The Do’s and Don’ts of Low Back Pain During Pregnancy

July 15, 2019

By Effie Koustas, MPT

Back pain can be debilitating and annoying for anyone yet happens to ~80% of us. Unfortunately, that doesn’t exclude pregnancy! Roughly 50% of all pregnant women will experience this at some point during their pregnancy. As we know, our bodies WILL drastically change during pregnancy. This includes increased weight gain and ligament laxity, both of which can contribute to low back pain, among other things. Keep reading to find out what you can do to help minimize and/or resolve this uncomfortable pain before it becomes unbearable.


Low back pain can cause hardships and affect our day-to-day living at any point, especially during pregnancy. We do know that It can occur in younger women more frequently and you are prone to low back pain if you have experienced it prior to pregnancy. Pain can range fr

om mild to severe, even affecting our sleep at night. When sleep in interrupted, the body has not had a chance to heal itself, therefore our bodies are still in distress the next day. During pregnancy, our bodies are constantly changing and, if you are in pain, your symptoms may worsen if not addressed immediately.

The good news is that it is not an unusual occurrence with pregnancy and one that physical therapy CAN help with. Several studies show the benefits of exercise during pregnancy, even if you have never exercised before! We will show you what exercises you should or shouldn’t be doing. We will educate you on proper body mechanics and postures throughout your day. Activity modifications, such as avoiding prolonged positions, may also be suggested. Although, there are certain treatments that we can’t use during pregnancy, heat and/or ice is acceptable.

Physical therapy along with other recommendations will help you to better manage your pain so that you feel more in control. Keeping stress to a minimum helps decrease back pain/spasms. As you follow up with your obstetrician, make sure you mention if your back is bothering you. About 25% of women don’t inform their provider, and therefore are left to their own resources to find pain relief. Don’t let that happen to you! Others don’t make the time or effort and think that it will just get better once they deliver their baby. In some cases, this may be true, however you may be causing unnecessary discomfort during your pregnancy and possibly later in life.

“How can physical therapy help?” you wonder. Several ways, despite feeling hopeless until your baby is born. At your first appointment, the initial evaluation, we will ask you all about your symptoms. This includes pain levels, your main complaints, aggravating and alleviating factors, your goals and expectations of physical therapy. Then we will evaluate your posture, range of motion of the affected area (most commonly your low back), assess strength, reflexes, sensation and administer appropriate special tests based on your complaints. This information will help us determine where the cause of pain is coming from and how we can best treat you. This will all be explained to you as well as what you can expect to feel along the way.

The most important tool will be learning is how to engage your transverse abdominis (TrA) muscle, then assessing if you have Diastasis Recti Abdominis (DRA), which is a separation in your rectus abdominis muscle. The rectus muscle, which runs vertically and located mid-stomach, is separated into the “6-pack” formation because it is divided by ligaments. During pregnancy, it is normal for our ligaments to get lax, because of the increased hormones in our bodies, specifically the hormone Relaxin. Therefore, this ligamentous laxity leads to a separation in our abdominal muscles due to the baby growing and putting stress on that muscle. Luckily, with proper training, this separation can be stabilized for the remainder of the pregnancy and even close on its own, without surgical intervention.

Your core is made up of 4 components: your transverse abdominis muscle (mentioned above) in the front, the multifidi in the back, the diaphragm up top and the pelvic floor on the bottom. Each one of these structures plays a very important role in core stability and can be trained effectively. Not only with contracting or firing your TrA to minimize your DRA, but it will simultaneously work with your multifidi to provide low back stability. Proper breathing while exercising will keep your diaphragm appropriately engaged. Lastly, the pelvic floor muscles, which are strained during pregnancy, help to complete the core anatomy.

Breathing is especially important during exercise (Cont. Next Page)and important in avoiding the Valsalva maneuver, also known as holding your breath. When we hold our breath, this forces our abdominal contents to push down and strain our pelvic floor. This, combined with pregnancy, places a great amount of strain on your pelvic floor, potentially creating other problems down the road. Learning how to incorporate breathing into exercise is essential as most tend to hold their breath and/or breathe through their upper chest, vs. deep into their lungs.

Once we have established the foundation of the core principles and isolating the appropriate musculature, we can progress core stabilization to an independent maintenance program at home or in the gym, per patient preference. This will include progressing your program by further challenging your body with incorporating arm and leg movements, all while the core is engaged.

We will then add a flexibility component, as needed. Not only is it important to strengthen your muscles but to also keep a balance between strength and flexibility. Having one is not more important than the other. Lastly, endurance training is the final piece to your workout routine for a well-rounded program. Once you marry all four of these (flexibility, strength, core stability and endurance), you are well on your way to a comprehensive routine that will keep you fit in pregnancy and beyond.


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