Women Ask Wednesday: How do I manage back pain in pregnancy?

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Pregnancy is just hard on your back. There’s just no denying that fact! At 27 weeks of pregnancy, my lower back is feeling all the growing pains. I had lent my support belt out to another mama two years ago…and never got it back. Alas, I ordered one online and eagerly awaited its arrival in the mail. The belt helps the most on the labor and delivery shifts and on days when I’m on my feet…but talking about lower back pain and sciatica pain has been the most common complaint in my clinic visits this past month too.

I thought a deep dive into some back remedies would be a great way to address this Women Ask Wednesday.

Some women have no back pain in pregnancy, some women have a little back pain in pregnancy, and some women are debilitated by their back pain in pregnancy. Literature cites that 2/3 of pregnant women will have back pain and 1/5 will have pelvic pain (Liddle & Pennick, 2015). Sometimes your first pregnancy has almost no back pain, while your subsequent pregnancies have more back pain. No matter where you fall, these are the things I recommend for any expecting mama (or postpartum!).

Stretching

There is nothing that feels so good during pregnancy than stretching. Your body is doing such an amazing job growing and expanding for the baby. But that growing also causes some aches and pains. My favorite exercises are below. I recommend these positions throughout the day for mamas experiencing discomfort, but also right before bed.

ACNM Back Pain handout – Full handout available here!

Exercise

Exercise. This interventions seems counterintuitive to most women in pain but it is often the one intervention that keeps back pain at bay and manageable. A 2015 Cochrane review found that a 8-12 week exercise program significantly reduced back or pelvic pain by 34% but also reduced back pain or pelvic pain sick leave by 24% (Liddle & Pennick, 2015). Interventions from the moderate-quality evidence consisted of exercise, manual therapy (massage/chiropractic care/acupuncture) and education. Overall, exercise offers improvement in pain, reduced need to use sick leave, and improved functionality (Liddle & Pennick, 2015). Exercise doesn’t have to be training for a marathon or doing Cross Fit in pregnancy. A 30 minute walk or some gentle yoga for 20 minutes is beneficial as well. If you don’t currently exercise at all, start with a small 10 minute walk around the block and slowly increase the time of your walk to 30-60 minutes. You’ll see improvements in sleep, energy and pain almost immediately!

Proper position changes

I didn’t even know I was changing positions so inappropriately until I went to pelvic floor therapy after my second baby was born. My physical therapist was very gentle and basically summed up most of my habits as “mom habits.” I learned that basic movements I used to pick up my kids or objects off the floor were terrible for my back and pelvic floor. The big take-aways I learned were these: use your legs/or a lunge to get up off the floor or pick things up from the floor – not your back; perform Kegels when standing up from the floor or sitting to help support your pelvic floor; and sit in chairs properly (make sure your back is actually against the supporting part of the chair). The Cleveland Clinic has a lovely summary with pictures of other recommendations for posture and movement during pregnancy here. If you want to read more my experience with physical therapy, read here!

Support belt

Pregnancy support belts are great for mamas that are on their feet a lot or just have a lot of dull back aching at the end of the day. The normal lordosis of pregnancy (a backward tit of your sacrum) causes discomfort for most women. Support belts offer additional support to your lower back while helping to evenly distribute the pressure and weight of the gravid uterus across your pelvis. There are many support belts to choose from on the market – unless you are a runner or you are struggling with pelvic floor prolapse, most mamas will find a $25 support belt does the trick. I recommend support belts as early as 16 weeks as they can help with round ligament pain as well. And they are a must for any hospital workers or shift workers.

Epsom salt soaks

Epsom salts are the an old remedy that provide many, many benefits in pregnancy. Sore, achy backs can be eased by the magnesium in the salts and used throughout all trimesters of pregnancy, as well as postpartum. Plus, Dr. Teal has every delicious scent of aromatherapy you could imagine on the market – a double win for relaxation and self care. Read more about epsom salts here!

Physical therapy

Occasionally, a mama will try all of the above interventions and their back pain continues to be debilitating. For those mamas, a course of physical therapy during the pregnancy is almost always indicated. Physical therapy is often centered on identifying the source of weakness or issue that is causing discomfort or pain, and then working towards a long term home plan to help prevent or lessen the pain. Women that present at 10 to 12 weeks with a history of back pain or back trauma (from a car accident, fall, assault, etc.) or have struggled with pelvic floor strength since their last birth are great candidates to attend physical therapy during their pregnancies. If you think you might benefit from physical therapy, ask your provider!

Massage

Massage is another old remedy for back pain and pregnancy aches. Prenatal massage offers a release of tense muscles while offering relaxation. Massage during pregnancy is a little more limited depending on your gestation, but most therapists are willing to work around positions that are uncomfortable for you or areas that are causing you more discomfort than others. The pandemic may limit prenatal massage abilities in your area but don’t count this intervention out!

Chiropractor

Chiropractor care is another intervention to try for back pain and is the third sought intervention after massage and yoga (Borggren, 2007). Evidence for chiropractic care in pregnancy is somewhat lacking but the overall thought is there is very little harm to the interventions; the average time to relief from chiropractic care is about 4.5 days with an average of 1.8 visits needed (Borggren, 2007). Some practices are incorporating a chiropractor into routine obstetric care – something that I think is a great idea – but most people will have to pay out of pocket for their care. I have patients that swear by their adjustments throughout pregnancy. Some patients go weekly and some monthly – but if you’re this far down the list and looking for a solution, call around to your community and see what is available from your local practitioners. Still unsure if chiropractic care is for you? Check out a blog post on back pain from the American Chiropractor Association.

TENS unit

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A TENS (transcutaneous electrical nerve stimulation) unit is another intervention to consider if traditional methods have proved ineffective for back pain. TENS units tend to be more popular in certain parts of the United States than others. When I trained in Denver, women would come into triage in labor with TENS units on their lower backs to help manage their pain. Another place they tend to see more popularity is the United Kingdom. The National Health Service has a great brochure explaining a TENS unit and how to use them. General.y, you can purchase a unit online for less than $50.

Heat or cold

Just like a pulled muscle, heat or cold can do wonders for some back discomfort. Choose which is more relieving to you and try short courses of 15-20min applied to the area of discomfort. I personally like the neck rice socks that people use for sore necks for pregnancy aches. The curve of the rice sock makes it easy for pregnant women to use on their lower back, lower bellies, or upper bellies than a traditional heating pad.

Lastly…grace!

Remember that your body is doing an amazing thing. All that growing and changing happens in support of a growing baby! Try these interventions and see which ones work for you.

I also added a new “Back Pain” section to the RESOURCES page as well if you want to see all the resources in one place.

Happy Wednesday!

Jamie


References

Borggren, C. (2007). Pregnancy and chiropractic: A narrative review of the literature. Journal of Chiropractic Medicine, 6, 70-74. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647084/pdf/main.pdf

Liddle, S., & Pennick, V. (2015). Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database of Systematic Reviews, 9. https://doi-org.frontier.idm.oclc.org/10.1002/14651858.CD001139.pub4

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