New Challenges During Pregnancy That Can Interfere with Being Active

Symptoms, causes, and treatment of back pain

Symptoms of Back or Pelvic Pain Due to Ligament Looseness at the Pelvis

• Pain stepping off a curb
• Pain turning in bed
• Pain climbing or descending stairs
• Pain walking on uneven surfaces
• Feelings of looseness or sliding in your joints

Diffuse middle and lower back pain is usually due to muscle spasms, strain, and fatigue. This dull and achy pain can be made worse bending, lifting, and sitting or standing for a long time. Sometimes, it can be sharp with sudden movements, and it is often worse at the end of the day. Weakness of the core stabilizing muscles, including the abdominal muscles, contributes to this discomfort. Middle and lower back pain of this nature usually is relieved with massage and stretching.

Symptoms of Back Pain Due to Muscle Strain

• Dull, achy
• Worse at the end of the day
• No specific area that hurts
• Better in the morning

How to Prevent Back Pain in Pregnancy

• Begin an abdominal- and spine-strengthening program before becoming pregnant.
• Allow yourself to recline when your back muscles feel tired (lay on your side on the 3rd trimester).
• Wear comfortable, well-cushioned shoes when walking or standing.
• Do gentle back stretches daily (see the end of this chapter).
• Do strengthening exercises at least three or four times a week.
• Avoid bending, lifting, twisting (no "BLT").
• Consider swimming or water aerobics to unload the spine.

Less frequent types of back pain during pregnancy include sciatica, night pain, and bone pain. Sciatica, or leg pain related to back pain, can occur but is very rare. If you are having leg pain, weakness, or numbness in the legs or pelvis, see your doctor as soon as possible. Back pain at night is often attributed to sleeping position and can also result from day-long fatigue and gravity-related biomechanical stress. Sleeping on your left side is more comfortable and also ensures the best blood flow to both you and your baby. Osteoporosis can sometimes be a cause of back and pelvic pain in pregnancy, and although rare, is another reason for taking calcium supplements and vitamin D and making sure you have a healthy diet with enough protein, fat, and calories.

Severe, continuous back pain can be a sign of fetal distress. If back pain is associated with fever, bleeding, severe cramping, or fluid leaks, call your doctor at once. Other internal causes that can lead to back pain include urinary tract infections; stomach or digestive disorders, including constipation; lung or heart problems; or other organ problems. Having pain that is persistent and not relieved by changing position, activity, or rest needs to be evaluated by your doctor. Neurologic symptoms including numbness, weakness, and loss of reflexes require close medical supervision. Do not exercise if you are experiencing any of these dangerous symptoms.

WARNING Call your doctor immediately if you have severe back pain, bleeding, severe cramping, or fluid leaks.

Most back pain can be relieved with modifications in posture, positioning, and activity schedule. Avoid bending, lifting, and twisting without bending your knees and stabilizing your spine (suck in your lower belly with these movements). Avoid activities that make the discomfort worse (such as jogging). Do not wear high heels, and preferably wear walking shoes with extra cushioning. Be aware of sitting, sleeping, and activity positions and posture, and use lumbar cushions and pillows as needed. Using a wedge-shape pillow to support you abdomen while lying on your side can be helpful to relieve back and pelvic pressure. Relaxation techniques and 10 minutes of ice or heat packs to the painful area (not over the front of the abdomen or pelvis) can be helpful. Exercising or swimming in a pool can be very effective to prevent and treat back pain. An SI brace can be helpful with back and pelvic pain due to ligament looseness; a more supportive maternity brace can be worn for general back pain due to postural and muscle strain. The supportive "mother to be" brace may also be worn while exercising to prevent jostling.

More aggressive, active treatment for back pain in pregnancy includes physical therapy, which is recommended for back pain that persists for more than a few weeks, seems to be worsening, or interferes with sleep or activities. Accepted alternative therapies include acupuncture, acupressure, and gentle manipulations. Do not use whirlpools, saunas, or heat over the abdomen and pelvis. The safest medication to take for pain relief is Tylenol; do not take any other medications, even those without a prescription, unless you ask your doctor first.