Low back and pelvic pain is common during pregnancy.
What can do to help myself – Low back and pelvic girdle pain
A variety of factors can contribute to the occurrence of low back and pelvic girdle pain in pregnancy. Weight gain causing a strain on joints and a change in your posture, previous back or lower limb pain, fatigue, home or work activities resulting in repetitive lifting and bending and descent of the baby into the pelvic cavity in the last four weeks of pregnancy can all add strain on the joints of the pelvis and spine. This may cause pain in the low back and groin and may radiate to the hips, down the legs, into the abdomen or ribs at bra strap level. Initially you may find difficulty with working, turning over in bed, standing on one leg, driving and household tasks. You will find that the longer you do something such as walking the more pain you get and when you are tired at the end of the day it is generally worse.
Ways to ease back and pelvic pain
- Avoid activities which cause pain and accept help from friends and family with household tasks
- Avoid repetitive lifting or bending. If it is related to your work ask your employed for a work place assessment
- Change positions frequently for example try not to sit for more than 30 minutes at a time
- Maintain a good posture and achieve a balance of exercise and rest
- Avoid constipation by eating a balanced diet and drinking regular fluids
- Use an ice pack for ten minutes over the painful area. Repeat regularly. If you cannot tolerate this, warm baths or heat packs will help with muscle relaxation, massage can help.
- Medication as recommended by your GP or midwife
See below for general advice about different activities and postures as well as other musculoskeletal conditions that can occur during pregnancy.
Stand with your feet hip width apart facing forward. Check your weight is balanced between each foot with your knees straight but not locked. Relax your shoulders down, gently drawing the shoulder blades down and towards each other. Stretch the back of your neck by thinking of lifting the crown of your head towards the ceiling. Holding this posture, gently lift the pelvic floor, drawing your belly button to your spine (as if tightening your belt one notch tighter than usual). Try to maintain this tension when working in standing and avoid stooping when doing activities such as washing up. If you work in standing it may be useful to lean against a wall, bend your knees and gently tilt your pelvis backwards so your spine flattens to the wall.
It is important to take regular walks to maintain your fitness. If you have a lot of pain when walking, avoid uneven surfaces such as cobbles and the beach. Try to maintain the upright posture developed in standing, think about “walking tall”, maintaining gentle tension in your pelvic floor and abdominal muscles (belly button to spine) to hold your hips level. Walking up hill requires a stronger contraction through the abdominal muscles to maintain the best possible posture. Don’t allow yourself to “waddle” side to side. When your heel contacts the ground gently squeeze your buttock muscles to help you stay tall.
Bending and Stretching
When picking up objects or doing housework such as loading the washing machine bend the hips and knees not the spine. If you contract the abdominal and pelvic floor muscles as you are bending or reaching this supports the back. Take care not to over stretch and avoid squatting.
Everything should be held centrally, close to the body or split the load so it can be managed equally left and right for example use two smaller shopping bags or a rucksack. Ensure you avoid carrying heavy handbags, the vacuum or toddlers. If you have to lift get as close as possible to the load to be lifted e.g. toddler, washing basket, Moses basket, vacuum, buggy and use the strong muscles of the legs to push up with whilst keeping the back straight and drawing in the abdominal and pelvic floor muscles.
Sit with your feet hip width apart, facing forward and heels positioned under knees. Try to position the hips at a right angle, with weight equal between left and right sit bones. Using a small rolled towel at waist height supports the natural curve of your lower back. Your shoulders should be relaxed with shoulder blades gently pulling back and down towards each other. Stretch the back of your neck by thinking of lifting the crown of your head towards the ceiling and drawing the chin back. Whilst holding this posture, lift the pelvic floor and gently draw belly button to spine. Ensure you sit on seats that give you support; you may need to use cushions to support your spine when relaxing. Avoid sitting on low chairs, with the legs crossed or tucked up sideways on the sofa. Sitting in these positions can make your pain worse.
Getting out of a chair
Shuffle your weight to the front of the chair then lean to bring your nose over your toes before pushing up with the legs to stand. Avoid twisting whilst standing up, especially if holding any type of load.
Avoid sleeping flat on your back after week sixteen of your pregnancy. When lying in bed lie on your side with one or two pillows under the top leg to keep it parallel to the ceiling. If one side of your pelvis is more painful than the other, lie with that side uppermost. If you wake in pain get up and walk around the house until the pain eases. When lying down a small pillow under your bump can give support also. When turning over in bed, bend your knees up towards your hips, keep them together. Turn your head in the direction you want to move and reach your arms over in the same direction. Keep the knees pressed together and roll onto the opposite side. Don’t sit up from flat before you roll as you may notice your tummy “doming”. When getting out of bed, roll onto side, lower legs over side at same time as pushing up with your arms. Keep your legs bent to aid in the motion of getting up. It is important to contract the abdominal and pelvic floor muscles firmly throughout any rolling or twisting movements.
Practicing relaxation during your pregnancy will help you to rest more effectively and comfortably. Often when we are tired and have discomfort we can feel tension. Tension causes an increase in blood pressure, heart rate, and rate of breathing which can lead to feelings of panic and loss of control. Using relaxation can help reduce, or prevent, tension from building up and can be used during labour may be able to cope better with the pain and feel more in control.
Exercise to help low back and pelvic pain
You can use a combined exercise of the pelvic floor, abdominal and back muscles together which can help ease back and pelvic pain. In standing, lean against a wall with your feet slightly away from the wall and your knees slightly bent. Gently pull in your lower pelvic floor and abdominal muscles and flatten your back against the wall. Hold the contraction for ten seconds and aim to repeat ten times at least three times a day or if you are experiencing back pain.
Diastasis Rectus Abdominis
The abdominal muscle has three layers. The rectus abdominis muscle is the layer under the skin which meets in the midline at the linea Alba, which is a fibrous band running from the bottom of the breastbone to the top of the pelvis. This muscle works strongly when coughing and lifting. The obliques are deeper abdominal muscles which allow you to twist and rotate at the waist. Underneath these muscles is the transversus abdominis which acts as a corset stabilising the spine during movement and controlling posture.
Diastasis is more noticeable in the later stages of pregnancy. You may notice that as you get out of the bath or as you sit up from lying that your tummy “domes” and when you are walking you want to support the tummy. During pregnancy the muscles and the linea alba stretch, thin and lengthen over your growing baby, causing weakness and poor control of movement. With a severe diastasis (up to 20 cm) the back is at greater risk of strain therefore appropriate exercises from your physiotherapist is important. A small diastasis (3cm) often gets better by itself.
Ways to minimise a diastasis
It is important to avoid heavy lifting or sitting up from lying incorrectly, as this may cause bulging and widening of the muscles. If you have a toddler you must take great care to avoid carrying them on your hip, lifting them and putting them in the car or bath as all these activities can overstretch the abdominal muscles and cause pelvic pain. Avoid high impact exercises such as aerobics; zumba and boot camps also sit ups and advanced abdominal exercises unless instructed. If you find your diastasis bulges during coughing, sneezing and opening your bowels Use your hand to support your abdominal muscles.
Abdominal exercises to help diastasis
To exercise the abdominal muscles lie on your side with your knees bent placing your hand on the lower part of your tummy under your bump. As you breathe out, gently draw in your lower tummy away from your hand towards your back. Hold for a count of ten continuing to breathe in and out as normal and then relax. Repeat this exercise ten times, three times as day. As you progress you can practice this exercise in sitting or standing. Try to use this muscle during any activity requiring effort, for example vacuuming, shopping or getting up from a chair.
Antenatal Carpal Tunnel Syndrome
During the later stages of pregnancy you may notice that you are retaining fluid and that you have swollen hands and ankles. A fibrous band across the wrist protects blood vessels, nerves and muscles as they pass into the hand. The area beneath this band is called the carpal tunnel. Swelling under this band causes compression of the nerve and blood vessels, which supply the muscles, and skin. This gives symptoms that may include:
- Tingling or pins and needles affecting the thumb, palm, and fingers of one or both hands
- Night pain
- Hands may be hot and sweaty and mottled in appearance
- Difficulty holding/gripping objects
- Pain/swelling in the forearms.
Please note if the swelling becomes severe, affects your face or gives you headaches you must contact your midwife immediately.
Ways to help the symptoms
- Remove all rings, watches and tight clothing which may restrict circulation.
- When resting keep your hands elevated on pillows and clench/ release your fists several times to improve the circulation.
- If your hands are particularly swollen use an ice pack or plunge your hands in to a bowl of iced water for up to ten minutes
- Use resting splints at night to keep your hands in a good position. These can be provided by your physiotherapist. If you have pain in only one hand, avoid sleeping on that side.
- At work avoid taking weight through your hands and keeping your wrists bent for long periods. Keep your wrists in a neutral position when using computers or working on a cashiers till. You can use your splints throughout the day to support your wrist.
This is the name given to discomfort over your lower ribs that is caused by your growing baby lifting your ribs up and out from their normal position. Try not to sit for long periods especially in the car and avoid sitting on low chairs. Stand without leaning backwards trying to keep your abdominals in a shortened position. Stretching exercises will help especially if you gently contract your abdominal muscles, try lifting your arm on the painful side to the ceiling then bend sideways away from the ache. Sleeping on the unaffected side with your arm stretched forwards on a pillow.