Back Pain

It's no surprise that most women experience some degree of back pain during their pregnancy. But it doesn t have to be just tolerated and passed off as one of those things . Lower back pain in pregnancy can have a spiral effect on your enjoyment of being pregnant and maintaining household, family and work related activities. However, there are specific things which you can do to help relieve the extent of your backache and hopefully, alleviate it altogether.

The most common area of the spine to be affected by pain is the lower back, particularly in the area just above the sacrum. This is the spot where the majority of pregnant women, at some stage, reach behind their back and place a hand in the lower region of their spine, just above the buttocks. If they are already prone to lower back pain, then it is often worse during pregnancy.

Pregnancy increases the risk of lower back pain because of the changes in a mother's centre of gravity. To avoid the sensation of falling forwards, she compensates for this by leaning backwards. This creates a strain on the lower back.

Lower back pain in pregnancy often gets worse in the later stages of pregnancy because of the weight of the baby and increase in mother's hormone levels.It can also become worse because of general weight gain.

Description of lower back pain in pregnancy

This is often described as a tightness or tenderness in the muscles and tendons supporting the lower back, which then radiates with movement. Lower back pain often restricts the mother's movement because of the feeling of pain when she is bending forward.

Around 50-80% of pregnant women experience some degree of lower back pain. It can even persist after pregnancy for some women after childbirth.

For women who have experienced lower back pain in their first pregnancy, there is an increased risk of it occurring in subsequent pregnancies.

Why is back pain during pregnancy so common?

Pregnancy hormones, in particular Relaxin, have an effect on the joints and ligaments throughout the body. Relaxin is an important hormone because it helps to loosen up the pelvic bones and tissues so that childbirth is easier. Throughout the pelvis, including the muscles and tendons of the lower back, tissues are not as strong and supportive as they usually are and as a result, pain develops.

There are also changes in:

• The mother's centre of gravity causing her to tilt forward.
• Overall weight gain.
• Stress and tension also has an effect on lower back pain. Because of the increase in stress hormones the muscles do not have a chance to relax and recover and can be permanently in a state of tightness. Over time this creates muscle fatigue and further tension.

What can I do to ease my pregnancy back pain?

First of all, check with your maternity care provider about what you can do. It's important to rule out any underlying cause for your lower back pain. Simply managing the pain is like putting a bandaid on a wound. It won t address the underlying issues which are causing the pain in the first place.

• Avoid gaining too much weight when you are pregnant. Check with your maternity care provider to see what your BMI is and aim not to gain more than around 10-12 kgs through your entire pregnancy.
• Adopt a tall, erect posture when standing, walking and sitting. Imagine a torch beam in the centre of your chest between your breasts which is shining a light ahead of you, rather than down at the ground.
• Hold your shoulders back but also focus on them being relaxed. A good supportive bra can help with this.
• Avoid standing still for long periods, but if you do need to, don t lock your knees.
• When standing, keep your feet some distance apart so you have a wider base to ground you.
• When you are sitting at your computer, make sure you have a supportive chair which evenly distributes your weight on your buttocks.
• Get up and move around frequently and avoid sitting for longer than 30 minutes at a time. As your pregnancy advances you will need to adjust your seating position and your chair height.
• Use a low stool to support your feet when you are sitting at your computer.
• Maintain an exercise programme throughout your pregnancy. Walking, swimming, yoga, and aqua aerobics are all excellent forms of antenatal exercise. If you feel the exercise you're used to is causing discomfort, then stop and look for something else.
• It's worth bearing in mind that some exercise options can make pain worse rather than make things better.
• Avoid heaving lifting and repetitive, jarring movements which can lead to muscle strain. Bending forwards and twisting can cause excessive strain to the lower back and pelvic joints.
• If you do need to bend over to pick something up, then squat down rather than bending over. Use the larger, more powerful muscles in your legs to get you down to the floor and then back up again. And hold onto something so you can also use at least one arm for extra assistance.
• Consider wearing a support garment such as a pregnancy girdle, recovery shorts or belly bands/bra. These can help to support the weight of the baby at the front whilst the back panels support the spine and improve posture. Currently there is no research to prove that belly bands are effective but some women still find them helpful.
• Avoid wearing high heeled shoes. These affect correct a walking gait, and tilt the pelvis further forward than its optimal position. Shoes with a low heel and good arch support are ideal.
• Heat or ice packs can be used to help relieve spinal tension. But check first with your maternity care provider which option is best.
• Warm baths and showers with a massaging head can be useful.
• Avoid lying flat on your back when sleeping and resting and try side lying instead. Bending your knees when you're in bed and using a firm, flat pillow or pregnancy support pillow could be very helpful.
• Lying on your left side is better for your own circulation and blood flow to your baby.
• Avoid stretching high up above your head to reach for things which are on upper shelves. Use a stable footstool to bring you up closer to the level you need to be.
• Investigate pregnancy massage, targeted physiotherapy, relaxation and stretching exercise options through a specialist obstetric physiotherapist. Ask about how to do lower back stretches and the correct way to do these without adding extra muscle strain.
• Get as much rest and sleep as you can. When you are sleeping your body is recovering and replenishing its energy stores. Use relaxation techniques to help you go off to sleep if you are having trouble sleeping.
• You may need to review how supportive your mattress is. If it is sagging and not keeping your spine in alignment then it's time to get a new one. Otherwise you could place a firm wooden base board between the underside of the mattress and the bed frame.
• Occasionally pain relieving medication is necessary. But first check with your maternity care provider to make sure these are safe to take during pregnancy.
• Anti inflammatory lotions, creams and gels can also be helpful. But again, check with your maternity care provider to make sure they're safe for you to use.

When to be concerned about lower back pain in pregnancy

• If the back pain continues despite trying lots of strategies to relieve it.
• Increasing levels of pain which are causing you distress.
• If you have other symptoms such as an elevated temperature, vaginal bleeding or feel you may be in early labour.
• Any burning or scalding sensation when you pass urine.
• If you regularly need to take pain relieving medication, or what you have been prescribed is not easing your lower back pain.
• If you are concerned for any reason about your back pain.

Check Hold it Mama The Pelvic Floor & Core Handbook for Pregnancy Birth & Beyond. By Mary O Dwyer RedSok Publishing.