Back pain and pregnancy | The causes, symptoms, and expert treatments

If this sounds familiar, keep reading for expert information, exercises, and movements that can help to improve your condition.

Key takeaways

• 50% of people carrying a baby will suffer with some form of lower back pain
• Back pain is the number one cause of sick leave during pregnancy
• Weakness in surrounding muscles can sometimes worsen this pain
• Not changing posture regularly and sitting for long periods are two common risk factors
• A strong abdominal muscles help support the lower back and pelvis
• Changing the position you sleep in can have a positive impact

Is back pain during pregnancy normal?

Yes, back pain during pregnancy is extremely common.

Research indicates that 50% of people carrying a baby will experience lower back pain during pregnancy. The impact of this is wide-reaching, with back pain being cited as one of the main causes of people taking time off work whilst pregnant.

Why is it so common?

• The body adapting to carry a child
• Changes to the pelvis in preparation for labour
• Hormonal changes
• Weight gain
• Weak core muscles
• Less energy to exercise and mobilise

What areas of the back are most affected?

The physiological and hormonal changes that occur during pregnancy can cause pain in a range of different places.

The most reported areas are:

• The lower back
• In the thighs
• The pubic bone
• The hips
• Above and around the sacrum
• The pelvic girdle

What causes back pain during pregnancy?

Growing and carrying a baby adds weight to the body. This can alter your centre of gravity and put more demand on your muscles and other supporting structures.

We used to think that pain in pregnancy was caused by the hormone ‘relaxin’ making joints ‘loose’. Recent evidence and research shows that this isn’t actually true and that the pelvis remains strong and stable during pregnancy and birth.

Pain perception during pregnancy

Sometimes the body and brain has a protective mechanism that can kick in, even when there is no immediate threat or harm, because pain does not always mean damage to the body. This reaction can be influenced by the brain’s memory of past pain experiences and our current emotions which shapes how the body can respond.

During pregnancy, there are lots of physiological changes that may increase the nervous system’s sensitivity. This increased sensitivity makes us more aware to bodily sensations, especially around the pelvis. As the body adapts to carrying a baby, it often adopts protective behaviours, such as muscle tightness, which can make movement feel more difficult, restricted, or painful.

Pain can sometimes last longer than it should or happens even when there's no real injury or threat. This happens because the body stays on high alert, making the nervous system extra sensitive. This shows how much the brain and nervous system influence our experience of pain, especially during pregnancy.

Other potential causes

Back pain during pregnancy can also occur when there are problems with how the muscles and joints in the back and the pelvis are working.

There may be:

• Uneven joint movement in the lower back or pelvis
• Weak muscles in your tummy, buttocks, inner thighs, or pelvic floor
• A previous injury to the lower back or pelvis
• The position of your baby
• Hormonal changes of pregnancy

If you have a physical job, you’ve gained a large amount of weight during your pregnancy, or you’ve had PGP or lower back pain in a previous pregnancy, you are more likely to experience pain again.

What can I do to get relief?

Keep moving

We never recommend sitting still throughout your pregnancy. Some movements and activities might aggravate your pain, but there will be others that do not, so focus on keeping active and building your routine around movements that work for you.

You might also find that your movement is better when you are less tired, so try exercising at a time of day that suits you. If your usual exercise routine causes pain or discomfort, try different activities like swimming, antenatal yoga, or Pilates.

Changing how you move

When it comes to pregnancy related back pain, many people find adjusting their posture and habits helpful.

If sitting is uncomfortable, try putting a cushion or rolled towel in the small of your back to support you. Elevating your feet on a small box whilst sitting at a desk can also help.

When reaching to the floor, try kneeling onto one knee instead of bending from your back. This takes the strain off the muscles in the lumbar region and encourages and engages other muscle groups.

Pelvic floor exercises

Pelvic floor exercises are a great way to boost circulation in and around the pelvis, which helps regulate your response to pain. Strengthening your pelvic floor will also assist during labour and help lower your risk of pain after childbirth.

When transitioning from sitting to standing or turning over in bed, try squeezing your pelvic floor muscles first. This will help you avoid putting undue stress on the muscles in your lower back.

Prenatal massage

Prenatal massage is specifically designed for pregnant people.

These massages use gentle, soothing strokes to relieve muscle tension, stress, and improve your overall well-being during pregnancy.

If you’re concerned about the safety of prenatal massage, consult your antenatal midwife or healthcare provider for more information.

Adjust your sleeping position

It is recommended that in your third trimester you sleep on your side.

This may not be a natural sleeping position for you, so consider using a pregnancy pillow or something similar to make the position more comfortable.

During the later stages of pregnancy, you might find using a pillow to support the bump and a pillow in between the legs can help with pelvic pain. Some people also choose to place a pillow against their lower back to prevent them rolling onto their back during the night.

Are heat pads safe during pregnancy?

It is safe to use heat or cool packs to relieve pain during pregnancy, but you should always wrap them with a towel or blanket to make sure they’re not placed directly on your skin.

These packs can be an effective way to relieve tension, cramps, and tightness when draped across your shoulder or against your back. For safety reasons, make sure to never place them on or around your bump or abdomen.

How can gentle exercise help?

Gentle stretches that target the lower back are great for tension and pain relief during pregnancy.

Your tummy muscles provide structural support for the back and may become weakened during pregnancy because of biomechanical changes to the body.

Strengthening them (along with the pelvic floor) and glutes can help take pressure off your lower back and encourage other muscle groups to engage and assist with load bearing.

Which exercises are best?

Cat-cow

1. Get into an ‘all-fours’ position with your hands underneath your shoulders and your knees underneath your hips
2. Exhale as you tilt your pelvis under and curl your back up into an arched position
3. As you inhale, tilt your pelvis out, let your belly drop and lift your head up
4. Slowly repeat this movement 10 times.

Seated pelvic tilts

1. Start in a seated position on a chair or exercise ball
2. Perform a basic abdominal contraction, where you draw your pelvic floor muscles ‘up’ at the same time
3. Tilt your pelvis forwards, arch your back, hold 3 seconds and return to your starting position
4. Now, tilt your pelvis backwards, round your back, hold, and return to your starting position
5. You can also rock side to side as you do this movement, shifting the weight from one sitting bone to the other
6. Hold the position for 3 seconds and release gently
7. Repeat this up to 10 times, 3 times per day.

Squats

1. Stand with your feet hip-width apart
2. Squat down while keeping your chest up and your back straight
3. Repeat this movement for 10 to 12 reps

Transverse abdominals

1. Start in an ‘all fours’ position
2. Let your stomach relax down towards the ground
3. Keeping your spine in a neutral/normal position
4. As you breathe out, tighten your abdominal muscles by drawing your belly button up towards your spine and away from the floor
5. Hold this position without moving your pelvis for 10 seconds
6. Breathe slowly and with every breath, tighten your tummy muscles
7. Repeat this movement 10 times. 

Glute bridging

1. Starting in a lying position on the floor, very gently curl the pelvis inwards starting from the tailbone
2. Slowly lift your spine away from the floor to create a ‘bridge’ position
3. Gently roll back to your starting position
4. It may feel like you aren’t getting very far at first, but don’t worry. This movement will feel easier with practice

After 28 weeks, it’s generally advised to avoid lying on your back to exercise. You can adjust this movement by performing it leant against a wall:

1. Stand with your back against a sturdy wall with your arms crossed or out by your sides for balance
2. Walk your feet forward slightly, making sure they’re kept a shoulder-width apart
3. Lift your hips up and away from the wall to create a standing bridge

Pelvic floor exercises

The pelvic floor muscles (PFM) are located at the bottom of your pelvis. They support the pelvic organs and play a vital role during pregnancy.

Pelvic floor muscle exercises are needed to:

• Improve muscle strength so you can control your bladder and bowels
• Support your pelvic organs to prevent prolapse

Can I take pain medication whilst pregnant?

We recommend speaking to your midwife or GP about this. This is because giving generalised advice about medication is very hard to do.

A face-to-face appointment with your midwife or GP will allow them to assess your condition and situation and give tailored advice about taking painkillers and other similar medications.

Is back pain more common in different trimesters?

Pain can occur at any point in pregnancy, but is generally more common later in pregnancy as your bump gets bigger.

Activities you should avoid when pregnant

A phrase to keep in mind here is “don’t bump the bump”.

We recommend avoiding any activity that involves jumping, falling, or potentially unsafe movements that could cause or worsen back pain. This guidance is for the safety of you and your baby.

Exercise should always feel comfortable and pain free. It’s important you listen to your body and work out what feels right for you.

It’s advised that you don’t begin any new exercise plans whilst pregnant, however if you are already active, you should be able to continue your routine with guidance and advice from your antenatal professional.

Is swimming safe?

Swimming is a great activity for alleviating joint and back pain. But is it safe if you’re pregnant?

The answer is yes. There is no current research that indicates swimming can be harmful for your baby during pregnancy.

Swimming is a great activity if you’re experiencing back pain whilst pregnant, as the water provides support for your back and joints. The added resistance is also great for strengthening the muscles that help take the pressure and strain off your back.

If you’re experiencing pelvic pain, avoid butterfly legs. Instead, try using strokes that involve leg kicking and more upper body movement. Backstroke, treading water, and aqua aerobics classes are some other great options.

How physiotherapy can help you

Always seek help if pain is impacting your quality of life. This includes your ability to complete everyday activities, or if it is impacting your mental health.

Physiotherapy aims to assess how pain is affecting your body, family, and lifestyle. An expert physio can spot the source of problems and provide a variety of different treatment options, including movements, exercises, and ways to strengthen weak or unstable areas.

Our team of physiotherapists at Nuffield Health are trained to spot the signs of pelvic floor instability and are experienced in looking after people who complain of pain during pregnancy.

Book an assessment now and find out how physiotherapy can help you move towards a pain-free pregnancy. Click here to get started.

Last updated Wednesday 7 August 2024

First published on Wednesday 7 August 2024