Back pain during pregnancy

Managing Back Pain During Your Pregnancy

Along with morning sickness, food cravings and weight gain, back pain can be a common complaint during pregnancy. There are a few things you can do, however, to prevent pregnancy-related back pain or manage your discomfort once it starts.

If you're pregnant and your back hurts, please talk with your doctor.

Preparing for a baby's birth can be an exciting time. But as any woman with a dog-eared copy of What to Expect When You're Expecting knows, a certain amount of physical discomfort is normal during pregnancy and, well, to be expected. Back pain is a common complaint in the months leading up to delivery, especially during the final trimester, but there are a few things you can do to manage your back pain so that you can keep the focus on what's most important — getting ready to welcome your new baby!

It's Not Just You...

According to the American Academy of Physical Medicine and Rehabilitation, more than 50% of pregnant women report low back pain at some point during their term; some studies have found the incidence to be as high as 70%. "The incidence of low back pain in pregnant women is well over double the incidence of back pain in those who are not pregnant in the same age group," says orthopaedic surgeon John G. Peters, MD, medical director of Medtronic, Inc., the world's leading spinal device company.

According to the American Pregnancy Association, women most frequently report low back pain later in their pregnancies, as the baby grows larger and heavier; however, some women also start feeling low back pain early in their term. Women who may be most at risk for developing back pain during their pregnancies are those who are overweight (though studies are inconclusive on this), or who experienced back pain prior to becoming pregnant. Women who lack flexibility and strength in their back and abdominal muscles and those carrying more than one baby also may be more susceptible.

Why Does My Back Hurt?

There are a number of reasons you can develop back pain during pregnancy. "It's a multifactorial issue," Dr. Peters says. "Hormonal alterations in soft tissue and even bone tissue play a part, along with changes in weight, spinal alignment, and activity level."

The hormones that are released during pregnancy allow joints and ligaments in the pelvic area to become more pliant and loose, in preparation for the birthing process, Dr. Peters explains. The downside of this softening is that it can affect the natural support your back normally receives, particularly as the weight of your baby increases.

A growing baby also causes your center of gravity to shift. Abdominal muscles stretch and weaken, making it more difficult to maintain good posture and further challenging your natural spinal alignment. "In the third trimester, for example, the forward flexion of the hips brings the pelvis and sacrum forward as well, contributing to a 'swayback' effect in the lumbar spine," Dr. Peters says. "Increasing breast tissue can also accentuate this shift in spinal realignment. Some of these tissue and mechanical alignment alterations are good for the body, in order to distribute weight gain to the middle of the body where, structurally, it's the strongest. But in a woman whose structure is weak where stress is magnified, low back pain can be the result."

Common patterns of pregnancy-related back pain include pain in the lower back, or lumbar spine, and pain that feels like it's centered even lower in the body, in the back, or posterior, of the pelvic area. If pressure is placed on the sciatic nerve or presses on a spinal disc, pain may extend through the hips, buttocks and legs.

How Can I Prevent Back Pain During My Pregnancy?

To optimize your chances of keeping back pain at bay, there are a variety of preventive measures you can take:

First, maintain a reasonable activity level and — under your doctor's supervision — incorporate exercises that gently stretch and strengthen your back and abdominal muscles. "Keep moving!" advises Dr. Peters. "The ability and motivation to remain active is very important during this time."
If you spend your days behind a desk, take advantage of opportunities to get up and stretch your legs — and back — while getting your work done. "Don't stay at your desk," Dr. Peters says. "Early in your pregnancy, discuss with your employer the ways in which you might be able to use a little more autonomy in how you carry out your job, if at all possible."
Maintaining good posture as your body changes is also important. As your center of gravity shifts forward, minimize the strain on your lower back by standing as straight as possible, keeping your shoulders back and your buttocks tucked under. When sitting, keep your feet slightly elevated, if possible. Choose a chair that supports your back — use a small pillow if necessary — and change positions frequently.
Be mindful of body mechanics. If you need to pick something up, don't bend over and lift using your back. Instead, squat using your knees, keeping your back straight as you lift. Avoid positions that require bending or twisting. Listen to your body — if something hurts, don't do it!
Don't be a slave to fashion. If you're hooked on high-heeled shoes, kick the addiction — at least for a few months. Cute "sensible shoes" do exist — just look for low heels and good arch support. Your clothing can also be back-friendly — look for maternity pants with a low, supportive waistband. Later in your pregnancy, you may want to use a support belt under your lower abdomen.
It may seem like the impossible dream at this point in your life, but do try to get a sufficient amount of sleep. Practice relaxation techniques, and keep stress to a minimum. Sleep on your side rather than your back, keeping your knees bent. Place pillows around your abdomen for support, if needed.

Easing Back Pain Once It Starts

If you are experiencing pregnancy-related back pain, consult with your doctor and follow his or her suggestions as to what's right for you. In addition to the above preventive measures, commonly prescribed therapies for easing pregnancy-related back pain can include:

Hot or cold therapy, in the form of a warm bath, a hot water bottle, or an ice pack.
Physical therapy specifically designed to address the needs of your changing body as your pregnancy progresses.
Anti-inflammatory/analgesic medications, as recommended by your doctor. Acetaminophen has been shown to be safe for pregnant women; others, including aspirin and ibuprofen, are not.
Complementary treatments such as chiropractic care, massage therapy, and acupuncture. Although these therapies have not been proven effective for treating low back pain, they may provide some relief for pregnancy-related discomfort, and perhaps some stress relief as well. Consult with your doctor first, however, to ensure there is no underlying spinal condition causing the pain.

"Women dealing with low back pain during their pregnancies do have options," Dr. Peters says. "But please, do not pursue a treatment therapy without the approval of your obstetrician."

Call Your Doctor Immediately If...

You're experiencing dull, cramping low back pain, as this could be a sign of preterm labor.
Your back pain is severe, starts suddenly, or is accompanied by fever.
You experience back pain as well as vaginal spotting or bleeding.
You develop numbness or weakness in your legs, buttocks, groin, or genital area.

Dr. John G. Peters is medical director of Medtronic, Inc. and recently was a practicing orthopaedic surgeon with Orthopaedic Spine Center, PC, in Indianapolis, Indiana.

Compiled also using information from the following sources:
Back pain during pregnancy resource page. American Pregnancy Association Web site. Available at www.americanpregnancy.org/pregnancyhealth/backpain.html. Accessed January 8, 2009.
Back pain during pregnancy resource page. American Academy of Physical Medicine and Rehabilitation Web site. Available at www.aapmr.org/condtreat/pain/pregnancy_lowback.htm. Accessed January 8, 2009.