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How will pregnancy affect my back and pelvis?Pregnancy may change the shape and behaviour of your back. Your lower back may flatten slightly (Okanishi et al, 2012, Gilleard et al, 2002b), or if you had an arched lower back before pregnancy, it may arch further.
The flattening of your back, and the hormonal changes that happen in pregnancy, can cause the joints of your back and pelvis to move more. The muscles of your back, tummy and pelvic floor are designed to move and support the joints of your back and pelvis. But as your uterus (womb) grows, it can become harder for them to do their job, and this can cause irritation and pain.
Your back is slightly protected by your baby, who acts as an internal support, but this also makes you less flexible. As your baby grows, your back will feel stiffer, and bending forward and twisting from the waist will be harder to do (Gilleard et al 2002a).
Your pelvis isn’t protected in the same way, and moves more. It's affected by the pregnancy hormones oestrogen and relaxin. These make the tough, pliable tissues that connect your bones (ligaments) more stretchy. This is one reason why pelvic pain is more common than back pain during pregnancy (Gilleard et al 2002a, Kristiansson 1997, Bjorkland et al 1999, Bjorkland et al 2000).
How can I protect my back and pelvis in pregnancy?Avoid heavy lifting
If you have to lift or carry anything, hold it close to your body. Bend your knees, not your back, and try not to twist. See if your toddler can climb on to a chair or sofa before you pick him up, and encourage older children to climb into their car seats or high chairs themselves.
When shopping, carry a bag in each hand. Or use a rucksack, which helps back muscles to work better (Snijders et al 1998).
Keeping fit and supple through gentle exercise is good for you, and can help to prevent back and pelvic pain (Ostgaard et al 1994, Clemente-Fuentes 2013, Keskin 2012, Richards et al, 2012, Stuge 2012). However, don’t overdo things. If something hurts when you exercise, don't push through the pain, as it could cause injury.
Being fit before you are pregnant won’t prevent pelvic pain from happening. But if you exercise three times a week or more once you become pregnant, and throughout your pregnancy, you'll be less likely to experience a lot of pain (Gjestland et al 2013, Haakstad 2013).
The best forms of pregnancy exercise include swimming, walking, cycling on an exercise bike, exercising on a large gym ball, aquanatal classes, pilates or yoga(Yan, 2013, Richards et al, 2012, Stuge, 2012).
Wear comfortable shoes
Just wear what feels best. If you are used to very high heels and swap to flats, you may feel uncomfortable at first. Your Achilles tendons, which run from the base of your calves to your heels, will soon adjust.
Improve your posture
Stand as if someone is making you taller by pulling a string attached to the top of your head. Tighten your pelvic floor muscles, and your tummy muscles will help to support your back.
Pelvic tilting can ease back strain caused by sitting or standing for long periods(Suputtitada et al 2002). When sitting, slowly work your pelvis back and forth rhythmically, without moving your shoulders, so your back becomes round, and then arched.
If you have pelvic pain, focus on the forward tilt, where you stick your chest and bottom out.
The flatter back that pregnancy causes may be one reason why so many women develop pelvic pain (Okanishi et al, 2012). Try to bend backwards regularly, particularly when you have been sitting down or bent over for a long time.
Don't put on too much weight
Having a high body mass index (BMI) makes you more likely to develop back and pelvic girdle pain during pregnancy (Kovacs et al, 2012). Though you shouldn't go on a diet in pregnancy, try to limit how much weight you gain. Eating a healthy, balanced diet, and exercising regularly, should help you to maintain a healthy weight.
Get into a good sitting position
Make sure that your back is well supported when you’re sitting down. You could use a cushioned support (lumbar roll) that fits over the back of your chair. Ideally, your back should be slightly arched, with your breasts pointing straight ahead, rather than down towards your bump. Part your legs slightly, to allow for your bump.
Using a birth ball encourages good posture and makes pelvic tilting easier. Sitting upright in a dining chair will help your back more than lounging in a soft chair or sofa. If you have to sit for long periods at work, try to get up and walk around every 20 minutes.
Try getting on your hands and knees
Going on all fours can reduce the pressure on your back from the weight of your baby. Try getting into the following positions whenever you can:
The cat stretch: step 1
The cat stretch: step 2
Round your back into a hump shape, tucking in your tailbone (see step 1 above), and then gently arch your back in the opposite direction (step 2), so your bottom sticks out.
You could also lean over an exercise ball and gently move backwards and forwards.
Lower tummy exercise: step 1
Lower tummy exercise: step 2
To strengthen your lower tummy, try this exercise. Find the middle position between arching up and down in the cat stretch (step 1). Hold your back still, breathe in, and do a pelvic floor squeeze. At the same time, pull your belly button in and up (step 2). Hold this for five seconds to 10 seconds, while breathing normally and keeping your back still.
Adopt a good sleeping position
Once you reach 16 weeks of pregnancy, lying on your back when sleeping can make you feel faint. That’s because your baby is pressing on your blood vessels (Ueland and Metcalfe 1975, Scott and Kerr 2005). Try lying on your left, with your knees bent up, with two or more pillows placed between your knees. This keeps the pressure off the muscles around your hips and pelvis.
Placing a wedge-shaped pillow under your bump can ease back pain (Stuge et al 2003). If your waist sags down into the bed, place a rolled-up towel or cylindrical maternity pillow under your waist.
Having rest is important, but so is keeping active. Sleeping or resting for more than eight hours has been linked to new mums having more persistent back and pelvic pain after having their baby (Stomp- Van den Berg, 2012).
How can I make day-to-day activities easier?Standing up
When you are standing from a sitting position:
- Do a few pelvic tilts.
- Sit on the edge of the chair, with your back arched, and your chest sticking out.
- Part your knees and lean forward, so that your nose is over your knees, keeping your back straight.
- Stand by pushing up with your arms, moving your head forwards and upwards, and keeping your back arched.
This method holds your back and pelvic joints locked in their most stable position.
Turning over in bed
If you are lying on your back and need to turn to your right:
- Arch your lower back, and tighten your pelvic floor muscles and lower tummy muscles.
- Bend your left knee up, turn your head to the right.
- Take your left arm over to the right of your body.
- Hold on to your bedding or mattress and pull with your left hand, taking your left knee over to the right.
- Bend your knees up as high as they will go.
Reverse this to turn to the left. If this still causes you pain, pull your parted knees up to your tummy and roll over to the side, keeping your knees as high as you can.
Getting out of bed
Try rolling on to your side. Bend both knees up as high as you can and then drop your feet over the edge of the bed. Push yourself up sideways, keeping your knees up for as long as you can. This locks out the pelvis, causing you to feel less pain.
If you have good tummy muscles, and your bump isn’t too big, try this method:
- Pull your knees as far as you can up to your chest. Separate your knees to clear your bump.
- Keeping your knees bent up, place your hands on either side of your body, lower your chin on to your chest, and push.
- Push yourself straight up, keeping your legs bent up. Try not to arch your neck backwards. Don’t allow your legs to straighten, as this will unlock your pelvis. Asking your partner to push you up can also help.
- Once upright, keep your legs bent up, until you are sitting at the edge of the bed.
Try a TENS machine
A TENS machine is a device that you strap to your waistband. Using one may help to control the amount of back or pelvic pain you feel (Keskin, 2012). The pins-and-needles sensation helps to interfere with the pain messages your back and pelvis are sending to your brain. Ask your midwife or physiotherapist if you'd like to borrow or hire a TENS machine.
Ask for help
If your job involves a lot of standing or walking about, or if you do a lot of heavy housework and have children to care for, you are more likely to have back or pelvic pain during pregnancy (Hagen Haakstad, 2013).
Ask your employer to do a risk assessment as soon as you know that you are pregnant. This is to check that your work duties are safe for someone who is pregnant. Don’t be afraid to ask colleagues to lift any heavy items for you, or family to help around the house.
Look after your emotional self
If you are feeling anxious or depressed, or are struggling emotionally, it may make the pain you are experiencing harder to bear. It may also mean that it lasts longer after you've had your baby (Chang et al 2013, Bjelland et al 2013). Talk to your midwife or doctor if you feel that things are getting too much, as they can help.
Too much rest can make back or pelvic pain worse. But it's also important to rest your pelvis at regular intervals.
Kneel or lean forward to protect your pelvic joints and to take the weight off your back. Try leaning forward over a big pile of cushions or pillows, or an exercise ball. Alternate between rest and activity, rather than spending long periods of time being active and long periods of time resting.
Try wearing a pregnancy support
Wearing a pregnancy support, such as a band, can help you to stay active if you have back or pelvic pain (Kordi et al, 2013; Richards et al, 2012). However, don't wear it all of the time, as it may make your muscles lazy. Try to wear it only while you are exercising, or while you are at work.
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