Are you pregnant and experiencing back pain?
Back pain can be debilitating, especially during pregnancy when your treatment and medical options are more limited. The pain tends to get worse as pregnancy progresses and as the baby grows
But the good news is there are some ways to relieve it, and — if you start early enough — also some ways to prevent it altogether.
- How Common is Back Pain During Pregnancy?
- When Does Pregnancy-Related Back Pain Occur?
- What Causes Back Pain During Pregnancy?
- Risk Factors for Back Pain During Pregnancy
- Pregnancy Back Pain Symptoms
- Does Back Pain Feel Different from Back Labor?
- How to Prevent Back Pain During Pregnancy
- 13 Tips to Relieve Your Achy Back
How Common is Back Pain During Pregnancy?
Back pain is incredibly common during pregnancy, in fact, it affects more than two-thirds of pregnant women (1) and is experienced in varying degrees of severity by most expectant women.
Though most women experience some level of general discomfort during pregnancy, 50 to 70 percent of women specifically report struggling with back pain during pregnancy.
When Does Pregnancy-Related Back Pain Occur?
While most people associate back pain with the end of pregnancy thanks to the bulging belly and extra weight, it can occur at any point — even before you’ve even put on a pound.
Back pain occurring before pregnancy is not pregnancy-related back pain. If the woman already has back pain prior to pregnancy that causes a higher chance of her having pregnancy-related back pain as well.
Editor's Note:Dr. Njoud Jweihan, MD
Here’s what you can expect at different points in your pregnancy:
First Trimester Back Pain
Early in your pregnancy, your uterus is just gearing up. Changing levels of hormones, specifically increasing levels of the hormone progesterone which is the hormone that maintains the pregnancy cause ligaments in the pelvic region to loosen a bit which results in your muscles adjusting leading to instability of your joints and this can result in back pain as your body shifts.
It’s also common to experience cramping during early pregnancy, which can often be (or associated with) lower back pain. Although pregnancy is known as a happy event, stress levels can increase during this time and present as physical symptoms such as fatigue, anxiety, and muscle pain commonly presenting as back pain.
Second Trimester Back Pain
Second-trimester back pain typically occurs during the latter half of this trimester, after 20 weeks Just to keep in mind, this can be a bit confusing due to the fact that mothers come in different shapes and sizes.
Patients who I have seen that are already overweight during pregnancy can have second trimester back pain even before 20 weeks. By this time, you’ve likely gained enough weight that it’s starting to put stress on your body, resulting in back pain.
Third Trimester Back Pain
Your third trimester is when lower back pain may be the worst. Your belly is heavier, putting considerably more stress on your back and your center of gravity shifts to the front of your body as baby grows and you will find yourself leaning backwards for relief. However, by continuing to lean backwards, you are adding strain on your lower back. Your body is preparing for labor and your joints are loosening, resulting in subtle posture shifts that can have a big effect.
You may also be more sedentary due to fatigue, and as your baby gets larger and runs out of room to move in your womb, it will put direct pressure on your abdominal muscles that help stabilize the spine and support the back depending on their positioning.
What Causes Back Pain During Pregnancy?
There are many reasons for back pain during pregnancy, including:
1. Weight Gain
As your baby grows, you gain weight. Your body is not accustomed to supporting this added weight, resulting in lower back pain. 25-30 pounds is the suggested amount of weight gain during pregnancy. Gaining extra weight can increase back pain even further.
2. Weakened Abdominal Muscles
Your primary support comes from your core muscles, which include your abdominal muscles, pelvic floor muscles, and back muscles. Weakening in one area of your core results in additional pressure and instability on the other parts of it.
As your belly grows, your abdominal muscles stretch — and can even separate. This is a condition called diastasis recti. Some women will even see a small bulge in the abdominal region when this occurs (2).
3. Loose Joints
During pregnancy, your body prepares for labor by producing a hormone called relaxin a hormone known to prevent contractions in early pregnancy. Later in pregnancy, relaxin is the hormone responsible for softening the cervix and expansion of the pelvic canal, getting your body ready for delivery. This helps loosen your pelvic joint, allowing it to open during labor for your baby to pass through. Unfortunately, though, relaxin affects all the ligaments that stabilize the spine, causing them to become loose and resulting in subtle posture shifts and muscle strain.
This may be another cause of your lower back pain, particularly the joints at the base of the spine, also known as the sacroiliac joints.
4. Poor Posture
With the added weight on your frame along with a shift in your center of gravity, your posture is likely to change during pregnancy. You will find yourself facing forward and try to counter that by leaning backward. This results in back pain because poor posture puts a strain on ligaments that are not accustomed to carrying the load.
5. Baby Positioning
Sometimes your baby may put direct pressure on your spine or a nerve, resulting in discomfort. For instance, increased back pain will result if the baby is positioned posteriorly, specifically occiput posterior when the baby is facing the mother’s abdomen and the baby’s head adds pressure to the mother’s sacrum.
6. Labor Pains
Sometimes contractions are felt in the lower back. Contractions feel different for every woman, but are often described as radiating pain or severe menstrual cramps. If you are having pain that builds up and then subsides at regular intervals, it could be contractions.
Although what is assumed to be contractions can be only practice contractions known as Braxton hicks which tend to be sporadic, If this occurs prior to 37 weeks of pregnancy, contact your doctor immediately.
7. Kidney Problems
Kidney stones are relatively rare in pregnancy, but physiological changes that occur in your body during this time do elevate your risk of developing them (3).
The same is true of kidney infections — while they don’t occur in every woman, pregnancy causes increased pressure on the bladder and urinary tract, increasing the risk of urinary tract infections (UTI). Untreated UTIs can result in a kidney infection known as pyelonephritis and that tends to be more serious in times of pregnancy.
Both kidney stones and kidney infections can cause severe back pain in pregnant women.
Risk Factors for Back Pain During Pregnancy
Back pain is incredibly common, but some risk factors do increase your chance of experiencing it (4).
Some of these risk factors are:
- Previous experience with back pain before pregnancy.
- Back pain during a previous pregnancy.
- Weak abdominal muscles.
- Low flexibility.
- Sedentary lifestyle.
- Carrying multiples.
- Gaining more weight than recommended.
Pregnancy Back Pain Symptoms
Back pain during pregnancy feels different for every woman, and also depends on the cause of her pain.
Back pain during pregnancy may feel like:
- A dull ache.
- Discomfort on one side or the other.
- Radiating pain.
- Pain in the center of the lower back.
- A deep ache in the buttocks.
- Pain that extends through the thighs and legs.
While sharp pains can certainly happen during pregnancy, this type of pain is much less common. Sharp back pain that shoots down the legs can also be related to nerve pain or a more serious condition. It is best to consult your doctor or healthcare provider immediately if you are experiencing sharp pains.
Does Back Pain Feel Different from Back Labor?
It can be difficult to differentiate between pregnancy-related back pain and labor pains you feel in your back. However, there are a few ways to distinguish the two.
1. Back Pain is Constant
Back pain is typically constant and achy. While the severity of it might wax and wane, it doesn’t come and go predictably. Labor pains occur at regular intervals with a severe intensity that usually does not ease up.
2. Back Pain Can Be Relieved
Usually, you can find some way to relieve back pain — whether it’s by changing positions, putting your feet up, or having your partner rub your lower back. If you’re experiencing labor, these methods will not resolve your pain — only the ending of the contraction will cause it to subside.
3. Back Pain Has a Trigger
While not always the case, you can often identify what you were doing earlier in the day that may have triggered back pain. You may have been on your feet for too long, slept poorly, or lifted something that resulted in a muscle tear. Labor pains tend to come on without a specific trigger, whereas back pain is a chronic condition.
4. Back Pain Is Not Accompanied By Abdominal Tightness
When you’re in labor, the uterus is contracting. Though you may feel it in your back, the contractions wrap around from the front. If you are experiencing contractions and back labor, you may notice your belly tightening at regular intervals along with your back pain.
Regular back pain is not accompanied by abdominal tightness.
While these tips may help you distinguish between regular back pain and early labor signs, be advised that once labor progresses, if you experience true “back labor” it may feel very different. During your period of hard labor — as opposed to early labor — back pain may not let up like regular contractions, and you may feel a constant pain if you are experiencing back labor (5).
Keep This Statistic In Mind
How to Prevent Back Pain During Pregnancy
Back pain is common during pregnancy, but that doesn’t mean there aren’t some things you can do to try and prevent it from occurring.
1. Choose Sensible Footwear
You’re not the first person to refuse to give up their heels during pregnancy, but believe me when I say that an ounce of prevention is worth a pound of cure. Even if you’re not currently experiencing back pain, swapping out your footwear can help you to keep your back muscles happier than they would be in your stilettos.
2. Exercise Regularly
Exercise and stretching are some of the best things you can do for yourself while you’re pregnant. It has numerous physical benefits, one of them being that it can help stave off back pain.
The good news is your exercise doesn’t even have to be vigorous to make a big difference. Even a 20-minute walk once a day can have huge benefits. Simply moving your body will help to strengthen your muscles and may allow you to keep back pain at bay.
Unless otherwise advised by your doctor, continue your exercise routine all the way through to the conclusion of your pregnancy — modifying as necessary, of course. Muscles can atrophy quickly, and if you’re accustomed to working out regularly but then cease to do so in the final weeks, you may notice back pain appear that you’d previously managed to keep at bay.
3. Strengthen Your Back Muscles
Since your back is at risk, it makes sense to strengthen it. Starting early in your pregnancy, engage in light weight-lifting exercises that can help to strengthen your lower back.
Some examples are:
- Deadlifts: Stand with your feet hip-width apart, knees slightly bent. Using light weights or even none at all, bend at your waist and allow your hands to hang toward the floor. Keep your core and pelvic floor tight, and maintain full control as you bend down and come back up. Deadlifts are also used by serious weightlifting competitors and are often done with heavy weights. If you are pregnant, remember to use light weights to avoid injury — it doesn’t take much to strengthen your lower back. You’re just trying to avoid back pain — not win a weightlifting competition!
- Arm and leg lifts: Get on all fours on the floor. Slowly extend one leg back and then up, maintaining full control the whole time. If you are able, lift the opposite arm and point it straight out. However, if you feel uncomfortable or if you are not able to maintain your balance, omit the arms or do them separately.
4. Strengthen Your Abdominal Muscles
Sit-ups aren’t exactly a pregnancy-friendly exercise. To strengthen your abdominal muscles, do the following exercises a few days a week. Remember that lightweight is recommended, and you should never push yourself too hard during pregnancy.
Simply using and moving your muscles will help to strengthen them sufficiently.
- Abdominal twists: Place your feet hip-width apart. Bend your knees so you are in a half-squat. Do not squat too deeply, and if you feel any discomfort, make your squat more shallow. Holding a lightweight in each hand against your chest, twist at the waist from side to side. Do not wildly swing your body, but instead maintain control and squeeze your abdominal muscles as you twist back and forth.
- Upper cuts: Standing again in a partial-squat position with light weights, make an upper-cut punching motion while twisting slightly at the waist. Keep your abs tight. You can also do this exercise without weights.
- Knee lifts: Stand up with your hands on your hips. Raise your knee in a slow and controlled motion, making sure you are lifting with your abdominals. If you can do so comfortably, crunch forward slightly as your knee comes up to work your abs harder. If you have trouble with balance, you can do this exercise while standing against a wall.
Remember to always consult with your doctor before attempting these exercises and make sure you do not have any risk factors that could prevent you from performing these exercises.
Sometimes no matter what you do to avoid it, you will still develop back pain during pregnancy. Remember that your body is under a great deal of stress by growing a baby, and it may be unavoidable. But if you do develop back pain, there are some things you can do to try and relieve it.
13 Tips to Relieve Your Achy Back
If you’re currently experiencing pregnancy-related back pain, here are some things you can do to try and relieve it.
- Incorporate light exercise: Use it or lose it, mama. If you haven’t been exercising but are starting to experience discomfort, you might be surprised by what a difference starting a light exercise and stretching routine can make. Don’t go crazy, but start doing things that are both relaxing and enjoyable to you, like walking or swimming.
- Choose supportive footwear: If you’re still wearing your pre-pregnancy shoes, your back pain might be signaling it’s time to stop. Opt for shoes with good arch support — and ones that don’t tie, since soon your feet will be out of reach.
- Get a massage: A prenatal massage can do wonders for you — just make sure the practitioner you choose has been specially trained in pregnancy massage. And check with your insurance — since this is often considered part of medical treatment during pregnancy, they might even cover the cost if you get a prescription from your obstetrician.
- Put your feet up: When you sit with your feet flat on the floor, it can pull at the muscles in your lower back. If you sit at work, bring a stool in to raise your feet slightly, and if you’re lounging at home on the couch, just kick those puppies up and relax.
- Take a warm bath: There’s a reason why birthing tubs are popular in hospitals and birthing centers — because water can be a magical, all-natural pain reliever. Soaking in a tub is perfectly safe, as long as you keep the water below 100 degrees.
- Alternate hot and cold: Just as if you had a sports injury, alternating heat and cold can help reduce inflammation in your muscles and then help them relax. Always start with a cold pack, and then use a heating pad for no more than 10 minutes at a time on medium or low heat. Always remember never to sleep with a heating pad while pregnant, and never use a heating pad on your belly. Always check the ingredients that are included in the heating or cooling pads and if they pregnancy safe.
- Wear a maternity belt: A maternity belt helps to support your belly and takes some of the pressure off your back. They can either be worn under your clothes or on the outside of your outfit. They’re admittedly not the cutest invention, but they sure are effective!
- Improve your posture: It’s easy to start slouching — either while sitting or standing — as your belly gets heavier. Try to be mindful of your posture and correct it when it’s out of whack. This will take pressure off of your lower back and also help strengthen your core muscles.
- Use a pregnancy pillow: Put a pregnancy pillow between your knees to keep your thighs parallel while you sleep. If you don’t, your legs can pull down on your hips which can cause lower back pain. The pregnancy pillow can also help position you properly, keeping you off of your back while you sleep.
- Use a tennis ball: No, you’re not playing tennis — unless you want to. Have your partner press and roll a tennis ball into your lower back where you feel the most intense discomfort.
- Lift safely: If you’ve constantly got back pain, you might need to make some lifestyle modifications to get through daily life. When you pick things up, squat rather than bend over. As you are standing from squatting position do not put pressure on your abdominal muscles, instead, put your elbow and forearm on your knees and use your arm strength to stand back up. This will help keep the pressure off of your lower back.
- Visit a chiropractor: Chiropractic adjustments are safe during pregnancy when they are performed correctly. Speak with your doctor if you’re interested in visiting a chiropractor and ask them for a referral so you know you’re seeing someone trustworthy and trained in pregnancy chiropractic.
I have worked with a good chiropractor who was skilled in chiropractic during pregnancy so I know how helpful this can be. They won’t do anything drastic but can straighten out the joints in your spine that, when slightly out of balance, can contribute to low back pain in pregnancy.
Editor's Note:Dr. Njoud Jweihan, MD
- Take medication: If these pain relief methods don’t work, acetaminophen — the kind of medication in Tylenol — is the go-to pain reliever that’s used during pregnancy. Overuse, however, has been linked to liver damage so try to use it sparingly. Always communicate with your doctor about the frequency and dosage they feel is appropriate for use during pregnancy. Make sure to stay away from “muscle rub” products during pregnancy. They usually contain aspirin, which is not recommended for use during pregnancy.