This article includes expert medical input from Origin pelvic floor physical therapist Ashley Rawlins, PT, DPT.
Aches and pains happen so often in pregnancy, they can seem almost inevitable — like there is some tipping point in the latter half of your second trimester when feeling good is no longer an option. And yet, while it's extremely common to have aches and pains in your body during pregnancy, it isn't actually 'normal' — and you don't have to just "push through it."
Yes, the tremendous amount of change that your body goes through in pregnancy does increase your risk for strain in your body and injury, but it doesn’t mean you have to suffer in silence as your body shape shifts to grow a human. You CAN be pain-free in pregnancy with the help of a physical therapist, who can help you understand what's happening in your body and make adjustments to stay strong and comfortable.
Read on for insight into how pregnancy changes your skeletal structure, the most common pregnancy aches and pains, and some expert tips that will help you move and sleep without pain.
Musculoskeletal Changes in Pregnancy
As you know all too well by now, your body morphs dramatically during pregnancy. Beyond your growing belly and breasts, there is far more change going on that can impact every bone, joint, muscle, nerve, and ligament, including all of the following.
Your rib cage expands.
You'll probably have to buy a bigger bra, and not just because your body is preparing for lactation by upping your cup size. Under the influence of pregnancy hormones, the ligaments that support the joints in your ribcage soften, allowing your ribs to expand.
This rib expansion helps you breathe as your baby gets bigger and your uterus begins to push up on your diaphragm and lower ribs. Pressure on your diaphragm (the main breathing muscle) combined with reduced flexibility in your abdominals (which are stretching to fit your baby), forces you to breathe less into your belly and more into your ribs and chest.
Your pelvic joints widen.
Pregnancy hormones also cause your pelvic ligaments to soften. This is super helpful to allow your pelvic joints to move and open for childbirth, but it can also put excess strain onto the pelvic ligaments and muscles, as well as irritate sensitive joint surfaces in your pelvis. The result can be pain in your low back or pubic symphysis. On average, the birthing person’s pubic symphysis will increase by 3.7 mm.
Your entire posture shifts.
And how could it not? With your growing belly and breasts pulling your posture forward, your center of gravity shifts from the middle to the front of your feet. To keep you upright, the curves in your lower and upper back increase, and your pelvis tilts forward. These adjustments can put added strain on many different areas of your body.
Your abdominal muscles separate.
As your baby and uterus grow, your abdominal muscles and connective tissues are stretched and lengthened. At the center of your abdominals is the connective tissue known as the linea alba, the line that separates the right and left sides of your abdominals (see a diagram here). This connective tissue will thin and stretch during your pregnancy, causing what is known as diastasis rectus abdominis (aka diastasis recti or ab separation).
Your nerves get irritated.
When you take into account all of these body changes, and then add in fluid retention (swelling), and compression from growing areas of your body (your growing abdominals and breast or chest tissue, for example) it's common for nerves in your hips and arms to become compressed, strained, and irritated.
The Most Common Pregnancy Aches & Pains
Every pregnant body is different, which is why some people will have minimal aches and pains during pregnancy, while others will find themselves struggling to walk from their bed to the bathroom. Here are a few of the ways that pain can show up in your body:
Pregnancy Lower back pain
With a growing belly and breasts, along with posture changes, and increased strain on your joints and nerves (hello sciatica!), pregnancy commonly leads to persistent lower back pain. As the muscles in your hips and core become less efficient, your back has to work harder which can lead to all sorts of muscle spasms and stiff, painful movements. Pain in the low back and pelvic area is seen in 72% of people during pregnancy.
Pregnancy Hip pain
Hip pain typically starts in the middle of the second trimester of pregnancy, due to the growing uterus and widening pelvis as the body changes to prepare to give birth. This change to the pelvis causes extra strain and tightness in the muscles, tendons, and ligaments attached to the hip.
PRegnancy Sciatica pain
The sharp, shooting, tingling pain down your buttocks and leg, known as Sciatica, is common in pregnancy for a number of reasons. The changes in your posture and fluid retention can place mechanical pressure on this large nerve, especially if you were already prone to this kind of pain before pregnancy.
Another common cause of this pain is the piriformis muscle. The pirifomis ordinarily sits comfortably along the path to the sciatic nerve, but in pregnancy the changes in your posture and mechanics can cause this muscle to spasm and tighten, leading to nerve irritation.
Pregnancy Pelvic pain
Changes in your weight, pelvis, and the way you move during pregnancy can cause pain to develop in one or more of your three pelvic joints (the right sacroiliac joint, the left sacroiliac joint, and the pubic symphysis joint). Because the pelvic girdle supports so many actions like balance and load transfer, we are prone to use and abuse these joints on a daily basis. It’s no wonder that up to 70% of people experience some amount of pelvic girdle pain by late pregnancy.
Pelvic girdle pain is a general term used to describe pain in any of the joints in the pelvis, and includes symphysis pubis dysfunction and sacroiliac joint dysfunction. Because your pelvis forms a ring of bones, strain and injury in one area of the ring will often affect other areas, so pain in more than one joint is very common.
Pregnancy Tailbone Pain (coccydynia)
Posture shifts can also lead to tailbone pain (coccydynia). Your tailbone/coccyx sits at the bottom of your pelvis and is largely supported by ligaments and the muscles of your pelvic floor. When your posture shifts, more pressure and force is shifted to your coccyx, causing your muscles to work overtime to help stabilize it. This leaves your tailbone vulnerable to pain, especially when sitting.
PRegnancy Rib pain
As the ribs expand and flare during pregnancy it can cause rib pain and strain in the joints. The growing pressure on the joints may be caused by hormonal changes, a kicking baby, abdominal pain brought on by a cough or sneeze, and more.
Pregnancy Neck and shoulder pain
In addition to strain from the posture changes in your upper back that were already mentioned, growth in your belly and breasts/chest causes your muscles to work double overtime to support your posture and added weight of growing life. This overcompensation can lead to all sorts of neck and shoulder pain.
6 Ways to Ease Pregnancy Aches & Pains
If you're reading this, you're probably already in pain and looking for fast relief. We've got you! Below are some things you can do right now to help prevent and reduce pregnancy pain in your hips, back, and pelvis.
#1 Keep your hips even.
- Activities such as standing with your weight shifted to the side, lunging, riding a bike or elliptical, vacuuming or sitting with your legs crossed can place a lot of uneven strain on your pelvic joints. If you can’t avoid some of these tasks, aim to keep your hips in alignment, as much as possible.
- Imagine that the front of your hip bones have headlights on them. When vacuuming, doing yoga, or when reaching down to pick something up, you want these headlights to be facing forward.
#2 Go up and down stairs sideways.
To go up the stairs:
- Stand sideways with your non-painful (or least painful) side facing up the stairs
- Using the railing or the wall for support, step up with your non-painful/least painful side first, and then bring your other side to meet it. Continue stepping up first with your “good” side.
To go down the stairs:
- Stand sideways with your painful/most painful side facing down the stairs.
- Use the wall or railing for support
- Step down with your most painful side, and then move the other side to meet it.
- Continue progressing down the stairs sideways by first stepping with your painful side.
3# Rest your back while standing.
Try putting one of your feet up on a small step stool, or open a cabinet below, and place your foot on the floor in the cabinet. Then switch to the other foot every 5-10 minutes.
#4 Get in and out of the car with care.
- Start by putting all your items into the backseat or trunk.
- Open your car door, and turn your back to the seat so that you are facing out of the car, and back up so that the back of your legs are touching the seat.
- Tighten your abdomen and pelvic floor muscles (as if hugging your baby with your muscles) as you reach your buttocks back to sit down.
- While still facing out, scoot back to the middle of the seat.
- While keeping your legs "zipped together" from your ankles to your inner thighs, tighten the muscles in your stomach and pelvic floor again. Pivot your body and bring your legs into the car at the same time, as a unit. If this is painful, you can also help to lift your leg into the car, using your arms, as shown.
- Use the same technique to get out of the car, instead of moving one leg out at a time as this will strain your pelvis.
#5 Roll like a log to get in and out of bed.
- Start by sitting on the edge of the bed (about at the middle), and inhale as you prepare to move.
- Exhale and gently squeeze your abdominal and pelvic muscles as you lean sideways onto the elbow of the arm that is closest to your pillow. At the same time, bring your legs up onto the bed keeping your knees slightly bent.
- Next, you'll roll from your side to your back by rolling like a log.
- Keep your knees together and your abdominals and pelvic floor tightened while you roll like a log onto your back — your hips, shoulders, and knees should move as a unit all at the same time.
- Do the same technique, but in reverse when you are getting out of bed.
#6 Sleep with support.
Your side is typically the best position to sleep throughout your pregnancy, particularly on your left side as this allows for the best circulation. Try the adjustments below to support your body while you sleep:
- Starting at your neck, make sure that your pillow isn’t too high. You want your head to be in line with your body, not tilted up or down. In general, one medium-thin pillow is enough. A folded towel can be added to achieve the best height (two pillows tend to be too high).
- To support your upper body and shoulders, rest your top arm on a pillow.
- Support your legs and hips by placing a long pillow or two between your knees — it should be long enough to also support your ankles, so that your hips, knees, and ankles are in alignment.
- Add a small folded towel under your waist, between the bottom of your ribs and top of your hips.
Don't Wait to Get Treatment for Pregnancy Pain
While having — or even reading about— pregnancy pain can be daunting, it's important to know that there are evidence-based, effective treatment options available. Origin physical therapists specialize in pregnancy and know how to help you fight inflammation, create strength and balance in your body, and heal your pain so that you can enjoy all the miracle work your body is doing.
Your PT can also help you prepare for childbirth by teaching you breathing and pushing techniques and explaining how to condition your pelvic floor to help prevent a severe perineal tear and support postpartum healing. While it's never too late in pregnancy to see a pelvic floor physical therapist, the earlier you start, the better!