In pregnancy, at some point between morning sickness and labor pains, you’ll more than likely experience another unwelcome guest: back pain. Between 50% and 70% of expectant mothers experience back pain, generally beginning in the second half of pregnancy as changes in body weight and center of gravity put added strain on the spine.
Back pain in pregnancy – often experienced as dull, persistent aches in the lower back – tends to affect younger women and those who had weak backs before pregnancy, or have had multiple pregnancies. For most women, pain occurs in the sacroiliac joint — where the pelvis attaches to the spine. It may begin as stiffness in the morning and then progress to soreness through the day.
Causes of Back Pain in Pregnant Women
There are many possible reasons pregnant women may experience back or spinal pain. Here are some of the more likely causes:
• Weight gain. During a healthy pregnancy, women typically gain between 25 and 35 pounds. This added weight must be supported by the spine, which can result in discomfort in your lower back. Further, the weight of the growing baby and uterus puts pressure on the blood vessels and nerves in the pelvis and back.
• Changes in posture. As your uterus becomes heavier, your center of gravity changes. You may gradually — perhaps 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 produces 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 rectal 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
The good news for most women is that back pain with pregnancy doesn’t last forever. Unless you had chronic backaches before you got pregnant, your pain will likely ease gradually before delivery. In the meantime, there are many things you can do to treat low back pain or reduce its severity or frequency.
• Exercise. Regular exercise will strengthen muscles and increase flexibility, relieving the added stress of pregnancy on your spine. A 2005 study reported in the International Journal of Gynecology and Obstetrics showed that women who exercised three times a week for 12 weeks during the second half of pregnancy had a decrease in severity of low back pain. 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. Talk to your doctor about using applications of heat and cold to relax your muscles and increase blood flow to your painful back. Start with 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 — applying a heating pad or hot water bottle to the back area. Be careful not to apply heat to the abdomen during pregnancy.
• Improving posture. Using proper posture when working, sitting, or sleeping can help relieve pain. 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, to avoid the strain that slouching places on your spine. Wearing a support belt may also be helpful.
• Counseling. If back pain is related to tension caused by emotional problems, talking to a counselor may be helpful.
• Acupuncture. Acupuncture is a form of Chinese medicine in which thin needles are inserted into your skin at certain locations. Recent studies have shown that acupuncture can be effective in relieving low back pain during pregnancy. The way acupuncture works to relieve back pain is not known, but experts suspect it may cause the body to release painkilling substances.
• Chiropractic. Chiropractic is a health care and healing system based on the application of non-invasive treatments and spinal adjustments to alleviate health problems caused by vertebral misalignments affecting bodily function. When performed correctly, chiropractic manipulation of the spine can be safe during pregnancy, but consult with your doctor before seeking chiropractic care.
• Medications. If your pain is not relieved by nonmedication treatments, speak to your doctor about appropriate 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.
Additional steps you can take:
• If you need to pick something up, use your legs to squat rather than bend over.
• Don’t wear high-heeled shoes.
• Don’t sleep on your back.
When to Seek Treatment From a Doctor
Back pain itself usually is not a reason to call your doctor; however, there are some situations where back pain signals a serious problem that requires your doctor’s attention. 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
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. If you are experiencing any of these problems, it’s important to be checked by your doctor immediately.