Pregnancy related lower back pain

We recently celebrated our daughters first birthday and with a few mums there and mothers to be we had a chat about back pain (as often it seems to happen as a physio).  It turns out that each of the women in the group had back pain and half had some since their children were born.  Their question was is this normal?

My first response is "what is normal?" and then my second reply was "maybe not normal but very common" (which is what I think they were getting at.  Studies tell us that back painof some sort during pregnancy happens in about 50% of women so if you are expecting a child and have back pain you are certainly not alone.

So what causes it?  

To answer this we usually break it down into three main types.Pelvis pain in the first trimesterIn the first 3 months there hasnt been much weight gain and no large changes that would place additional mechanical stress on the lower back.  However there are hormonal changes (the hormone relaxin is usually blamed) which has been associated with changes in the tension of ligaments around the pelvis and lower back.  Particularly if it is pain around the pelvis, pain in the first trimester could be due to these changes.Lower back painPain a bit higher upin the back in the second or third trimesters is usually associated with either ongoing changes from the pelvis (that may may have started due to hormonal changes) or mechanical changes such as weight gain, postural changes, shifting in the centre of gravity and weakening and fatigue of the abdominal muscles due to being stretched.  All these can place a larger load on parts of the spine and lead to pain.So what can you do about your pregnancy related low back pain?Well the first step is trying to understand the cause and where the pain is to devise an effective strategy.  Based on this there are a number of things that work.

• Physiotherapy or chiropractic can be very effective in managing lower back symptoms.  Treatment can be modified to suit but a lot of the techniques used with back pain in non-pregnant individuals work well for pregnancy related back pain.
• Pregnancy belt.  This is a particular type of belt used to help stabilise the pelvis.  In some cases and particularly in the last few weeks) the belt might be one of the only things that can work.
• Exercise.  Maintaining good muscle control in the back and abdominals as well as leg and arm strength will guard against the effects of abdominal weakening as well as minimise the effect of compensatory postures.  Studies have shown that a 12 weeks strengthening program will reduce lower back pain during pregnancy.
• Education on posture and uses of cushions, sitting positions and modifying tasks to reduce pressure on the lower back is important.  We try to impart this information early on to reduce the chances of lower back pain developing.

All in all back pain is common but treatment can work to reduce and manage lower back pain in most women during pregnancy and beyond.