Expert / 5 October, 2022 / Dr Stefaan Vossen
Although women often experience aches and pains during pregnancy – pelvic pain and back pain during pregnancy are the most common – these pregnancy symptoms are usually seen as unavoidable inconveniences that you just have to ‘put up with’. However, there are lots of reasons why you shouldn’t just put up with pain and discomfort, and why looking after your back is essential to your pregnancy, labour, and postpartum recovery.
When one of my long-standing patients (who is also a para-athlete) was pregnant we spoke about how pregnancy and birth would be an equal, if not bigger, challenge than any athletic event she had taken part in, but that she had far less support to prepare for it. You’d never set out to complete a marathon without undertaking a training plan, yet we somehow expect women to go through pregnancy, birth, and recovery with minimal physical preparation or ‘training’!
It can be helpful to approach pregnancy, birth and postpartum like training for a very specific series of athletic events!
Women are often scare-mongered into reducing their movement and physical activity during pregnancy and postpartum for fear of hurting themselves or their baby. In most cases, this is not only unnecessary but unhelpful. Back pain and other common pregnancy aches and pains are more likely to persist if you become overly worried about your back or overprotect your back by limiting movement, exercise and activity. Having a strong and supple back is not only protective against back pain and other pains (like pelvic pain) during pregnancy; it can also help you prepare for a better birth experience and postnatal recovery.
Firstly, be reassured that if you experience back pain during pregnancy and postpartum it’s unlikely to indicate anything serious. Most back pain arises from sensitisation of the pelvic and back structures, not from identifiable tissue damage (although that can sometimes be the case and should be identified early for the best recovery plan).
Many of the ways you can care for your back during pregnancy are the same as at any other time, including:
If you’re worried about safe movements take a class with a therapist (physio or sports therapist) or try antenatal yoga or pilates. If you find relaxation difficult it’s safe and beneficial to try treatments like pregnancy massage (usually from the 2nd trimester), dry needling/acupuncture, chiropractic or osteopathy.
There’s usually no need to stop your usual physical activity, especially in the early stages of pregnancy. Exercise is beneficial for your body and mind and can ease many pregnancy symptoms.
Build your confidence in your back and your body by keeping fit and strong. With the medicalisation of pregnancy and birth it can feel like this is happening ‘to’ you rather than ‘through’ you. If you keep doing your normal activities, educate yourself about your rapidly changing body and get personalised support to keep your body strong and supple, you’ll approach the later stages of pregnancy and birth feeling more empowered and comfortable.
A lot of focus is put on ‘good’ posture and positions for sitting and sleeping. As you go through pregnancy and beyond, your centre of gravity and activities are constantly changing. This means that what is a ‘good’ posture for you one day might not be the next! In terms of back pain, the evidence shows that rather than good or bad posture being a problem, what matters is for you to move and change your posture often so as to vary the loading behaviour and minimise fatigue and the discomfort that comes with that.
Healthy sleeping habits and a good pregnancy sleep wedge, eating a balanced diet and aiming for a healthy body weight throughout your pregnancy, and keeping well hydrated are all beneficial for your back as well as your baby.
You may experience general aches and pains due to hormonal changes, fatigue, and nausea.
Although it’s not ruled out, many therapists avoid hands-on treatment in the first trimester. This is not because it’s riskier, more because you might worry that it is during this early period. You can still be prescribed stretches and given self-care advice. If you haven’t been following an exercise plan before your pregnancy it’s not a good idea to take up a high-impact fitness plan, but it is a good idea to start building your core strength and mobility with low-impact exercises and stretches.
As your centre of gravity changes and your baby grows you may start to experience lower back pain, symphysis pubis dysfunction or pelvic girdle pain. Your body is releasing a hormone called relaxin which “relaxes” the joints in your body ready for growth changes and birth. If your muscles aren’t strong enough to stabilise these joints, this can cause pain. This may be worse in second or subsequent pregnancies as your abdominal and pelvic muscles may be weaker.
Exercises and stretches to strengthen and mobilise these muscles can help with pain now and prepare you for labour. For reassurance that your exercise technique is safe and beneficial consider seeing a clinician – like a physio or chiropractor – who can prescribe exercises and also offer hands-on treatments if required.
As your baby bump grows, your centre of gravity is constantly moving forwards which causes strain on your back and pelvis and sometimes causes pain around the front of your pelvis. You may also get sciatica type pain down your leg. To make room for your little one, your organs are also put under a lot of pressure. Depending on your baby’s position and pressure in your tummy, it is quite common to get mid-back and rib tightness, abdominal discomfort or even shortness of breath.
Chiropractors are skilled in providing safe relief during this stage. Chiropractors can also assess the alignment of your spine and pelvis which can cause discomfort in pregnancy, due to your change in centre of gravity and ligament laxity. Keeping up with pelvic and spinal health is proven to shorten labour times and reduce the need for interventions during birth. Treatment is safe and adapted specifically for your body, to help soothe any pain you may be experiencing.
Your postpartum back care needs will depend on what your pregnancy and birth experience have been. Your body is still very much in a state of flux, and you’ll also be adjusting to completely new daily activities. Women can experience a range of back pain and other musculoskeletal symptoms in this period. These symptoms can be made worse by frequent feeding posture (whether bottle or breast), disturbed sleep, forgetting to eat and drink at regular intervals, and if you’re experiencing postpartum depression.
It’s safe and beneficial to seek early postnatal advice for yourself and your baby from an experienced antenatal practitioner – like an osteopath, chiropractor or a physio who offers ‘Mummy MOTs’. While your symptoms may be ‘normal’ in this recovery and adjustment period that doesn’t mean you just have to ‘put up’ with them. Getting expert personalised advice will reassure and empower you or, in the rare situation where your pain is indicating a more concerning problem, you’ll get help sooner which will enable you to recover more quickly and fully.
Women often worry about hurting their backs by doing too much too soon after pregnancy. If you follow guidelines about resuming activity after birth, c-section, or episiotomy, this should be more than adequate for your back. Like you, your back is stronger than you think! Even during this early postpartum period gentle movement and stretches are still beneficial. Think of this as an invaluable post-marathon cool-down and recovery!
For more detailed advice about pregnancy and postnatal wellbeing including how to look after your back and trimester-specific exercises and stretches, download your free eBook at https://coreclinics.co.uk/resources/
Article by Dr Stefaan Vossen (chiropractor) is Clinical Director at Core Clinics.
Disclaimer: The content of the above article is intended to give general information and does not constitute medical advice. You should always consult a suitably-qualified and experienced healthcare professional about any health or wellbeing concerns.