Pregnancy Back Pain: How Physiotherapy Can Help

Why pregnancy loads the back

Several changes happen at once. The growing bump shifts your centre of gravity forward, which increases the curve in the lower back. The abdominal muscles stretch and become less able to support the spine. Hormones such as relaxin soften ligaments to prepare the pelvis for birth, which also makes joints in the back and pelvis less stable. And weight gain adds load.

Add broken sleep, lifting older children and long working days, and it's no surprise the back protests.

Lower back pain or pelvic girdle pain?

Not all pregnancy back pain is the same. Lower back pain is felt above the waist in the lumbar spine. Pelvic girdle pain is felt lower down, at the back of the pelvis or at the front over the pubic bone, and is often worse when turning in bed, climbing stairs or standing on one leg to dress. They're treated differently, and our article on pregnancy-related hip and pelvic pain covers the pelvic side.

How physiotherapy helps

Assessment first, to work out where the pain is coming from and which movements provoke it. Then treatment usually combines:

• gentle hands-on techniques to ease muscle tension and joint stiffness
• exercises to support the back and pelvis, such as pelvic tilts, cat cow and supported pelvic floor and core work
• advice on posture, sleeping positions and daily movements
• a pregnancy support belt where it helps

All of this is adapted to your stage of pregnancy.

Sleeping and daily life

Side sleeping with a pillow between the knees, and another under the bump, takes strain off the back. Getting out of bed by rolling onto your side first, then pushing up with your arms, avoids twisting. When lifting, bend your knees and keep the load close. Our prenatal mobility exercises guide includes gentle movements for daily use.

When to seek help urgently

Back pain with bleeding, fluid leakage, fever, burning when passing urine or rhythmic cramping pain needs your maternity team, not a physiotherapist. So does severe pain that comes on suddenly.

Staying active through pregnancy

Staying active during pregnancy generally helps back pain rather than causing it, as long as the activity suits your stage and health. Walking, swimming, pregnancy yoga and stationary cycling are common choices. Many women find that regular activity reduces stiffness and improves sleep.

Exercise should be adapted as pregnancy progresses. Lying flat on your back for long periods is usually avoided later in pregnancy. High-impact activity, contact sports and anything with a risk of falling are generally best avoided.

Before starting a new exercise routine in pregnancy, check with your doctor, especially if you have complications. A physiotherapist can design a programme that suits your stage and addresses back pain specifically.

Starting early

Treatment works best when it starts early, before pain limits walking and sleep. If back pain is affecting your daily life, our pregnancy and postnatal physiotherapy team can help, at the clinic or at home.