Pregnancy, Physical Therapy and the Lower Back

The creation of a new life can be a wonderful and exciting experience. There are a number of things that need to be done in order to prepare for this life-changing event, such as building a nursery, buying clothes, toys and much more. Many people forget to acknowledge the things that can be done to help reduce and compensate for the biomechanical and physiologic changes that occur during pregnancy. Preparing for the increased stress on several muscles and joints throughout the body is imperative to decrease the effect on the lower back and pelvic girdle region.

Up to 50% of women report back pain at some stage during pregnancy and in one-third the severity of the pain is such that it interferes with daily life. In some cases the lower back pain resolves shortly after delivery. For others it continues and can become a chronic problem. With all of the heavy lifting that is required once the baby arrives, a lot of stress is put on the lower back (i.e., diaper bag, car seat, etc.). It would be in the best interest of the mother to be the most prepared for those ventures so that back pain during pregnancy does not become aggravated with activities afterwards.

Q: What causes low back pain during pregnancy?
A: Many factors contribute to back pain during pregnancy:

• Relaxin is a hormone that is secreted in response to pregnancy that facilitates the birth process by causing laxity in the ligaments allowing the pelvis to expand for the growth of the fetus. Relaxin is released at its height in the first trimester causing the joints (specifically the sacroiliac and lumbar facet joints) to become hypermobile putting a strain on the ligaments.
• Lumbar lordosis, or increased curvature of the spine, puts direct pressure on the joints in the lumbar spine and the nerves exiting the spine. This can cause lower back pain and possibly radiating pain into the legs. The increased lordosis is caused by a women's center of gravity shifting forward in response to the growing fetus.
• Previous history of low back pain predisposes women to back pain pre and post partum.
• Herniated disc in the lumbar spine can be present because of the increase stress. This disc that is located between connecting vertebrae can push out and pinch on the surrounding nerves causing low back pain as well as pain radiating into the legs. If you begin having saddle numbness, urinary retention, severe back pain, leg weakness, and pain in both legs, check with your doctor immediately because you may have a herniated disc that is causing nerve compression which may lead to permanent neurologic damage.

Q: Is aerobic exercise beneficial during pregnancy?
A: Available evidence supports aerobic exercise during pregnancy both for the mother and her developing baby. The following are some of the benefits of exercise:

• Prevents gestational diabetes
• Decreases postural changes, thus less back pain
• May facilitate labor
• Prevents accumulation of excess body fat
• Promotes psychological well-being
• Boosts immune system function
• Delivers blood and oxygen to the heart and brain more efficiently
• Aids in quicker postpartum recovery
• Increases the cardiovascular capacity of the baby

Exercise should be light to moderate, where the heart rate increases no greater than 150 beats/minute. Make sure to warm-up and cool-down 5-10 minutes before and after exercise. Select safe, non-ballistic exercise movements and avoid thermal or hyperbaric environmental stress during exercise. Exercising while lying on your back should also be avoided in the second and third trimester. Stop your work out and call your doctor if you have any of the following symptoms when exercising:

• Dizziness or faintness
• Increased shortness of breath
• Irregular or rapid heartbeat
• Chest pain
• Trouble walking
• Pain
• Vaginal bleeding or fluid leakage
• Uterine contractions that continue after rest

Q: What exercises should be done during pregnancy to help avoid low back pain?
A: Strengthening your core muscles is extremely important! These deep trunk muscles play a key role in stabilizing the spine, particularly with dynamic activities. The transverse abdominis, a lower abdominal muscle, is imperative for achieving core stability. See the exercise in figure 1.

Another group of muscles that are important to strengthen are the gluteal muscles which support the hips and in turn support the back. Gluteus maximus is targeted with the exercise in figure 2 and gluteus medius is targeted with the exercise in figure 3.

Pelvic floor muscles are the last group which support the reproductive organs and help to maintain continence. Strengthening these muscles prior to labor will lessen the likelihood of tearing during delivery as well as decreasing the chances of urinary incontinence or leakage after birth. To strengthen these muscles perform a Kegel exercise, where you gently squeeze “up and in” around the rectum and urethra. Perform Kegels lying in bed, standing, and in sitting.

It is also important to note that recent research suggests that exercise performed during pregnancy should be done under the supervision of a physical therapist to ensure optimal results.

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