Lower back pain and pregnancy

If you're pregnant and have lower back pain, you're not alone. A 2004 study (Low back pain during pregnancy: prevalence, risk factors, and outcomes (link is external) published by Yale researchers in the American Journal of Obstetrics & Gynecology (link is external) found that nearly 70% of the 645 pregnant women responding to a 36-question survey reported lower back pain during their current pregnancy. The researchers also found that:

• Pregnant women who have experienced lower back pain prior to their current pregnancy (e.g., during their periods, during a previous pregnancy, prior to ever becoming pregnant) are particularly susceptible to lower back pain
• Lower back pain disturbed the sleep of 58% of study respondents
• Lower back pain negatively impacted the daily lives of 57% of the women surveyed
• Two-thirds of women surveyed in this study did not share back-pain problems with their pre-natal caregivers and--if and when they did--only one-quarter of  these caregivers recommended any kind of treatment

Because I know that lower back pain in pregnancy is a manageable and in most instances a preventable problem, it's of course best if women who plan to become pregnant prepare their bodies for the dramatic physical, musculoskeletal, and hormonal changes that lie ahead. This, as the study confirms, is especially important for women with a history of back pain. But because so many expectant mothers are--at this very minute!--experiencing lower back pain and, in many instances, not seeking or receiving help, this is the topic I'll focus on for now.

Body stressors during pregnancy

I'll start by stating the obvious: During pregnancy a woman's body undergoes a number of changes, many that are inherently stressful. These of course include:

• Extra weight
• A shift in the center of gravity (link is external)
• The impact of the hormone relaxin (link is external) on ligaments (link is external)

If, as we consider the lumbar region of the body, we reference the very pregnant Natanya in the photo just below, we can begin to imagine why lower back pain can be a problem for some 7o% of expectant mothers.  

Center of gravity

With pregnancy comes a shift in the center of gravity that can be compensated for with good movement patterns and by engaging the internal oblique muscles (link is external), which run along the side of the abdomen at about the level of the waist. These muscles can be used to flex the thorax (link is external) forward and prevent the lower back from arching.  (The thorax is the part of the body between the neck and the abdomen.) By rotating the ribcage forward and, once again, lengthening and flattening the lower back to "anchor" the ribs, even women well advanced in their pregnancy can maintain a comfortable center of gravity. Shifting the weight back solidly on the heels is also a good thing, because it counters distortion in alignment, while also offering the advantage of not overspreading the feet, which can result in loss of structure.

Relaxin

Pregnant women need to take especially good care of their ligaments because the hormone relaxin (link is external), which is produced by the ovaries and the placenta and which helps prepare the expectant mothers pelvis for delivery, also works to remodel other soft tissues, cartilage, and ligaments in the body. As a result, pregnant women are at risk of losing structure--for example (and as described above), in the feet.

Lower back pain and pregnancy - some solutions!

The good news is that by making adjustments women at every stage of pregnancy can prevent lower back pain from occurring, or -if pain is already an issue- take real steps to manage this pain. As a Doula, Nurse, Yoga Teacher and the head of the Shakti Yoga Wheel prenatal and pregnancy program I would like to outline a few helpful tips to support a healthy posture during pregnancy.

Six tips

1. Anchor your ribs
2. Engage your inner corset
3. Hinge your hips when you bend
4. Stack your weight over your heels
5. Engage your gluteus medias muscles
6. Stretchsitting using the yoga wheel

While the suggestions outlined in this post can begin to make a difference, much more can be gained from our e-book “Enjoy your pregnancy with an open heart”.

1. Anchor your ribs

With regard to the rib anchor, it's important to know that the ever-growing baby is potentially pulling the mother's back into an arch. An expectant mother who gives in to this pull will be increasingly swaying her back, which can cause lower back pain and other problems. Anchoring the ribs involves keeping the lower border of the rib cage flush with the abdomen. This lengthens the back and helps to frame and lengthen the lumbar spine. (link is external) By engaging internal oblique muscles (link is external) as the baby gets bigger, the expectant mother not only reduces the risk for lower back pain, she also gets very valuable abdominal muscle exercise during pregnancy. This not only negates the problem of lower back pain, it makes pregnancy an opportunity to strengthen abdominal muscles, rather than a liability to lose muscle tone. 

2. Engage your inner corset 

Anchoring the ribs and periodically engaging the inner corset--that is, contracting the deep muscles in the abdomen and back to lengthen and support the spine--is the ticket to well-toned abdominal muscles before, during, and after pregnancy. No matter how pregnant a woman is, these muscles can be entirely engaged, which is especially beneficial, given that the usual abdominal exercises--for example, lying on the back and doing crunches--are not recommended.

3. Hinge your hips when you bend

Everybody needs to hip-hinge when they bend, but this is especially important for pregnant women. This is because lowering the body by bending with the knees and curving the back (as is so common in our culture) puts added stress on the spinal discs at a time when the discs are already being challenged by the additional weight of the pregnancy.  Keep in mind that the front of each disc in the curve being formed when the back is bent is compressed, pushing the contents of the discs backward, toward the spinal nerves. All authorities agree that this is a risky direction to distort the spine. The features of hip-hinging especially important for pregnant women are to get the legs externally rotated and set apart in a wide stance, so that when they hinge forward, there's room for the belly to settle between the legs. In other words, the legs have to be out of the way, so that the belly can settle between them. If the knees are not externally rotated, but facing in, then the thighbones will interfere with the torso settling.

Because so much bending is involved in motherhood, a very good time to master hip hinging is before and during pregnancy. Doing so will prepare the expectant mother for all the bending that is to come.

4. Stack your weight over your heels

Positioning the pelvis so that it's slightly tipped forward (anteverted) allows for a natural stacking of vertebrae without muscle strain. Vertebral stacking is important for everyone, but a for a pregnant woman carrying extra weight and with an altered center of gravity, it's really essential. Not only does healthy stacking yield good posture that leaves spinal discs decompressed, it also protects ligament integrity. Ligaments already loosened by the hormone relaxin are less likely to be taxed when bones are correctly stacked. This will also help protect the feet, which--as noted above--are at risk of losing structure.

5. Engage your gluteus medias muscles

Engaging the gluteus medius, the muscle located in the upper, outer quadrant of the buttocks, helps prevent lower back pain[/caption] Our "glutes," or buttocks, are made up of three major muscles: the gluteus maximus, gluteus medius (link is external), and gluteus minimus. Located in the upper, outer quadrant of the buttocks, the gluteus medius is the "middle" muscle, the one that moves the leg to the side and rotates the thigh.

We were very interested to learn that researchers at the University of Iowa Department of Orthopaedics and Rehabilitation (link is external) conducted a study that found a strong correlation between lower back pain in pregnant women and weakness of the gluteus medius. Specifically their 2009 pilot study, Association between gluteus medias weakness and low back pain during pregnancy (link is external), found that "pregnant women with gluteus medius weakness were roughly 6 to 8 times more likely to have low back pain than those without weakness.

Where to learn more?

The Shakti Yoga Wheel prenatal workshop helps pregnant women, improve their body structure and function as they engage in everyday activities.  While the e-book, “Enjoy your pregnancy with an open heart” is most helpful when it's read in by each chapter you will depend your knowledge in the prenatal yoga workshop and learn how to use the yoga wheel to decompress your spinal discs and transform sitting, standing, walking and lying into a healthy, therapeutic activity. You will learn how to

• Engage your deep back and abdominal muscles to protect your spine: Inner Corset
• Hip-hinging: Protect your spine and knees by learning to bend at the hips
• Learn how to sit anywhere without slouching, pain or tension
• Stack your bones well and prevent wear and tear
• Learn how to decompress your spinal discs and nerves

Find out more about our workshops or send us your questions or requests.

Gila Shire - Doula, Nurse, Yoga Teacher R-YT500+

Copyright © picture Center of Gravity courtesy of Natanya Washburn, Photographer Elisa Ferrari