Exercise for back pain during pregnancy

Pregnant women and back pain
Eighty percent of women will experience back pain at some point during their pregnancies. The severity of this pain during pregnancy ranges from mild discomfort after standing for long periods of time to debilitating pain that interferes with daily life. Although back pain can be a sign of a more serious condition, including labor, in most cases, it is the result of changes happening within the body.

Factors that influence back pain during pregnancy
The spine is vulnerable due to the following factors during pregnancy:

Hormone production during pregnancy makes joints less stable (to allow the pelvis to spread as the baby grows)
Typical weight gain of 25-35 pounds during pregnancy, with the majority or extra weight distributed around the abdomen
Increase in postural strain as the body compensates for changes in the pregnant woman’s center of gravity

Although it may seem enticing to rest when experiencing pain and not undertake an exercise routine, gentle stretching and movement will often decrease muscle spasm and restore improved spinal function, resulting in decreased pain (1). Exercise also boosts energy levels and contributes to an easier labor, delivery and post partum recovery. The components of a balanced exercise program during pregnancy include cardiovascular, strength and flexibility training.

Cardiovascular exercise for back pain during pregnancy
An activity that increases the body’s heart rate for a sustained period of time is considered cardiovascular exercise. Walking, biking, and swimming are all considered safe for most pregnant women and can be performed for 20 to 45 minutes, 3 to 5 days a week. Pregnant women should take care to exercise at a mild to moderate level, but not to the point of exhaustion. Keep in mind that any exercise is better than none, so even a 10 minute walk at lunch time is beneficial.

Strengthening exercises for back pain during pregnancy
Strengthening the abdominal muscles, back muscles, pelvic floor, buttock, and thigh muscles can effectively help prevent and decrease back pain. It is recommended that the strengthening exercises be performed in a slow and controlled manner. The strengthening poses can be held for 3 to 10 seconds and repeated 10 to 30 times. Breathe out during the exertion phase of the exercise and inhale as you relax. The following are suggested exercises for each of the major muscle groups mentioned:

Pelvic Tilts (for abdominal muscles): The simplest way to learn the pelvic tilt is to lie on the back with knees bent, feet resting on the floor. Place your hand in the small of your back, and you will most likely notice a space between your back and the floor. Now try to flatten the lower part of the spine against the floor, so that you feel no space between your back and the floor. The buttocks should be relaxed in order to isolate the abdominals. The pelvic tilt can be performed while lying on your back, standing, on your hands and knees, or sitting.
Arm and Leg Raises (for back muscles and buttock): Kneel on your hands and knees with a straight spine. Do a pelvic tilt to keep your pelvis stable and then lift your right arm and left leg to form a straight line with your spine. Pause in this position and then slowly lower your arm and leg. Alternate lifting the opposite arm and leg. If you have difficulty keeping your balance in this position, modify the exercise by performing only the leg or arm raises separately.
Kegels (for pelvic floor muscles): To exercise the pelvic floor muscles, try to envision pulling the muscles of the vaginal area up and in towards your baby. You should not feel your buttocks, thighs, or abdominals tightening as you do this.
Wall Squats (for abdominal muscles, buttock muscles and thigh muscles): Stand with your head, shoulders, and back against a wall with your feet about 1 to 2 feet away from the wall. Press your lower back into the wall and squat as if you were going to sit down, with the knees approaching a 90-degree angle. Come back up slowly, keeping your back and buttocks in contact with the wall.

Stretching exercises for back pain during pregnancy
Stretching is at least as important as cardiovascular and strength training for back pain prevention and treatment during pregnancy, so try not to sacrifice this crucial component of the exercise program. In order to improve flexibility, it is recommended that stretches be performed daily after you are warmed up. Hold the stretches (never bounce) for 20 to 30 seconds, and repeat 3 times.

Although there are many stretches that can safely be performed during pregnancy, the muscles that most often contribute to back pain are the back, hamstring (in the back of the thighs), and chest and neck muscles.

Back stretch: Start on your hands and knees, with your legs wide apart and hands placed forward just a little in front of your head. Place a small pillow under you to give support to your abdomen, if needed. Sit back on your knees and stretch your arms forward to feel a stretch along the spine.
Hamstring stretch: Face a chair and place one foot up on it, keeping both hips and feet facing forward. Keep your back straight and lean forward from your hips to feel a stretch in the back of the thigh. If you can’t stand tall or your knee bends, try a lower step.
Chest stretch: Stand with your head upright and with your back straight. Clasp your hands behind your back, and without leaning your shoulders forward, gently stretch your arms up and back to feel a stretch in the front of your shoulders and arms.
Neck stretch: Sitting or standing, bring your head forward and tipped to one side. With the hand on the same side as your head is tipped, reach up behind your head and give a gentle pull. Turning your head as you pull can help isolate the specific neck muscles needing stretching.

Due to the multitude of changes happening within the pregnant body, back pain tends to be a common complaint, and exercise is a simple way to achieve comfort and relief during this exciting time. It is important to always discuss your symptoms with your health care provider to ensure exercise is appropriate for you and to be informed of any guidelines or restrictions that may be recommended. Some pregnant women may benefit from more intensive or individualized treatment for their back pain.

By: Alicia Silva, MSPT
December 21, 2004

Reference:

Silva, A. Preventing and Managing Back Pain During Pregnancy. Expect Fitness. 2004.