What causes low back pain in pregnancy ? 

By Dr Isabella Clark – Osteopath in the Sydney CBD

How common is low back pain in pregnancy?

Pregnancy related low back pain and pelvic pain is a common complaint that occurs in 60-70% of pregnancies, however most women will experience symptoms and pain at some point throughout their pregnancy. 

Why is low back pain so common in pregnancy?

Source: physiopedia

During pregnancy, the enlarging uterus changes the load and body mechanics. It’s shifts the centre of gravity forwards, increasing the stress on the lower back. Postural changes can be used to balance the anterior shift possibly causing a hyper-lordosis, which increases the mechanical strain on the lower back. It also puts an extra stress on the intervertebral disc, possibly causing a decreased height an overall compression of the spine. Furthermore, on average, women gain around 11-15 kgs, this extra weight gain exaggerates the lumbar lordosis, increasing the stress on the lower back. 

The abdominal muscles also stretch to accommodate the expanding uterus. As they stretch, the muscles become tired and lose their ability to maintain normal body posture, causing the lower back to support the majority of the increased weight of the torso. 

Without a doubt hormones play a huge part in the musculoskeletal changes that take place.  A significant portion of women first experience pain during the first trimester of pregnancy. At this point mechanical changes do not yet play a significant role in the onset of pain, as the ‘bump’ is still undetectable.  This suggests that hormonal changes during pregnancy can cause inflammation and pain in the back. It has been suggested that the hormone relaxin increases 10 times in concentration during pregnancy, softening the collagen and causes ligamentous laxity and as a result discomfort. The sacroiliac ligaments, but also other ligaments who surround the pelvic girdle become loose. This causes a decrease in the stability and brings on a potential strain in the pelvic girdle and lower back. 

What to do for low back pain during pregnancy?

During pregnancy our bodies generally very responsive to change. Even the smallest of measures can make a great difference. 

Here are a few ergonomic changes to try, which will help reduce some of the acute pain:

  1. Keeping your knees together as you roll over in bed, or getting in and out of the car
  2. Learning to engage your glutes and hamstrings to help with the discomfort of things like standing from sitting, or walking up stairs
  3. Mobilising your mid-back, to help gain some extra movement up higher to take the load off from down below
  4. Avoiding high heels
  5. Sleeping with a body pillow which supports both your belly and can also sit between your legs
Source: The Pillow

Finally, manual therapy may be effective in managing your lower back and pain, not only in terms of releasing tight muscles, or mobilising joints,  but also in prescribing rehabilitation exercises and providing advice that are specific to your condition.

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