POSSIBLE CAUSES: As you become more and more pregnant (bigger and bigger!) your enlarging uterus shifts your posture and tends to weaken your abdominal muscles putting strain on your back. also, the expanding uterus may press on nerves in your pelvis causing back pain. Furthermore the extra weight you’re carrying in pregnancy means more work for your muscles and more stress on your joints. All this adds up which is why back ache affects 75% of pregnant women and is usually worse at the end of pregnancy. It may persist after the baby arrives, but usually goes away in a few months.
HORMONE CHANGES during pregnancy loosen joints and ligaments that connect your spine to your pelvic bones contributing to discomfort and making you feel less stable. This discomfort may be worse when you walk, stand, sit for long periods, change position in bed, rise from a chair or the tub, bend over, or lift things.
ACTIVITIES THAT WORSEN: Sitting or standing for long periods of time and lifting usually make it worse, and it tends to be more intense at the end of the day. It may be triggered by activities such as walking, climbing stairs, getting in and out of a tub or a low chair, rolling over in bed, or twisting and lifting. High heels worsen the pain (please switch to running shoes) . Positions in which you’re bent at the waist – such as sitting in a chair and leaning forward while working at a desk – may make back pain worse.
COULD IT BE SCIATICA? True sciatica, which can be caused by a herniated or bulging disk in the lower part of the spine, affects only about 1 percent of pregnant women. If you have sciatica, your leg pain will usually be more severe than your back pain. You’re likely to feel it below the knee as well, and it may even radiate to your foot and toes. And you’ll probably feel a tingling, pins-and-needles sensation in your legs or possibly some numbness. With severe sciatica, you may have numbness in your groin or genital area as well. You may even find that it’s hard to urinate or have a bowel movement. If you think you have sciatica, call us immediately if you feel a loss of sensation or weakness in one or both legs or a loss of sensation in your groin, bladder, or anus (which may make it hard to pee or have a bowel movement, or – alternatively – cause incontinence). We would refer you elsewhere for appropriate treatment (this is outside our training or competence).
WHO IS MOST LIKELY TO BE HAVE BACK PAIN: Not surprisingly, you are fare more likely to have low back pain if you’ve had it before, either before pregnancy or with a prior pregnancy. You are at clearly higher risk if you’ve lead a very sedentary lifestyle (sit alot) and have poor flexibility and weak muscles in your back and abdomen. Carrying twins markedly increases your chances of sufferring with an aching back. Being markedly overweight is another factor contributing to low back pain during pregnancy, but research results do not all agree on this.
WHAT TO DO?
Exercise – You may feel more like curling up in bed than exercising if your back hurts, but don’t take to your bed for long periods. Bed rest is generally not helpful in the long run for low back pain and may even make you feel worse. In fact, exercise may be just what you need.
Check with your caregiver before beginning an exercise program, though, because there are some situations in which you may have to limit exercise or forgo it altogether. Then, consider:
Strengthening exercises to help build the muscles that support your back and legs, including your abdominal muscles.
Stretching exercises to help the muscles that support the back and legs become more flexible. Be careful to stretch gently, because stretching too quickly or too much can put further strain on your joints, which have been made looser by pregnancy. Prenatal yoga is one good way to stay limber, and it can help improve your balance, too.
Swimming is a great exercise option for pregnant women because it strengthens your abdominal and lower back muscles, and the buoyancy of the water takes the strain off your joints and ligaments. Consider signing up for a prenatal water exercise class, if one is available in your community. These can be very relaxing, and there’s research suggesting that water exercise may decrease the intensity of back pain during pregnancy.
Walking is another option to consider. It’s low impact and easy to make part of your daily routine.
Low Back Pain – try doing pelvic tilts, which can ease back pain by stretching your muscles and, over time, strengthening them as well. Here’s how: Get on your hands and knees, arms shoulder-width apart and knees hip-width apart. Keep your arms straight, but don’t lock the elbows. Tuck your buttocks under and round your back as you breathe in. Relax your back into a neutral position as you breathe out. Repeat at your own pace.
BE CAREFUL – Whether you’re an athlete or a newcomer to exercise, listen to your body and don’t do anything that hurts. Finally, watch for warning signs that you may be overdoing things or developing a problem that needs medical attention.
BE AWARE OF POSITIONING AND PROPER BODY MECHANICS:
Stand up straight. This gets harder to do as your body changes, but try to keep your bottom tucked in and your shoulders back. Pregnant women tend to slump their shoulders and arch their back as their belly grows, which puts more strain on the spine.
Sit up straight (especially if you sit a lot during the day) Supporting your feet with a footstool can help prevent or reduce low back pain. Consider using a small pillow called a lumbar roll behind your lower back. Take frequent breaks from sitting. Get up and walk around at least every hour or so.
Avoid standing for too long. If you need to stand all day, try to take a midday break and rest lying on your side while supporting your upper leg and abdomen with pillows.
Be aware of anything that makes the pain worse. If you have low back pain, try to avoid or limit activities like stair climbing, for example. Stay away from any exercise that requires extreme movements of your hips or spine.
Wear comfortable shoes and avoid high heels. As your belly grows and your balance shifts, high heels will make your posture even worse and increase your chances of stumbling and falling.
Always bend from your knees and lift things from a crouching position to minimize the stress on your back. Pregnancy is NOT the time to risk throwing your back out. Get someone else lift the heavy things and reach for things high on a shelf. Avoid excessive twisting movements. Skip activities like mopping and vacuuming that make you have to bend and twist at the same time. If there’s no one else to help with these chores, move your whole body at once rather than twisting to get to out-of-the-way spots. Divide up the weight of things you have to carry. Carrying one shopping bag in each hand is better than the uneven stress of carrying one larger, heavier bag.
Get out of bed carefully: Bend your legs at the knees and hips when you roll over to your side. Use use your arms to help push yourself up as you relax your lower legs over the side of the bed.
To get a better night’s rest, try sleeping on your side with a pillow between your knees. Near the end of pregnancy, use another pillow or wedge to support your abdomen.
TREAT YOURSELF WELL: Taking steps to ease soreness and tension and generally taking good care of yourself is wise. At least your likely to feel better temporarily. Take the time to experiment with the following measures:
Learn relaxation techniques to help you cope with the discomfort and may be very useful at bedtime if your back pain makes it hard to get to sleep.
Try heat or cold. There’s some evidence that heat may provide a bit of short-term relief. Try soaking in a warm (not hot) tub, which can also help you relax. Or place a hot water bottle (or hot pack) on your lower back. Although there’s no hard evidence that cold helps, applying a cold pack is easy to do and worth a try if heat doesn’t work for you. Whether you use heat or cold, cover the pack or bottle with a thin cloth to protect your skin.
Treat yourself to a massage by a therapist trained in prenatal massage – it may provide some relief. If your insurance doesn’t cover therapeutic massage, get your partner or a friend to give you a gentle backrub – it will not cure you, but it might help you relax. (Most insurance companies don’t cover massage, though a referral might help. It’s worth looking into.)
Maternity Support Belt – may be helpful (www.bellybandit.com) the bamboo style.
Physical Therapy – may help and they can teach you exercises to do on your own to prevent later episodes of low back pain
Chiropractic care may be helpful – though research that’s specific to pregnancy-related back pain is scant.
Physician (MD) care – specialist referral – often limited by restrictons imposed by pregnancy
Acupuncture may help – reduce the intensity of back pain during pregnancy.
CALL OR GO TO EMERGENCY ROOM if:
Your back pain is severe, constant, or getting progressively worse, or if it’s caused by trauma or accompanied by a fever.
You’ve lost feeling in one or both legs, or you suddenly feel uncoordinated or weak.
You have a loss of sensation in your buttocks, groin, genital area, or your bladder or anus, which may make it hard to pee or have a bowel movement, or, alternatively, cause incontinence.
You have low back pain in the late second or third trimester. This can be a sign of preterm labor, particularly if you haven’t had back pain before that.
You have pain in your lower back or in your side just under your ribs, on one or both sides. This can be a sign of a kidney infection, especially if you have a fever, nausea, or blood in your urine.