes with less than 3 cm heels, support your lower back with a pillow when you sit, and sleep on your side, with a pillow under your belly if necessary.
Which symptoms require immediate medical attention?
Lower back pain in the second half of pregnancy appears due to the shift of the center of gravity, weakening of the ligamentous apparatus, preparation of the body for childbirth.
However, back pain can also be a symptom of dangerous diseases or complications.
Seek medical attention:
- if you experience pain in the upper back and neck, accompanied by high blood pressure, headache or dizziness;
- with a decrease in the mobility of the shoulder joints and numbness of the fingers;
- in case of pain in the thoracic spine, which is accompanied by pain in the ribs and heart;
- for back pain accompanied by leg numbness;
- with aching pain that does not go away and does not weaken with a change in body position;
- for pain accompanied by fever, edema, pain during urination;
- with sharp, intense, cramping pains.
During pregnancy, you feel not only great joy in expecting a baby, but also a great responsibility for his health. One of the main conditions for a favorable course of pregnancy and the birth of a healthy baby is observation by a highly professional obstetrician-gynecologist.
Unfortunately, the number of pregnant women at high risk to both mother and child is on the rise.
It is therefore important to see a doctor as soon as possible. In the early stages of pregnancy, an obstetrician-gynecologist must determine the health status of the expectant mother and conduct screening studies of the fetus on time. We offer comprehensive pregnancy support packages for you.
Pregnancy management at the Academic Medical Center is based on the provisions of the MOH pregnancy management protocol and 25 years of successful medical experience. Our comprehensive packages include a full range of necessary consultative and diagnostic measures from the moment of registration to delivery.
More pregnancy management packages.
Lower back pain and pregnancy
As a result, there are changes in the spine, in the muscles of the abdomen and back and the shape of the lumbar curve of the spine (hyperlordosis), and all this becomes relaxed.
Poor posture and poor muscle tone can also affect spinal mechanics.
The lumbar curve of the spine begins to slowly increase as the pelvis begins to move back. This posture begins to affect the weakened muscles and leads to the accumulation of fatigue in the muscles of the lower back. A woman may experience moderately painful muscle spasms at first, which may be the first sign of the possibility of persistent low back pain as the pregnancy progresses. The growing uterus shifts the center of gravity and weakens the abdominal muscles, changes posture and puts excessive stress on the back. If the uterus affects the nerves, then this can lead to pain. In addition, being overweight during pregnancy puts more stress on the muscles and joints, and therefore, by the end of the day, a pregnant woman may feel discomfort.
Experts describe the two most common patterns of low back pain during pregnancy: low back pain that occurs in the area of the lumbar vertebrae in the lower back, and posterior pelvic pain, which is felt in the back of the pelvis.
Some women have symptoms of both types of low back pain.
Lower back pain is similar to the pain that a woman experienced before pregnancy. Pain is felt in the lower back and around the spine, approximately at waist level. Women may also experience pain that radiates to the legs. Prolonged sitting or standing can aggravate the pain and, as a rule, the pain tends to increase towards the end of the day. Many more women experience back pelvic pain, which is felt less than lower back pain. The pain may be deep inside the buttocks, on one or both buttocks, or in the back of the thighs. Pain can be triggered by activities such as walking, climbing stairs, getting in and out of the bathroom on a low cabinet, turning in bed, or twisting and lifting heavy objects.
Positions that involve leaning forward, such as sitting, in a chair, and working at a desk while leaning forward, can exacerbate posterior pelvic pain. Women with posterior pelvic pain are also more likely to experience pain over the pubic bone.
When low back pain radiates to the buttocks and thighs, sciatica is often suspected - although sciatica is not very common in pregnant women. True sciatica, which can be caused by a herniated disc or the presence of a disc protrusion in the lumbar spine, occurs in only 1 percent of pregnant women.
If there is compression and inflammation of the sciatic nerve (herniated disc), then the pain in the legs is more severe than with normal low back pain. Pain can be felt not only in the thigh, but also below the knee or even radiate to the foot. It is also possible the presence of sensory disturbances, such as numbness or tingling sensations.
With severe sciatica, there may be numbness in the groin area, as well as in the genital area. You may also have trouble urinating or defecation. If a pregnant woman has suspicions of sciatica, then she must definitely contact her doctor. If symptoms such as impaired sensation in the legs and weakness in one or both legs or loss of sensation in the groin and impaired urination or defecation appear, then you need to see a doctor urgently! Such symptoms may be evidence of the development of the "cauda equina" syndrome in the presence of a herniated disc in a pregnant woman, and in such cases an emergency operation is necessary.
Risk factors for low back pain
It is not surprising that, most likely, low back pain in pregnant women is most likely if there were already pains before pregnancy or there were degenerative changes in the lumbar spine (protrusions, herniated discs). Also at higher risk are pregnant women who led an inactive lifestyle before pregnancy, as a result of which their back muscles are weak, as well as the abdominal muscles. Pregnancy with multiple fetuses (twins) significantly increases the risk of lower back pain. Obesity may also be a risk factor for developing low back pain during pregnancy.
Diagnosis of low back pain.
Examinations such as CT (MSCT) are rarely used to diagnose the causes of low back pain in pregnant women due to possible teratogenic effects on the fetus. MRI is also not recommended, especially in the first trimester of pregnancy. But, if there are clinical indications, then MRI can be performed. Therefore, as a rule, the diagnosis of low back pain in pregnant women is mainly based on physical examination data, symptoms and medical history (for example, the presence of a disc herniation before pregnancy).
Treatment
The use of any medication during pregnancy is very risky, as all medication will also be passed on to the fetus. Therefore, the usual prescription of painkillers, muscle relaxants, or steroids (NSAIDs) for back pain is contraindicated in pregnant women. In addition, the use of acupuncture physiotherapy is also not recommended. It is possible to use light massage and very gentle manual therapy techniques.
At the forefront of the treatment of back pain in pregnant women comes exercise therapy (gymnastics) and certain recommendations for daily activities. Gymnastics can be specialized, such as prenatal yoga. Good effect gives swimming and walking.
Swimming is an excellent exercise choice for pregnant women because it strengthens the abdominal and lower back muscles, and being in the water relieves stress on joints and ligaments.
Need to maintain proper biomechanics during pregnancy:
- Stand up straight. This becomes more and more difficult to do as the shape of the body changes, but one must try to keep the back straight and the shoulders back.
Pregnant women tend to drop their shoulders and arch their back as their belly grows, which puts more stress on the spine. - If it is necessary to sit during the day, then one should sit straight. Leg support (bedside table) can help prevent lower back pain, and you can also put a special pillow under the lower back. Take frequent breaks from sitting. You need to get up and walk for several minutes, at least once an hour.
- It is equally important not to stand too long. If you need to stand all day, then it is advisable to rest while lying on your side during a break, supporting your upper leg and stomach with pillows.
- Avoid movements that increase pain. If there is posterior pelvic pain, then one should try to limit activities such as climbing stairs. It is also advisable to avoid any activity that requires extreme movement of the hips or spine.
- It is important to wear comfortable shoes and avoid high heels. As the abdomen grows, the center of gravity shifts and when wearing shoes with heels, the risk of falls increases.
- Always bend your knees and pick things up from your haunches to minimize stress on your back. Spinal twisting should be avoided and activities such as vacuuming or mopping should be avoided.
- Divide the weight of the items to be carried. For a uniform load, it is necessary to carry the weight in two bags.
With severe pain and weak muscle corset, you can wear a belt.
Particular attention should be paid to pregnant women with herniated discs, as in a certain percentage of cases, it is possible to develop cauda equina syndrome during pregnancy, a very serious neurological condition.
Seek immediate medical attention if any of the following symptoms occur:
- Back pain pain is very severe, persistent, or gradually increases, or if the pain appears after an injury, or if it is accompanied by a rise in temperature.
- Numbness in one or both legs, or feeling that the legs do not obey
- Loss of sensation in the buttocks, groin, perineum, or impaired bladder and bowel function.
