Let’s talk about one of the most common complaints we see both during and after pregnancy! As many as 50% of women will experience lower back pain during pregnancy and many will go on to develop lower back pain afterwards too.
Why do women experience back pain post pregnancy?
During pregnancy, as the baby grows inside your tummy, your hormones, balance and posture all change. As the baby grows and gets heavier, the pressure moves towards the pelvic floor. Towards the third trimester, you will experience widening of the abdominal muscles, sometimes causing a separation – known as diastasis recti or DRAM. This is a normal process to make room for the growing baby, but it inevitably places excess stress on the entire body.
After giving birth, your body is in a new state of “normal”. After carrying around a little bub (or bubs) for 9 months, some of these changes don’t simply return to pre-pregnancy states. Common changes include:
- Breast size
- Abdominal strength and size
- Pelvic floor control
- Hip and pelvic strength and control
- Exercise tolerance
How do these changes lead to pain?
Postural stress on the spine can place excess stress on muscles, joints and ligaments. During pregnancy, one of the biggest changes to occur is widening of the pelvis to make way for delivery. This process is made possible through hormones (such as relaxin) making ligaments around the pelvis more lax. Couple this with weakened muscles of the core, pelvic floor and surrounding hip/lower back muscles and this effect is amplified. Without strong muscles to support the hips, pelvis and lower back, the lumbar spine and sacroiliac joints (SIJ) can get cranky! Often women will experience pain with general activities such as walking, sitting and turning over in bed whereas others may experience pain with exercise.
Exercise after having a baby
Returning to exercise after having a baby can be hard, but it’s a must! Without managing it correctly, it can lead to increased lower back pain. For more information on pre and post-natal exercise especially in the weeks/months after giving birth, check out our in depth blog “Exercise Post Pregnancy”.
There are a number of reasons why this might occur, including:
- Ligament laxity – due to the production of relaxin, a hormone released to facilitate widening of the pelvis for delivery
- Poor posture
- Reduced strength in muscles that were strong before pregnancy
- Poor muscular control
- Exercise that is too high impact or too intense
There are numerous reasons why back pain can occur during or after exercise and numerous areas such as the lower back or SIJ can be problematic.
The most common issue we see is returning to or participating in exercise without addressing weakness of pelvic floor/core and hip muscles. Especially fitness that requires good strength and control such as high intensity workouts or resistance training. This happens when the exercise requires stability through the lower back and core, but your body isn’t able to control this well enough and places too much stress on structures around the lower back.
How do we address this?
Firstly, this is the most common question we get asked by mums. The answer is: it depends. It depends on how far post pregnancy you are, the cause of your pain, how severe it is, what level of exercise you are doing and your goals. This is why working with a physiotherapist is so important. We can assess any contributing factors, and support you in addressing these so you can exercise pain free. A mum 8 weeks post-partum doing only walking will be managed differently to a mum 6 months post-partum doing F45 type training. Similarly, a mum with poor pelvic floor control will be managed differently than a mum with poor glute strength and control.
So, how can we help?
Your physiotherapist can assess your issue by first taking a thorough history of your pregnancy and any concerns you may have, as well as gauge what exercise you would like to get back into and your goals. Then we can assess your pelvic floor, core and pelvic control, posture, muscle strength and more. At Revive Physiotherapy and Pilates we are lucky enough to have access to Real Time Ultrasound to accurately assess your pelvic floor. For more information on post natal assessments, check out our blog “Don’t Forget Mum! Post-Natal Assessments and Care“.
Whilst we need to get you strong and support your back, we can firstly give you advice on the type of exercise that will be safe, which ones to avoid temporarily and specific positions and lifestyle modifications to help. Here are some ways we can reduce your achey pains and tight muscles:
- Joint mobilisations
- Trigger point work
- Dry needling
We can then address contributing factors through exercise:
- Pelvic floor exercises
- Hip, core and lower back strengthening and control
- Mobility exercises
Below are some of the exercises we might prescribe at different stages to improve core and hip/pelvic strength and control. These are quite general and non-specific but can be a great start for those experiencing lower back pain with exercise. There are many different exercises and some will be more suited to you depending on your injury but try some of these as a starting point!
Top Tips For Exercising Post Pregnancy
- Engage the core to stabilize the lower back
- Warm up with glute, core and lower back activation exercises
- Avoid exercises which aggravate your pain – use alternatives or modify the exercise
- Gradually ease into higher impact and higher intensity exercise
- Set up a good foundation – get strong before getting back into high impact and intense aerobic training
We’d love to help you become pain free and keep you doing what you love doing, so get in touch if you would like more help to get on top of your pain during or after pregnancy!