“I should be glowing not aching!”- The facts about low back pain during pregnancy

I was recently invited to write a guest blog for social group Hampstead Mums, on the causes, risk factors and treatment options for pregnancy-related low back pain.

A real dampener during pregnancy

I see lots of mums-to-be in clinic experiencing back pain, and it can be a real dampener on their pregnancy experience. Low back pain (LBP) during pregnancy is common and affects between 45% and 90% of woman at some stage during their pregnancy. The condition tends to increase as pregnancy advances, and in some cases the pain may radiate into the buttock, leg or foot (termed ‘sciatica’). For two recent evidence-based reviews on pregnancy-related LBP see here and here.

The precise cause is unclear, but it’s speculated to be related to the change in spinal-pelvic posture to accommodate the growing baby, increased body mass, increased flexibility of the spine and pelvis due to hormonal changes or possible vascular (blood flow changes). The good news is that for many pregnant women experiencing LBP, the pain will resolve soon (in some cases immediately) after delivery; however, some mums will continue to experience pain more than 1-year after delivery.

Low back pain during pregnancy can be extremely uncomfortable, unpleasant and distressing. Additionally, many mums-to-be also experience disturbed sleep, difficulties attending work or performing daily activities, and a worry that their back pain is a sign of a problem with their growing baby. Despite these significant physical and emotional impacts on pregnant mums, back pain it’s often seen as ‘normal’ and ‘part of the package’ of being pregnant and therefore, doesn’t always receive the level of advice or attention from health professionals it deserves.

Pregnancy-related LBP is less understood compared to typical ‘non-specific’ low back pain in the non-pregnant population’, however we are beginning to know more about the risk factors for developing LBP during pregnancy, and what the effective treatment methods are.

Risk factors for low back pain during pregnancy

Recent research has shown that some of the strongest factors associated with developing pregnancy-related LBP are: excessive body mass, high levels of depression and anxiety, a previous history of back pain and the amount of physical activity/exercise taken before or during pregnancy. It’s worth considering how these risk factors relate to you, and identifying strategies (in discussion with your midwife, obstetrician or other health professional) to address them either prior to, or during your pregnancy, to minimise your risk of developing LBP.

Treatment and management options for pregnancy-related back pain

There are several treatment approaches which have been shown to be effective for pregnancy-related LBP [see Cochrane review here..]. Exercise and physical activity, either used alone, or used in combination with other therapies, can improve pain and disability (e.g. stiffness, difficulty walking and moving- see a meta-analysis of RCTs here). Regular exercise (before and during pregnancy) carries significant additional health benefits for mums-to-be including improves physical fitness, reduces the risk of excessive with gain, reduces risk of pre-eclampsia (high blood pressure), improves sleep, reduces anxiety and depression and importantly, and reduces the risk of low back pain.

During pregnancy, the exercise recommendations are similar to those in non-pregnant populations with, with minor modifications (e.g. amount of weights lifted or positional alterations to accommodate bump- see review paper here). Either water-based (e.g. swimming or water aerobics) or land-based exercises are effective for preventing and managing back pain, and exercise during pregnancy is generally very safe for mum and baby; however, it’s always best to run it by your health professional beforehand.

The specific form/type of exercise doesn’t appear to be that important for LBP; so, choosing something you enjoy, is affordable and easily accessible will increase the ‘stickability’ factor, so that you and baby will receive the maximum benefit. Pregnant mums are recommended to perform at least 30 minutes of moderate exercise on most days of the week. A recent systematic review suggests a mixture of cardio (aerobic) exercise and resistance (anaerobic) exercise is particularly effective for the health of mum.

My top tips for low back pain in pregnancy

If you’re pregnant and have concerns about your back pain, you should speak to your health professional, who you can advise you accordingly. Below I’ve listed my top tips to effectively tackle low back pain during pregnancy.

1. Keep calm. Pain levels are influenced by levels of sleep, anxiety and stress. Take comfort in the fact that back pain during pregnancy is very common and treatable. It is largely due to sensitivity of the spinal tissues rather than any actual damage.
2. Carry on. Keep moving and walking as normally as possible. Your mobility levels will naturally drop as your pregnancy advances, but excessive resting in bed due to back pain has been shown to hinder recovery.
3. Backs with bumps love to move. If you’re not already exercising, then now’s a good time to start. If you’re new to exercise, then begin slowly and gently. Exercise while experiencing back pain is very unlikely to harm or damage your back, however, you might find your back a little sore and sensitive during or after exercise. Don’t worry, this will ease over time as your body adapts.
4. Hands-on help. Manual therapy, such as osteopathy can be effective and is safe for treating pregnancy-related back pain. Osteopathy treatment involves gentle stretching and soothing movement of joints and soft tissues (e.g. muscles), and combined with reassurance, advice and exercise guidance can be helpful to ease back pain.
5. Need(le) a little relief. Acupuncture (either by a traditional eastern acupuncturist, or by another health professional such as a manual therapist) is safe during pregnancy and can be beneficial for related back pain. Whether the beneficial effects are due to expectation (i.e. placebo), the relaxation effect, the brain producing natural pain-relieving chemicals or by promoting the flow of ‘Qi’ (or energy), or a combination of all the above is unknown, but research suggests it’s definitely worth a try.