January 30, 2023
Written by Arash Sayari, MD
Back pain during pregnancy is a common issue that affects many women. This can range from mild discomfort to severe and debilitating pain. Back pain can also worsen as pregnancy progresses. And pain from pregnancy doesn’t just stop at the low back; it can radiate down the legs (as in sciatica), to the pelvis, and even to the sacroiliac joints (SI joints). Unfortunately, we are limited in our treatment options during pregnancy, but it’s helpful to know the causes and potential fixes as your baby grows for 9 months.
Here are some causes and tips for managing back pain during pregnancy:
Weight gain
As a woman's body changes during pregnancy, her center of gravity shifts, which can put strain on her back and result in pain.
Weight gain is normal during pregnancy, and how much a mother gains is multifactorial. Though there are accepted “normal” ranges of weight gain, it generally depends on various environmental and genetic factors. It’s important to visit your OBGYN at your regularly scheduled visits to check your weight and ensure you’re in a healthy range. Maintaining a healthy lifestyle is not only healthy for your baby, but also for minimizing excessive weight gain during pregnancy, which can lead to, and exacerbate low back pain.
Hormonal changes
Pregnancy hormones cause ligaments to relax and loosen, leading to instability in the joints and causing pain.
Estrogen and progesterone are only a few of the hormones that fluctuate from the time of pregnancy to the time of delivery. These hormones strategically prepare the mother’s body for delivery. This includes loosening of various ligaments and soft tissues to allow for a growing baby, but also to allow for a safer delivery. Specifically, the ligaments about the pelvis stretch to allow for a spacious birth canal. Unfortunately, this can result in unnatural movement through the SI joints and muscles of the low back, causing pain and discomfort. It is important to focus on regular stretching and exercise to encourage gradual and less painful movement through these joints. Be sure to discuss safe exercise and stretching techniques with your OBGYN.
Poor posture
As the uterus grows, it can cause the woman to lean forward and alter her posture, leading to back pain.
When you have a baby (or babies!) steadily getting bigger inside your uterus, it shifts your center of gravity and can cause you to hunch over or lean back to balance the extra weight. Atypical biomechanics and asymmetric weight over your spine can increase the risk of discomfort and pain.
Physiological changes
As the uterus expands, it can put pressure on the sciatic nerve, causing sciatica, a type of back pain.
As expected, direct pressure on various nerves will refer pain to your back and legs. Often, this form of pain fully resolves after delivery.
Sleeping position
Sleeping on your back during pregnancy can put pressure on the blood vessels and nerves in your back, causing pain.
Sounds like an easy task, right? Find a happy, and comfortable, way to fall asleep. Of course, it’s easier said than done. Using heating pads, pillows, and wedges can all help with improved sleep posture.
Here are a few other tips to treat back pain during pregnancy
- Exercise: Gentle exercises such as walking, swimming, and prenatal yoga can help improve posture and strengthen the muscles that support the back.
- Good posture: Maintaining good posture when sitting, standing, and sleeping can help relieve pressure on the back.
- Heat therapy: Applying heat to the affected area using a heating pad, hot water bottle, or warm towel can help relieve pain.
- Massage therapy: This is a great excuse to get your significant other to offer a massage to help relax tense muscles and relieve pain.
- Physical therapy: Physical therapy can help improve posture and strengthen the muscles that support the back.
In more severe cases, we often prescribe physical therapy. Obviously, most moms want to avoid taking medication while pregnant, but over-the-counter pain relievers, such as acetaminophen, can be helpful in relieving back pain. Be sure to discuss safe medication options with your OBGYN.
In cases where pain is persistent or worsening, or when there are concerns of nerve damage, we may obtain an MRI to guide our treatment regimen to potentially include spinal nerve blocks and/or epidural injections. Following a safe delivery and recovery from pregnancy, more tailored treatment options, including surgery, can be discussed.
In conclusion, back pain during pregnancy is a common issue, though not always normal. It can be successfully treated, and women should not suffer in silence and should speak with their doctor if they experience severe or persistent back pain.
About Arash Sayari, MD
Dr. Arash Sayari is a fellowship-trained orthopedic spine surgeon focusing on the neck, spine, and low back.
Dr. Sayari completed his residency training in orthopedic surgery at Rush University, a top program based on U.S News & World Report rankings. He then completed a fellowship at the highly-ranked Cedars-Sinai Medical Center in Beverly Hills, CA. There, he trained amongst leaders in orthopedic and neurosurgical spine surgery, learning techniques in minimally invasive spine surgery, robotics, and motion preservation.
