Let’s talk about lower back pain!
It is one of the most common issues that any Physiotherapy clinic will see and for Physiotherapists that work with women’s health clients – pregnancy and lower back pain go together like bread and butter!!
Why do women experience back pain in pregnancy?
During your pregnancy your body undergoes posture changes and so there are also mechanical changes in the way your muscles are positioned and can work! Some muscles are lengthened and some muscles are shortened. Sometimes this leads to tight muscles, stiff joints and pain because movement becomes restricted or some muscles might be working too hard and need support.
Does everyone get lower back pain in pregnancy?
No! But a lot of women do experience some back pain during at least some point in their pregnancy. Sometimes labour pains are also felt in the back but, again, not with everyone! Every woman is different!
My friend got back pain at 6 weeks – is that from the pregnancy or a different thing?
Hormone changes kick off really early in pregnancy! Some of these hormones like Relaxin affect can your joints and connective tissue and so sometimes women find that their body is feeling different quite quickly, other women won’t notice until the very end of pregnancy (or sometimes not at all). Everyone is different and there is a wide range of normal.
Are there things I can do to stop myself from getting a sore back?
Absolutely!! There are a lot of things you can do to help manage or prevent back pain in pregnancy. Probably the best tip I can provide is to get it looked at by a Physiotherapist as soon as you start to feel uncomfortable, don’t wait until you’re struggling to walk because of pain and tightness!!
Keeping fit and staying strong throughout your pregnancy is the best way to prevent back pain but it’s important to know what exercises you should and shouldn’t be doing – that’s where a Physiotherapist can help! You shouldn’t take up new exercise activities once pregnant but you can often continue your current ones so long as they are safe and modified to pregnancy!
Supporting your changing body by ensuring that it moves well and is supported by strong muscles is important for staying as pain-free as you can!
What kind of treatments or techniques can a Physio use to help me with back pain whilst I’m pregnant?
Where do I start! There are so many ways to help with back pain and usually I will use a combination of the following:
- soft tissue massage and release techniques for tight muscles (I also have specially designed pillows so that you can lay on your stomach!!! #comfort )
- taping to offload muscles, support joints, help with posture, support belly, support pelvis, shoulders = you name it!
- tubigrip and pelvic belts/bands to support pelvis, hips, lower back and support growing belly (tubigrip is amazing for this!!)
- exercises for strength to help support glutes, pelvis and posture to avoid or reduce low back pain
- mobility exercises to improve flexibility and movement (which often contributes to back pain)
- modifications and advice on how to continue to exercise through pregnancy
Just to name a few!!
Are you currently pregnant and suffering from Lower Back Pain?
Experiencing lower back pain after having a baby is very common! Your body just went through the process of growing a human for 9 months and then delivering your bundle (or bundles!!) of joy!
Your body is now in a state of new normal. It doesn’t “go back” to being quite the same as before! In some aspects it is forever changed by the process of pregnancy and there is absolutely nothing wrong with that!
Common changes in the body can include:
- your posture
- your breast size (can fluctuate quite a lot over course of pregnancy and breastfeeding)
- your abdominals
- your pelvic floor
- your hip and pelvic control
- your exercise tolerance (this is a big one!)
The changes in your posture that occur during pregnancy can lead to tightness in some muscles or poor alignment as well as weakness and loss of strength and this can lead to back and neck pain postpartum.
Postpartum your body is rapidly adjusting to its new normal – hormones are re-adjusting, your once pregnant belly is shrinking as your uterus returns to its resting state, the demand on your pelvis is changing, your posture is changing and you’re likely losing both fluid and weight in the first few weeks! There is a LOT going on!
So why does your back often hurt postpartum?
Well, largely, due to the process of delivery (and the rapid changes that follow) and the changes to yourcore muscles. Without a strong, supportive core your spine can lack support and control that it once had and this can lead to discomfort and pain.
Your “core” is made up of a few more muscles than just your abdominal area = I also like to include the glutes (bottom muscles) and, of course, the paraspinals (muscles next to your spine on either side) which are all involved in providing support to your back!
The abdominal wall is one of the areas of the body that changes the most during pregnancy. The wall becomes stretched around growing baby and in the third trimester almost all women will have some level of abdominal separation; check out this blog for more information about “Diastasis Recti” (tummy muscle separation).
This process is entirely normal and postpartum you may need help in establishing a strong core again! That’s where Physiotherapist’s come in!
The rectus abdominus muscles (commonly known as your “6 pack” muscles) are joined by a piece of fascia called your “linea alba”. It is important to establish good tension and activation through this area in order to form a strong and controlled abdominal wall (which in turn supports your organs, controls your trunk and prevents pesky back pain!).
In order to activate and draw the linea alba to a more “closed” or “taut” position postpartum you need to learn to activate your deepest core muscles – transverse abdominis.
As this muscle stretches to accommodate baby during pregnancy – it needs a) healing time and b)retraining in order to resume its function of stabilising the spine, supporting the front wall of your abdominals and teaming up with your pelvic floor to support your “core control” functions!
What about the glutes? How do they tie in to lower back pain?
Without strong glutes to support your leg and hip position, your back will get cranky! Your glutes are responsible for controlling and stabilising your hip and pelvis as well as movement of your leg (a.k.a they are working hard!). During pregnancy – there is a LOT more going on in your pelvis so your glutes are often working EXTRA hard!
Post pregnancy, your pelvis needs strong glutes and good control in your deep hip rotator muscles in order for your hip and leg to interact well. If the don’t? Then you’ll have tight muscles, cranky muscles and likely lower back pain!
Getting strong glutes isn’t just about doing lots of squats (although, I do love recommending squats!), it’s about retraining movement in the hip, working on those little muscles (as pictured on the right in the above image) and establishing good patterns that you then load and build upon to get STRONG!
Great, I know I need strong now but what about the mean-time? I’m hurting – Can you help me?
Absolutely! Whilst we need to get you strong to support your back, we also want to make sure we sort out those tight muscles and achey hips! We can utilise treatments such as:
- massage (we also have AMAZING massage therapists)
- trigger points
- heat packs (definitely a home favourite for most clients!)
Returning to Sport and Exercise After Having A Baby!
Returning to your favourite sport or fitness activity post baby (or babies!) is often a complex task for a few reasons:Your lifestyle and schedule is different
You might be returning to work as well as returning to exercise which means you’ll need excellent time management skills, and
Your body is different [this one is an important one!]
It’s so common to see women present to the clinic with lower back pain when they have recently returned to sport or are increasing their training load after having children.
Why do women often get back pain when returning to sport or exercise?
There could be a number of reasons, including:Returning to vigorous sport too early postpartum
- Ligament laxity (due to presence of relaxin hormone)
- Poor posture/mechanics postpartum
- Poor strength in muscles that were strong prior to pregnancy
- Poor endurance or muscular control = may be more prone to injury
- Core weakness/poor control (this is a big one!)
- Weakness in pelvic floor or poor control/endurance.
- Poor hip control/strength
- Unrelated reasons – on field injuries, etc!
As you can see lots of things can lead to back pain in mummies who are returning to sport!
The biggest issue I see is probably returning to high impact sport too soon/too quickly or weakness of abdominal wall and core control = two very big factors in injury risk for mums! Both of these tend to be key factors in the incidence of back pain in mums who have gone back to training!
What do we screen for when someone comes in wanting to return to sport or exercise?
Thorough history is always the first thing I do – what your fitness and sporting activities were like pre-babies, any previous injuries and how your body coped during pregnancy. Then I’ll look at your goals – what exercise or sport you’d like to get into, what challenges you want to set for yourself and then we’ll discuss realistic timelines for achieving these!
Part of the screening process is ascertaining information about your pelvic floor, your core control and pelvic control, your posture, your muscle strength and lower limb or upper limb control (or both depending on the sports you’re wanting to get back into!) – there’s a lot to look at and they are all very important components of safe return to exercise.
What can you do to prevent back pain?
The most common question! The answer is: it depends. It depends on the sport, on your pregnancy(ies), your recovery, your goals! This is why working with a Physiotherapist is so important – we can screen for the factors that often cause delays in return to sport and we can help facilitate strong returns!
What are the key takeaway messages about returning to sport or exercise after having had a baby?
- It is important to return to sport gradually and safely after having a baby – your body has changed, your exercise endurance is affected by pregnancy and preventing injury is of key importance – you don’t want anything to slow you down from achieving your goals!!
- Having your pelvic floor checked in addition to your core, pelvic control and general strength, balance and control is really important – setting a good foundation to work from is key.
- Physiotherapists can help with these things and you can see them as soon after having a baby as you want. Feeding, holding, settling babies can be tiring on the shoulders and neck for sure! Generally we wait until 6-8 weeks postpartum to check core muscles and pelvic control but for aches and pains before then – come and see us!
If you want to return to sport or exercise after having a baby, get in touch below!
We’d love to chat with you and offer you a FREE phone consultation to diagnose if we are the right fit for you and can help you become pain free for good and keep doing what you love doing!
If you’re interested in having a chat with one of our passionate Physiotherapists about returning to sport and exercise after having a baby, simply fill in the form below.
We look forward to hearing from you soon!