What’s causing my back pain?
You can probably blame your growing uterus and hormonal changes for your aching back.
Your expanding uterus shifts your center of gravity and stretches out and weakens your abdominal muscles, changing your posture and putting strain on your back. It may also cause back pain if it’s pressing on a nerve. In addition, the extra weight you’re carrying means more work for your muscles and increased stress on your joints, which is why your back may feel worse at the end of the day.
What’s more, hormonal changes in pregnancy loosen your joints and the ligaments that attach your pelvic bones to your spine. This can make you feel less stable and cause pain when you walk, stand, sit for long periods, roll over in bed, get out of a low chair or the tub, bend, or lift things.
You’re not alone. As many as three-quarters of pregnant women experience back pain at some point. Most often the pain appears in the later months or becomes worse as pregnancy progresses. It may also persist after the baby arrives, but postpartum back pain usually resolves in a few months.
The good news is that there’s no link between back pain and pregnancy outcome.
What kinds of low back pain are common in pregnancy?
Experts describe two common patterns of low back pain in pregnancy: Lumbar pain occurs in the area of the lumbar vertebrae in your lower back, and posterior pelvic pain is felt in the back of your pelvis. Some women have symptoms of both types of low back pain.
Lumbar pain is like the low back pain you may have experienced before you were pregnant. You feel it over and around your spine approximately at the level of your waist. You might also have pain that radiates to your legs. Sitting or standing for long periods of time and lifting usually make it worse, and it tends to be more intense at the end of the day.
Even more pregnant women have posterior pelvic pain, which is felt lower on your body than lumbar pain. You may feel it deep inside the buttocks, on one or both sides or the back of your thighs. It may be triggered by activities such as walking, climbing stairs, getting in and out of a tub or a low chair, rolling over in bed, or twisting and lifting.
Positions in which you’re bent at the waist – such as sitting in a chair and leaning forward while working at a desk – may make posterior pelvic pain worse. Women with posterior pelvic pain are also more likely to have pain over their pubic bone.
Could it be sciatica?
When low back pain radiates into the buttocks and thighs, it’s often confused with sciatica – a condition that’s actually relatively uncommon. True sciatica, which can be caused by a herniated or bulging disk in the lower part of the spine, affects only about 1 percent of pregnant women.
If you have sciatica, your leg pain will usually be more severe than your back pain. You’re likely to feel it below the knee as well, and it may even radiate to your foot and toes. And you’ll probably feel a tingling, pins-and-needles sensation in your legs or possibly some numbness.
With severe sciatica, you may have numbness in your groin or genital area as well. You may even find that it’s hard to urinate or have a bowel movement.
If you think you have sciatica, be sure to see your practitioner. Call her immediately if you feel a loss of sensation or weakness in one or both legs or a loss of sensation in your groin, bladder, or anus (which may make it hard to pee or have a bowel movement, or – alternatively – cause incontinence).
Who’s most likely to have low back pain during pregnancy?
Not surprisingly, you’re most likely to have low back pain if you’ve had this kind of pain before, either before you got pregnant or during a previous pregnancy. You’re also at higher risk if you’ve lead a very sedentary lifestyle and have poor flexibility and weak back and abdominal muscles.
Carrying twins (or more) increases your odds of having an aching back. Obesity may be a risk factor for developing low back pain during pregnancy, but study results are conflicting.
What can I do about it?
You may feel more like curling up in bed than exercising if your back hurts, but don’t take to your bed for long periods. Bed rest is generally not helpful in the long run for low back pain and may even make you feel worse. In fact,exercise may be just what you need.
Check with your caregiver before beginning an exercise program, though, because there are some situations in which you may have to limit exercise orforgo it altogether. Then, consider:
- Strengthening exercises to help build the muscles that support your back and legs, including your abdominal muscles.
- Stretching exercises to help the muscles that support the back and legs become more flexible. Be careful to stretch gently, because stretching too quickly or too much can put further strain on your joints, which have been made looser by pregnancy. Prenatal yoga is one good way to stay limber, and it can help improve your balance, too.
- Swimming is a great exercise option for pregnant women because it strengthens your abdominal and lower back muscles, and the buoyancy of the water takes the strain off your joints and ligaments. Consider signing up for a prenatal water exercise class, if one is available in your community. These can be very relaxing, and there’s research suggesting that water exercise may decrease the intensity of back pain during pregnancy.
- Walking is another option to consider. It’s low impact and easy to make part of your daily routine.
- For lumbar pain, try doing pelvic tilts, which can ease back pain by stretching your muscles and, over time, strengthening them as well. Here’s how: Get on your hands and knees, arms shoulder-width apart and knees hip-width apart. Keep your arms straight, but don’t lock the elbows. Tuck your buttocks under and round your back as you breathe in. Relax your back into a neutral position as you breathe out. Repeat at your own pace.
Pregnancy may require you to change some of your usual exercise routines. (If you’re new to exercise, check out our exercise suggestions for beginners.) In fact, there are some specific guidelines for exercising safely during pregnancy – such as not lying flat on your back and not getting up too quickly – that you’ll want to keep in mind.
Whether you’re an athlete or a newcomer to exercise, listen to your body and don’t do anything that hurts. Finally, watch for warning signs that you may be overdoing things or developing a problem that needs medical attention.
Be aware of positioning and proper body mechanics.
- Stand up straight. This gets harder to do as your body changes, but try to keep your bottom tucked in and your shoulders back. Pregnant women tend to slump their shoulders and arch their back as their belly grows, which puts more strain on the spine.
- If you sit all day, be sure to sit up straight. Supporting your feet with a footstool can help prevent lumbar pain, as can using a small pillow called a lumbar roll behind your lower back. Take frequent breaks from sitting. Get up and walk around at least every hour or so.
- It’s equally important to avoid standing for too long. If you need to stand all day, try to take a midday break and rest lying on your side while supporting your upper leg and abdomen with pillows.
- Be aware of movements that make the pain worse. If you have posterior pelvic pain, try to limit activities like stair climbing, for example. And avoid any exercise that requires extreme movements of your hips or spine.
- Wear comfortable shoes and avoid high heels. As your belly grows and your balance shifts, high heels will throw your posture even more out of whack and increase your chances of stumbling and falling.
- Always bend from your knees and lift things from a crouching position to minimize the stress on your back. This isn’t the time to risk throwing your back out, so let someone else lift heavy things and reach for high objects.Avoid twisting movements, too. Pass up activities like vacuuming and mopping that require you to bend and twist at the same time. If there’s no one else to do these chores, move your whole body rather than twisting or reaching to get to out-of-the-way spots.
- Divide up the weight of items you have to carry. Carrying a shopping bag in each hand with half the weight in each is much better than the uneven stress of carrying one heavier bag.
- Take care when getting out of bed: Bend your legs at your knees and hips when you roll to the side, and use your arms to push yourself up as you dangle your lower legs over the side of the bed.
- To get a good night’s rest, try sleeping on your side with one or both knees bent and a pillow between your legs. As your pregnancy advances, use another pillow or wedge to support your abdomen.
Try some TLC:
Taking steps to ease soreness and tension and generally taking good care of yourself can’t hurt. At the very least, you’ll feel better temporarily. Take the time to try these measures:
- Learn relaxation techniques. They may help you cope with the discomfort and may be especially useful at bedtime if your back pain is just one more thing that makes it hard to get to sleep.
- Try heat or cold. There’s some evidence that heat may provide a bit of short-term relief. Try soaking in a warm (not hot) tub, which can also help you relax. Or place a hot water bottle (or hot pack) on your lower back.Although there’s no hard evidence that cold helps, applying a cold pack is easy to do and worth a try if heat doesn’t work for you.Whether you use heat or cold, cover the pack or bottle with a thin cloth to protect your skin.
- Treat yourself to a massage. Prenatal massage by a trained therapist may provide some relief. If your insurance plan doesn’t cover therapeutic massage and paying for one will strain your finances, you may want to enlist your partner or a friend to give you a gentle backrub – it may not address the underlying problem, but it might help you relax. (Most insurance companies don’t cover massage, though a referral from your caregiver might do the trick. It’s worth looking into.)
Are there other things to try if the above measures don’t help enough?
Yes, but begin by letting your caregiver know if your back pain doesn’t respond to the measures above. She can evaluate your situation, discuss treatment options, and refer you to a specialist, if necessary.
Some options to consider and discuss with your caregiver:
- There’s research suggesting that acupuncture may help reduce the intensity of back pain during pregnancy.
- Some back pain sufferers respond well to physical therapy. Plus, a physical therapist can teach you exercises to do on your own to prevent later episodes of low back pain.
- Some women find that chiropractic care is helpful, though research that’s specific to pregnancy-related back pain is scant
- Your caregiver may suggest trying a “sacral belt.” (For some women, this device seems to help lessen the pain when walking, although for others it doesn’t help at all, and for a few it may even increase pain.)
- If your pain is severe, your caregiver may prescribe pain medication.
Are there symptoms that should prompt an urgent call to my caregiver?
Yes. Call immediately if:
- Your back pain is severe, constant, or getting progressively worse, or if it’s caused by trauma or accompanied by a fever.
- You’ve lost feeling in one or both legs, or you suddenly feel uncoordinated or weak.
- You have a loss of sensation in your buttocks, groin, genital area, or your bladder or anus, which may make it hard to pee or have a bowel movement, or, alternatively, cause incontinence.
- You have low back pain in the late second or third trimester. This can be a sign of preterm labor, particularly if you haven’t had back pain before that.
- You have pain in your lower back or in your side just under your ribs, on one or both sides. This can be a sign of a kidney infection, especially if you have a fever, nausea, or blood in your urine.