Preventing Back Pain During Pregnancy

Four million American women will successfully give birth this year. The bad news is that two out of every three of these women will suffer lower back and pelvis pain by the 36th week of pregnancy. The good news is that the vast majority of these symptoms resolve three months after delivery, and taking some simple steps to protect your back while pregnant can significantly decrease symptoms and perhaps even prevent back pain altogether.

Why does pregnancy cause low back pain? The answer is twofold. First, as the fetus grows, a woman's abdominal wall stretches to accommodate the expanding womb, and the extra room needed for this has to come from somewhere. Because the abdominal muscles are stretched far beyond their normal state during pregnancy, they lose their ability to perform their normal role in maintaining body posture and as a result, the lower back takes on an abnormal amount of weight from the torso.

The hormone relaxin is the second explanation for low back pain. During pregnancy, the hormone relaxin is present in 10 times its normal concentration in the female body. Relaxin is good in the sense that its function — as you might guess from the name — is to relax the joints in the pelvis so the baby has room to pass through the birth canal. Unfortunately, relaxin also causes abnormal motion in many other joints of the body, causing inflammation and pain. Fortunately, there are a couple of simple strategies that can help minimize the pain:

  • Reduce your physical activities. If possible, minimize certain activities that maximally stress the lower back and pelvis. These activities include standing on one leg, climbing stairs, walking long distances and standing for long periods of time.

  • Maximize your vocational ergonomics. Take many short breaks, try to lie down, and educate yourself on structural fitness, i.e, body ergonomics, to avoid low back stress. Also, avoid lifting anything over several pounds.

  • Strengthen your back muscles. You can strengthen the back muscles safely during pregnancy as long as there is no weight from the torso compressing the pelvis. There are three simple exercises you can try. Prior to exercising, ask your doctor if he or she thinks these exercises are appropriate for you. Remember that the goal is not to become the next Miss Bodybuilder U.S.A., but rather to gently exercise your muscles to avoid lower back and pelvic pain.

    • Exercise 1: Get on your hands and knees as if you are going to scrub a floor. Lift your right arm up to the sky, so that it is level with your back, and at the same time, lift your left leg as high as you can, but no higher than the level of your hips. Hold this balancing posture for a second, without compressing your lower back. Do the same thing with the left arm and right leg. Keep alternating for 10 to 15 repetitions. This exercise helps strengthen the abdominal, shoulder and gluteal muscles. Please note: Make sure nobody can see you because they may laugh!

    • Exercise 2: Get on your hands and knees again, aligning your wrists and your elbows under your shoulders and your knees under your hips. Inhale slowly and as you exhale, arch your back like an angry alley cat so that your body makes a convex C-shape. Hold the arch for a couple of seconds and repeat 10 to 15 times. This will help strengthen lower back and abdominal muscles.

    • Exercise 3: Lie on your back and perform mini-situps, keeping your knees bent to reduce the stress on your back. Lift your head and torso six inches from the ground and hold it for a second. Repeat this 10 to 15 times. This will help strengthen the lower back. Be careful not to pull up on your head as you lift as this would strain your neck. You have enough to deal with, without adding neck pain to the mix!

    • Exercise 4: This is the same as Exercise No. 3, but add a twist by drawing your right elbow toward your left knee, and vice versa, while lifting. This will help to strengthen the oblique muscles of the abdomen.
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Use common sense when performing any exercise regimen. If you experience any abdominal discomfort or any other abnormal symptoms while performing the exercises, stop immediately and call your doctor. You should also call your doctor if you have any of the following problems:

  • Severe pain: the mechanical pain of pregnancy should always resolve with rest.

  • Pain radiating down the leg into the foot with weakness in the leg: This may be the sign of a herniated disc causing nerve compression. This does occur in rare cases during pregnancy and can be painful. Spinal surgery during pregnancy is possible, but with obvious risks.

Knowledge and prevention are a woman's best ally during pregnancy, especially when experiencing pregnancy-induced back pain.

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Spiro Antoniades, M.D., is an orthopaedic and spine surgeon practicing in Baltimore, Md. For more information visit the Web site for the Maryland Spine Center.