Managing Pregnancy Low Back Pain

About half of all pregnant women will develop low back pain at some point during their pregnancy, making it the most common pregnancy pain (Artal, 1992). We define low back pain as pain in the lumbar area only. Pain felt beneath this (in the posterior pelvic region) is actually more likely Sacroiliac Joint Pain, and should be managed differently.  While low back pain is unfortunately quite common, the good news is there is a lot you can do to help your clients minimize pain, or prevent it altogether.  Read on for the key causes of low back pain, and some effective strategies to help address it with your clients.

What Causes Low Back Pain?

  • Alignment Shifts: The growing belly often pulls the pelvis forward into an anterior pelvic tilt, which puts excess pressure on the low back. The greater the weight gain (or belly size), the greater the alignment shift, and potential pain.
  • Effects of Relaxin: Relaxin is the hormone that increases throughout pregnancy.  It softens a woman’s joints, ligaments, and connective tissue to allow her body to adapt to her growing baby, and to provide added mobility for birth.  The downside is that it increases flexibility and decreases stability, especially in the pelvic region.  This decreased stability places even greater pressure on her lower back.
  • Weak Deep Core & Glutes: These muscles help support and stabilize the spine.  If they are underactive (as they tend to be in many individuals), the lower back takes even more pressure.
  • Fatigue/Exhaustion: This can lead to a lack of energy to sit tall and watch posture (slouching places more pressure on the low back) or exercise properly.

How to Help Prevent or Manage

  • Coach her into neutral alignment: Help her counteract the anterior pelvic tilt.  Learn how to help your clients find their own neutral alignment and ensure she stays in neutral as much as possible throughout her day.  Focus on strengthening her deep core and glutes and training her to use them properly during movement.
  • Reinforce proper SEATED alignment: Recall sitting is one of the activities people typically display the worst alignment in. Slouching, sitting cross legged, or sitting on one knee can wreak havoc on pelvic alignment and put a great deal of strain on the lower back. Encourage your clients to sit up tall – being careful not to over-correct and flare their ribs.  Bottom of rib cage should be in line with top of hip bones. If this position is too difficult for your client to maintain throughout her work day, encourage her to get some sort of back support so she can still maintain neutral.  Or, better yet, encourage her to get up and take frequent “moving” breaks.
  • Reinforce proper BENDING OVER alignment: Remember that bending over is the other activity people commonly display very poor alignment in. Teach her to bend properly by hinging at her hips and maintaining neutral spine vs. rounding forward (during her workouts and daily life).  Make sure she masters the Ground Pickup and uses this form every time in her daily life!
  • Strengthen her Core Canister and Glutes: When these muscles are strong, and properly functioning, they release pressure from the lower back. Remember to have her master 360° Breathing first to properly activate the Core Canister, and ensure she incorporates this into all her movements.
  • Encourage proper footwear: The more she can wear supportive shoes (sneakers) with good cushion, the better! Even if she cannot wear sneakers to work, encourage her to do so on her commute if she walks a lot.  Women should avoid high heels and no heels, as both these put a lot of added strain on the back.
  • Avoid putting added strain on her back during exercise: During the later stages of pregnancy, be careful with bent over movements due to the added weight of her belly. You may need to offer regressions like Single Arm Supported Reverse Flyes, and the same approach for movements like standing bent over rows.
  • Consider gentle stretches or massage: Gentle stretches (like Cat/Cow or Cradle Rocking) can also provide some temporary relief for mild pain. If pain becomes bothersome, a massage (from a prenatal certified masseuse) can typically provide some temporary relief.  Though remember, these are just temporary fixes, and the pain will return if the underlying issues of alignment and weak core/glutes are not addressed.

Learn how to help prevent and manage many other pregnancy and postpartum pains and injuries at one of our Certification Workshops.

Sources:

Artal, R. (1992). “Exercise and pregnancy.” Clinics in Sports Medicine, 11, 2.
Core Concepts. “Pregnancy related low back pain.” http://www.coreconcepts.com.sg/condition/pregnancy-related-low-back-pain/