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The Gist: What is back pain during and after pregnancy?

Also known as: a back spasm or throwing your back out

Back pain, and particularly lower back pain, is very common during and after pregnancy as your body is constantly changing and you are carrying a baby either in your belly or in your arms. It can be experienced anywhere from the upper to the lower back. It is typically caused by tight and overactive muscles or stiffness in the facet joints.

Back pain is often sore and achy in nature but can occasionally become more sharp with certain movements. You may feel stiffness in the spine, which can result in less motion in the mid back and low back. Bending and rotating may be hard and you may feel knots in the muscles along the spine. You may also feel stiff and tight in the muscles of the hips.

The anatomy of back pain

The back consists of 24 (pre sacral) vertebrae separated by discs that articulate with each other to form facet joints. There are 2 facet joints formed between 2 vertebrae, one of the left and one of the right. The joints allow the spine to bend and twist within its limits. There are also muscles that run along the spine to add support and help you move. Back pain is typically caused by tight and overactive muscles or stiffness in the facet joints.

Who gets lower back pain? When does it occur for women?

During pregnancy, the body puts on more mass as the belly and breasts grow. The growing belly causes the pelvis to naturally tilt forward, which results in a larger lordosis, or curve, in the low back. Furthermore, as the breasts and belly get bigger, the center of mass shifts forward. Even after delivery, the center of mass still shifts forward as the breasts are still larger and the baby is often being held in front of the body.

This shift, regardless or whether it's during or after pregnancy, means that the muscles in the core and back have to work harder to maintain balance and posture. When the core is weak and unable to provide adequate support, the muscles in the back can over-activate and go into spasm causing pain. The joints can also become stiffer and cause restrictions and pain with movement.

Back pain can arise anytime during your pregnancy from late first trimester all the way to the end of your pregnancy. Every body and every pregnancy is different. Do not be discouraged if you start to feel discomfort earlier than someone else you know.

The Origin Way: Physical therapy for back pain in pregnancy and postpartum

When assessing the back, we look at everything from the arches in your feel to the way you lift your arms. Because your back and trunk connect your upper body to your lower body, no part can be ignored. We assess the way you move to find the root cause of the problem.

We will treat your back pain comprehensively with manual therapy techniques, a personalized exercise program, and specific movement strategies. These can include modifying the way you stand up, bend, lift and carry. Your Physical Therapist can also help you modify the exercises you already love to do, like yoga or pilates.

You Physical Therapist may also discuss the use of a belt or brace for additional support, particularly as your belly continues to grow during pregnancy.

How long does it take?

Most patients start feeling some relief quickly, particularly if there is one movement that is driving their pain. For example, if your pain gets worse every time you bend and you change the way you bend, you may start feeling better pretty quickly. However, long term changes come with improving your strength and stability, which can take 6-8 weeks.

What to expect in the future

Your Physical Therapist will give you the tools to support your long term health. They will teach you how to best move for your body, strengthen your core and pelvic girdle, and provide strategies for you to use if your pain returns in the future. We want to turn a flare up that would have been 3 weeks into 3 hours by empowering you with the knowledge and skills to handle it.

Additional Reading and Sources

Katonis, P, et al. "Pregnancy-Related Low Back Pain." Hippokratia, LITHOGRAPHIA Antoniadis I.-Psarras Th. G.P., July 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3306025/

Bewyer, Kathryn J, et al. "Pilot Data: Association between Gluteus Medius Weakness and Low Back Pain during Pregnancy." The Iowa Orthopaedic Journal, The University of Iowa, 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2723701/

Ha, Vo Van Anh, et al. "Physical Activity During Pregnancy and Postpartum Low Back Pain: A Prospective Cohort Study in Vietnam." Asia Pacific Journal of Public Health, vol. 31, no. 8, 2019, pp. 701 - 709., doi:10.1177/1010539519890148, https://doi.org/10.1177/1010539519890148

Kesikburun, Serdar, et al. "Musculoskeletal Pain and Symptoms in Pregnancy: a Descriptive Study." Therapeutic Advances in Musculoskeletal Disease, SAGE Publications, 19 Nov. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6262502/

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