Physical Therapy in the Treatment and Prevention of Pregnancy-Related Back Pain

Mother’s Day is tomorrow, so with that in mind, I would like to provide some information for pregnant women and new moms regarding the benefits of physical therapy during this time in their lives. I have noticed that many women are ill-prepared for the musculoskeletal changes that their bodies incur during this time. Young women who were once athletes complain of joint pain and weakness that they never imagined. They assume they are “out of shape,” but the reality is, pregnancy itself creates muscular imbalances that lead to pain. A physical therapist can help to treat these issues and assist with return to a desired level of physical activity.

I began thinking about this issue a few years ago, when a friend of mine called me. She was in tears due to severe low back pain. It started a week before the call, after she leaned forward to place her nine-month old daughter in her crib. She tried to treat it with heat, rest, and gentle yoga, but to no avail. We met in a teletherapy session, and I prescribed a home exercise routine to help with abdominal and gluteal strengthening, two muscle groups that are particularly vulnerable to imbalances during pregnancy. In a matter of days, her back pain went from unbearable to tolerable, and she had complete relief at the two-week mark.

Let’s review what happens to the musculoskeletal system during pregnancy and why back pain becomes such a prominent feature during this time.  The most notable muscular changes occur as the abdomen distends to accommodate the growth of the baby. In many women, the abdominal distension is so significant that the tendon connecting the two sides of the abdominal muscles can rupture and cause diastasis recti, a separation of the two sides of the muscle.

The abdominal muscles create core stability during bending, twisting, reaching, and carrying, and if they are stretched out of their normal position, the body engages other muscles in the trunk to create stability. These muscles become tight and lead to lower back discomfort. When there is a sudden change in posture, as when my friend stood up from bending forward over the crib, it can cause a muscle spasm, which is the result of a muscle being overworked. In addition to causing pain, a muscle spasm creates abnormal movement. The muscle cannot work in its typical manner, so compensations occur, leading to further discomfort and weakness.

The lower back, or lumbar spine, undergoes a postural change due to the increased weight of the abdomen and decreased ability of core muscles to provide stability. The lumbar spine naturally has a curvature, referred to as lumbar lordosis, which is exaggerated during pregnancy. This creates tightness of the muscles in the lower back and decreased range of motion at the hips. As the curvature of the lower back changes, so does the position of the pelvis, which leads to decreased gluteal muscle strength.

The gluteal muscles provide pelvic stability during movement and also create hip motion. If the gluteal muscles are not able to contract efficiently, then they are not properly stabilizing the pelvis. This is necessary for correct lumbar spine motion; if the pelvis has to accommodate for abnormal hip motion and work to stabilize without adequate muscle restraints, the motion of the lumbar spine will also be affected.

Finally, the passive restraints of the ligaments that hold the bones of the pelvis, hips, and spine in position are compromised due to the release of a hormone called relaxin. This increases the pliability of the ligaments to allow the pelvis to widen and accommodate the growing baby. Relaxin has a global effect, causing increased laxity in ligaments all over the body, including the spine and abdomen. The decreased stability makes it even more important to improve the strength of the surrounding musculature, as muscles will have to work harder to create the missing stability.

So how does physical therapy help with all of this? Truthfully, we cannot prevent all incidences of low back pain in pregnancy, but we can significantly minimize their frequency and severity with surprisingly simple strengthening exercises. The exercises will target the core muscles that undergo changes during and after pregnancy. A physical therapist can provide a “pre-hab” program to create strength and mobility in the hip and back muscles that are most prone to abnormal movement during pregnancy. This will allow the mom-to-be to “bank” strength before pregnancy-related changes begin. Prevention is the most effective way to treat such issues.

During pregnancy, it is important to work with a physical therapist to maintain muscle strength and flexibility. As the baby grows and posture changes, your physical therapist can progress and adjust your exercises to accommodate this. She can also provide you with guidelines for independent exercise routines.  It is beneficial to continue cardiovascular exercise such as swimming and walking throughout pregnancy for improved mobility, weight control, and stress management. Maintaining strength and flexibility will allow for participation in these activities without limitation by back pain.

After delivery, the musculoskeletal system does not, unfortunately, automatically revert to its pre-pregnancy state. It has undergone nine months of rapid changes and requires targeted intervention to ensure that the core muscles can provide the necessary stability and mobility of spinal motion. Caring for an infant puts new demands on the body, as my friend from the beginning of the article discovered, and we want to ensure that new moms are able to keep up with this, without the burden of back pain.

If you have any questions regarding musculoskeletal care before, during, or after pregnancy, please contact Dr. Kopko at Freeform Physical Therapy.

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