Pregnancy and Back Pain
Greg Stemkowski MS, PT, CSCS, PES
Procore Physical Therapy P.C.
One of the negative side effects of pregnancy is low back pain (LBP). Although I will never experience this type of LBP, I have intimate second hand knowledge from my wife. We have two boys that were over 10lbs at birth and have caused my wife a lot of LOP, especially in the final trimester of her pregnancy. The causes of LBP due to pregnancy are usually related to hormone changes, physical changes, and can occur during late pregnancy with functional activities.
During pregnancy, mom's hormones change to accommodate the growth and development of the baby. Relaxin is a hormone that is released that has the effect of relaxing the joints and ligaments of the female body. This will allow the fetus to grow within the womb and eventually be delivered. An unwanted side effect of relaxin is increased joint mobility, which allows for abnormal motion and function in joints. The sacroiliac joint, a nearly fused joint of the low back, becomes loose during pregnancy and can be a source of LBP.
Obvious physical changes to the mother during pregnancy can also result in LBP. These changes include expansion of the abdomen and enlargement of the breasts. These changes result in a fundamental change in the mothers posture. The low back arch, called lordosis, increases and the upper back curve, called kyphosis, becomes more pronounced resulting in a "sway back" posture. This posture compresses the low back muscles and joints while stretching the abdominal muscles making them inefficient in supporting the back. The upper spine hunches forward due to the added size and weight of the breast causing the upper back muscles become stretched and weak. Over time, the progressing weight of the baby results in increased pain of the low back.
As the mother nears birth and the baby is at its largest, the size of the abdomen will often cause the mother to become off balance. Simple tasks of daily living become more challenging and can make the mother more prone to low back strains.
The following are helpful ideas that could benefit a mother with LBP. Because the joints are more mobile during pregnancy and new stress is placed on her body due to altered weight distribution, it is increasing important that she maintain good spine alignment during activities of daily living. Even weight distribution upon both feet will avoid overloading the pelvis. A neutral spine position refers to a spine that is neither extended nor flattened, but in a position that allows the muscles to work optimally to support the spine. It is a position that can be achieved by drawing-in the abdomen and squeezing the buttock cheeks together. It is usually the position of most comfort.
A neutral spine position should be maintained at all times, especially with activities of daily living. A few tips on maintaining a neutral spine can be very helpful in limiting LBP when completing everyday activities. When standing for extended periods of time, place one foot up on a stool. This will help support the abdomen and rotate the pelvis backward, taking pressure off the spine. Squat or kneel with a straight back instead of bending to pick up objects from the floor. This will prevent over use and fatigue of the low back muscles and possible low back strains. If lifting is required, squatting is better than bending in preventing low back pain and/or strain. Frequent rest breaks to allow the low back musculature to recover from daily activities is also a good way to limit LBP. If moms LBP becomes too intense or does not relieve with rest and support, she should seek the council of her doctor. These tips may not relieve all LBP but hopefully they will give a new expecting mother some relief from the burden of pregnancy.