Back Pain in PregnancyJan 19, 2022
In part two of our series with physiotherapist and pregnancy/postpartum pelvic health expert Krysta Norwick, Dr. Alicia discusses the very common issue of lower back pain in pregnancy. While it is highly likely to occur to most pregnant people at some point, that doesn’t mean that you can’t do anything to help reduce and/or treat the pain and symptoms! Join us as Krysta and Dr. Alicia discuss the reasons we get back pain in pregnancy and postpartum, symptoms to keep an eye on, and potential treatments!
Reasons for Back Pain
As we shared in previous episodes, shifts in hormonal balances impact our musculoskeletal system - our muscles, tendons, ligaments, and bones! As a result, the way our body moves may shift to compensate for these changes causing us discomfort, much like in other times of hormonal change such as our teenage years or menopausal time.
Sometimes it's a bit difficult to identify if you're experiencing lower back or pelvic pain as your lower back ends where your pelvis starts. Pain can also happen at any stage of pregnancy. Recent research shows that the gestational age of the baby does not impact how severe the lower back pain is - it can happen at different severities at different stages of pregnancy.
Mechanical back pain - due to movement patterns, muscular imbalances, and posture changes which come hand-in-hand with pregnancy - is a common cause, but easily treatable and a care provider or physiotherapist can offer solutions which we discuss more below and on the podcast!
In pregnancy you often get a slow onset of back pain, which you might notice with specific movements such as leaning forward or lifting things, but it is possible for it to come on quickly as well. You might feel a dull, achy pain in your lower back or pelvic area, and you may also feel neurological sensation which might cause numbness or tingling moving down into your muscles or down the leg, all the way to the foot.
In the postpartum period, the symptoms may feel similar, or sometimes if you've had back pain during pregnancy, it may be gone immediately after giving birth. But the pain can also linger, change or come on rapidly because of the major adjustment your body has just gone through as well as the lifestyle changes of caring for baby. Click here to learn about Postpartum Wrist Pain! More severe pain can manifest as a frozen sensation, or weakness in the area. Talk to your primary healthcare provider if you are experiencing either of the above types of pain, or talk with a physiotherapist who can diagnose the origin of the pain and create a treatment plan.
Other types of lower back pain to keep an eye on that may be associated with a more serious issue include:
- Preterm Labour: If you're getting closer to term, around 25-26 weeks or later and are experiencing intermittent but consistent lower back pain every 10 to 15 minutes or so with a minute or two of back pain, this could be a sign of preterm labour. If you’ve rested and the pain has been consistent for over an hour or two, and your stomach feels harder, call your maternity provider.
- Bowel & Bladder Function: If you are experiencing fecal incontinence or you’re unable to urinate in conjunction with lower back pain (or not) in pregnancy, contact your maternity provider urgently! Note that we are not talking about the need to urinate frequently which is rather common and unalarming in pregnancy, but rather the inability to urinate when needed.
- Upper Back Pain: If you are experiencing significant pain starting in your upper back and moving down into your sides and having fevers or chills associated with it, the cause may be a kidney infection or stone, which unfortunately isn’t too uncommon in pregnancy. Again, contact your care provider if that is the case.
A variety of approaches can be taken when easing back pain in pregnancy, so again it is best to consult your primary care physician or a physiotherapist to determine the exact cause of yours:
- Strengthening: Most people know that your core muscles are important for stabilizing your abdomen and supporting your lower back. Strengthening those muscles can ease some of the pain.
- Resting: However, to optimize the function of those muscles, sometimes we need to actually pace our muscles and give them a rest so they can recharge their strength and endurance.
- Releasing: People may tend to assume, especially in the postpartum phase, that their pelvic floor is now weak and they need to strengthen it but this is not actually always the case. Some people's pelvic floor in pregnancy and postpartum is tight or too wrapped up and they need to learn to release it. A hyperactive pelvic floor can manifest as back pain or menstrual cramp type pain.
- Physiotherapy: Having a proper assessment from a physiotherapist can help determine whether strengthening or stretching and releasing is your needed form of support, as mentioned above. Physiotherapists can also help teach you how to position yourself for sleep, supporting and relaxing your body as much as possible when your ligaments are more relaxed in preparation for labor and delivery in late pregnancy.
- Novel Movements: Introducing novel movements is really helpful for lower back and pelvic pain. Moving in a different way than you do normally (for example, walking backwards) can release holding and painful patterns of movement.
- Massage/Chiropractor: Massage can also help reduce pain.
- Wearing a Belt or Band: Wearing a belt or a band around your pelvis to help support your pelvis and your lower back can be really helpful for symptom management, especially nearing the end of your pregnancy it lends a little bit of external support so that you can still do the activities of daily living that you need to do.
- Exercise: There is a lot of evidence that movement throughout pregnancy, even gentle exercise like a walk or swim, is very helpful in decreasing aches and pains through pregnancy, improving the birth experience, and postpartum recovery.
- Education: Chronic or prolonged pain can become an issue when our mental attitude towards it is a negative or defeatist one. Taking some space to use your parasympathetic system - your relaxation system to calm your nerves - is another important piece of the puzzle. Something as simple as deep belly breathing, for example 20 big, deep, breaths, can be an effective pain management tool.
As you can see, treating back pain is a team sport including your maternity care provider, physiotherapy, massage, exercise, mental health experts and you! Do not hesitate to reach out for help, especially if you are experiencing any of the more severe symptoms described above.
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