Pregnancy: Back pain during pregnancy

What's causing my back pain?

Back pain during pregnancy is a common complaint — and it's no wonder. Most pregnant women experience back pain, usually starting in the second half of pregnancy. You're gaining weight, your center of gravity changes and your hormones are relaxing the ligaments in your pelvis. Often, however, you can prevent or ease back pain during pregnancy. Consider seven ways to give pregnancy back pain the boot.

You can probably blame your growing uterus and hormonal changes for your aching back. Your expanding uterus shifts your center of gravity and stretches out and weakens your abdominal muscles, changing your posture and putting strain on your back. It may also cause back pain if it's pressing on a nerve. In addition, the extra weight you're carrying means more work for your muscles and increased stress on your joints, which is why your back may feel worse at the end of the day.

There are many possible reasons why back pain happens. Here are other more likely causes:

Weight gain . During a healthy pregnancy, women typically gain between 25 and 35 pounds. The spine has to support that weight. That can cause lower back pain. The weight of the growing baby and uterus also puts pressure on the blood vessels and nerves in the pelvis and back.
Posture changes. Pregnancy shifts your center of gravity. As a result, you may gradually -- even without noticing -- begin to adjust your posture and the way you move. This may result in back pain or strain.
Muscle separation. As the uterus expands, two parallel sheets of muscles (the rectal abdominis muscles), which run from the rib cage to the pubic bone, may separate along the center seam. This separation may worsen back pain.
Stress . Emotional stress can cause muscle tension in the back, which may be felt as back pain or back spasms. You may find that you experience an increase in back pain during stressful periods of your pregnancy.
Hormone changes. During pregnancy, your body makes a hormone called relaxin that allows ligaments in the pelvic area to relax and the joints to become looser in preparation for the birth process. The same hormone can cause ligaments that support the spine to loosen, leading to instability and pain.

Treatments for Back Pain in Pregnancy

More good news: Unless you had chronic backaches before you got pregnant, your pain will likely ease gradually before you give birth.
Meanwhile, there are many things you can do to treat low back pain or make it rarer and milder:

Exercise . Regular exercise strengthens muscles and boosts flexibility. That can ease the stress on your spine. Safe exercises for most pregnant women include walking, swimming , and stationary cycling. Your doctor or physical therapist can recommend exercises to strengthen your back and abdomen.
Heat and Cold . Applying heat and cold to your back may help. If your health care provider agrees, start by putting cold compresses (such as a bag of ice or frozen vegetables wrapped in a towel) on the painful area for up to 20 minutes several times a day. After two or three days, switch to heat -- put a heating pad or hot water bottle on the painful area. Be careful not to apply heat to your abdomen during pregnancy.
Improve your posture. Slouching strains your spine. So using proper posture when working, sitting, or sleeping is a good move. For example, sleeping on your side with a pillow between the knees will take stress off your back. When sitting at a desk, place a rolled-up towel behind your back for support; rest your feet on a stack of books or stool and sit up straight, with your shoulders back. Wearing a support belt may also help.
Counseling. If back pain is related to stress, talking to a trusted friend or counselor may be helpful.
Acupuncture . Acupuncture is a form of Chinese medicine in which thin needles are inserted into your skin at certain locations. Studies have shown that acupuncture can be effective in relieving low back pain during pregnancy. Check with your health care provider if you're interested in trying it.
Chiropractic. When performed correctly, chiropractic manipulation of the spine can be safe during pregnancy, but consult with your doctor before seeking chiropractic care.
Keep these principles of good posture in mind: Stand up straight and tall, Hold your chest high, Keep your shoulders back and relaxed, Don't lock your knees, When you stand, use a comfortably wide stance for the best support. If you must stand for long periods of time, rest one foot on a low step stool — and take time for frequent breaks. Good posture also means sitting with care. Choose a chair that supports your back, or place a small pillow behind your lower back. Consider propping your feet on a low stool.
When lifting a small object, squat down and lift with your legs. Don't bend at the waist or lift with your back. It's also important to know your limits. Ask for help if you need it.
Don't wear high-heeled shoes.
Don't sleep on your back. Sleep on your side. Keep one or both knees bent. Consider using pregnancy or support pillows between your bent knees, under your abdomen and behind your back.
Physical activity.
Regular physical activity can keep your back strong and might actually relieve back pain during pregnancy. Bed rest is generally not helpful in the long run for back pain and may even make you feel worse. In fact, Physical activity may be just what you need such as: Strengthening, stretching, it could help the muscles that support the back and legs become more flexible. Be careful to stretch gently, because stretching too quickly or too much can put further strain on your joints, which have been made looser by pregnancy.Prenatal yoga is one good way to stay limber, and it can help improve your balance, too. Walking is another option to consider. It's low impact and easy to make part of your daily routine.
Swimming is a great exercise option for pregnant women because it strengthens your abdominal and lower back muscles, and the buoyancy of the water takes the strain off your joints and ligaments. Consider signing up for a prenatal water exercise class, if one is available in your community. These can be very relaxing, and there's research suggesting that water exercise may decrease the intensity of back pain during pregnancy.

Be aware of positioning and proper body mechanics.

Stand up straight. This gets harder to do as your body changes, but try to keep your bottom tucked in and your shoulders back. Pregnant women tend to slump their shoulders and arch their back as their belly grows, which puts more strain on the spine.
If you sit all day, be sure to sit up straight. Supporting your feet with a footstool can help prevent lumbar pain, as can using a small pillow called a lumbar roll behind your lower back. Take frequent breaks from sitting. Get up and walk around at least every hour or so.
It's equally important to avoid standing for too long. If you need to stand all day, try to take a midday break and rest lying on your side while supporting your upper leg and abdomen with pillows.
Be aware of movements that make the pain worse. If you have posterior pelvic pain, try to limit activities like stair climbing, for example. And avoid any exercise that requires extreme movements of your hips or spine.
Wear comfortable shoes and avoid high heels. As your belly grows and your balance shifts, high heels will throw your posture even more out of whack and increase your chances of stumbling and falling.
Always bend from your knees and lift things from a crouching position to minimize the stress on your back. This isn't the time to risk throwing your back out, so let someone else lift heavy things and reach for high objects.Avoid twisting movements, too. Pass up activities like vacuuming and mopping that require you to bend and twist at the same time. If there's no one else to do these chores, move your whole body rather than twisting or reaching to get to out-of-the-way spots.
Divide up the weight of items you have to carry. Carrying a shopping bag in each hand with half the weight in each is much better than the uneven stress of carrying one heavier bag.
Take care when getting out of bed: Bend your legs at your knees and hips when you roll to the side, and use your arms to push yourself up as you dangle your lower legs over the side of the bed.

If your back pain persists, you may want to consult your doctor to see what else you might try. You should call your doctor right away if you experience any of the following:

Severe pain
Increasingly severe pain or pain that begins abruptly
Rhythmic cramping pains

Be sure to consult your doctor before taking pain medications. Acetaminophen (Tylenol) is safe for most women to take during pregnancy. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve) are not advised. In some cases, your doctor may recommend other pain medicines or muscle relaxants that are safe during pregnancy.

In rare cases, severe back pain may be related to problems such as pregnancy-associated osteoporosis, vertebral osteoarthritis, or septic arthritis. Rhythmic pains may be a sign of preterm labor. So if you are experiencing any of these problems, it's important to be checked by your doctor.