Back pain in pregnancy: posture, exercises and when to worry

In the morning, you have to roll onto your side to get out of bed. In the evening, after a day on your feet or in front of a screen, your lower back aches. Back pain in pregnancy is so common that you end up thinking you just have to put up with it. According to Quebec's public health institute (INSPQ), it affects about one pregnancy in two.

It is not dangerous for baby, and it can be eased far better than you might think: through the way you move, carry, sleep, and through suitable physical activity. You also need to recognise the back pain that is not mechanical, the kind that signals contractions or an infection.

Why do you get back pain when pregnant?

Two things add up. First, hormones: they soften the ligaments to prepare the pelvis for the birth, which puts the joints of the lower back and pelvis under strain. Then mechanics: the weight of the bump pulls your body forward and increases the curve of your lower back, which doctors call lordosis.

The UK's NHS notes that back pain can start early, from the first trimester. It often increases with the size of your bump, tiredness and days spent standing still.

Lower back, pelvis, sciatica: which pain is it?

Not all back pain is the same, and recognising each kind helps you ease it better.

Pelvic girdle pain affects up to one pregnant woman in five to varying degrees, according to the NHS. Some women even feel a clicking in the pelvis. It is more common after pelvic pain in a previous pregnancy, in physical jobs or with excess weight.

Pain that runs down the leg deserves a medical opinion: the INSPQ advises seeing a doctor if pain persists, gets worse or spreads to the legs.

Everyday moves that protect your back

The NHS and INSPQ advice comes down to a few easy habits:

• Lifting: bend your knees, keep your back straight and avoid heavy loads. The bucket of water for cleaning, the shopping from the souk and the older child begging to be carried can wait until someone helps you.
• Turning: move your feet rather than twisting at the waist.
• Carrying: share bags between both hands.
• Shoes: flat, with good support for the foot.
• Sitting: back straight and supported, with a cushion in the small of your back if the chair is low or soft. Get up regularly if you work sitting down.
• Getting out of bed: roll onto your side, knees together, then push up with your arms to sit.
• Getting dressed: sit down, especially to put on trousers and shoes if your pelvis hurts.
• Resting properly, especially late in pregnancy. A warm bath or a gentle massage can bring relief.

How to sleep with back pain when pregnant

On your side, knees slightly bent, with a pillow between your knees: that is the position recommended by both the INSPQ and the NHS. It lines up the pelvis and takes pressure off the lower back. Late in pregnancy, a second pillow under your bump helps even more.

If your mattress is too soft, the INSPQ and the NHS suggest sliding a board underneath to firm it up. To turn over in bed when your pelvis hurts, keep your knees together and turn your whole body in one movement. All our position tips are gathered in the article on sleeping while pregnant with a pregnancy pillow.

From the shop

Pillows to ease your back at night

The NHS and the INSPQ advise sleeping on your side with a pillow between your knees. A long pregnancy pillow does that job while supporting your bump and back, then comes in handy for breastfeeding.

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Which exercises help back pain in pregnancy?

Moving remains the best treatment. France's National Authority for Health (HAS) states that physical activity during pregnancy reduces lower back and pelvic pain, although it does not prevent it. For an uncomplicated pregnancy, it recommends 150 to 180 minutes of endurance activity a week, spread over at least three sessions. Walking, swimming, aquanatal classes and prenatal yoga are safe choices, detailed in our article on exercise during pregnancy.

The NHS suggests a simple exercise to do every day:

1. Get down on all fours, knees under your hips, hands under your shoulders, back flat.
2. Pull in your tummy and round your back up towards the ceiling, letting your head and bottom relax gently.
3. Hold for a few seconds, then slowly return to a flat back, without letting it sag.
4. Repeat 10 times, slowly and rhythmically.

Stop if the exercise brings the pain back. After 24 weeks of pregnancy, the HAS advises avoiding exercises lying flat on your back.

Physio and pregnancy support belts: what to expect

When the pain is strong or makes walking difficult, talk to your midwife or gynaecologist. They can refer you to a physiotherapist trained in pregnancy care. According to the NHS, physiotherapy aims to ease pain, strengthen the muscles of the tummy, back, hips and pelvic floor, and stabilise the pelvis. The earlier it starts, the better.

A pelvic support belt is among the aids a physiotherapist may recommend, especially for pain in the pelvis and pubic symphysis. It helps some women and not others. It is better to choose one with a professional, who will check its size and position, than to buy one at random. It does not replace physical activity or the right everyday moves.

As for medicines, the NHS says paracetamol can be used unless you are told otherwise. Even so, no painkiller should be taken without asking: the dose is set by your doctor or pharmacist, and some common painkillers are not suitable in pregnancy.

When should back pain worry you?

Mechanical pain changes with movement and settles with rest. The pain that should alert you looks different. The INSPQ points out that late in pregnancy, back pain that spreads to the tummy or comes back at regular intervals can signal the start of labour. Before 37 weeks, that is a reason to be seen immediately: the signs are detailed in our article on threatened preterm labour.

Pain on one side only, high up below the ribs, with fever or burning when you pee, is among the signs the NHS asks you to report quickly: it may point to a urinary or kidney problem that needs checking without delay. To tell other tummy pains apart, see also lower abdominal pain during pregnancy.

Back pain is easier to manage as a team: your partner and family can take over the carrying, the bending and the cooking on your feet. It is not a whim; it is prevention.