In this post, I’ve asked Dr. Nuket Curran PT, a physical therapist of 18 years, to discuss pregnancy and postpartum back pain, and what new moms can do to alleviate their pain and discomfort. Her focus for the last decade has been management of low back pain. Dr. Curran has been treating patients for orthopedic conditions and educating new physical therapists at several local universities.
If you suffer from low back pain after having your baby, it’s actually quite common. Postpartum back pain can be directly associated with the hormones that pregnancy and nursing creates in our bodies. In fact, you may still have relaxin, one of the hormones released during pregnancy and nursing, in your body for months after birth and even after you finish nursing.
Relaxin has several jobs including preparing the body’s tissue for pregnancy and relaxing the ligaments that support the joints to prepare you for delivery. Relaxin ultimately allows you to stretch as needed when the child is born. The thing about this ‘relaxing’ process, is that your joints still may remain “loose” until the hormone lowers its production, which could take up to 5 months postpartum.
When you bend over to get your child out of the crib, seat or carrier and notice a catch of pain in your back, this could be due to this laxity or relaxing of the ligaments. In this case, your lumbar spine needs a little more muscular assistance to stabilize and support your spine in order to decrease the pain. It can be that simple. (Note: In more serious conditions, like spondylolisthesis, slippage of one vertebrae on another, this would require medical assistance for correction.)
Simple ways to alleviate postpartum back pain include stretching, use of heat and ice, along with stabilization exercises. For acute pain, or brand new pain, ice is often used to decrease the blood flow to the area which decreases swelling – one of the main causes of pain. It also provides a numbing effect, telling the surrounding nerve pain fibers to “simmer down” and stop firing so fast and furiously. The result = less pain. Your main goal in the acute stage of any injury or onset of pain is to calm it down and decrease any local swelling. That’s why ice is so useful in the early days. You should ALSO keep moving through the pain, but in a sensible way. Applying ice as often as possible will help decrease the pain as you begin strengthening. Wearing a Recovery Wrap, for example, enables you to keep moving which is essential.
After the initial 72-hour period, you can opt for ice or heat to flood the area and also provide pain control. When you apply heat, you increase blood flow to the tissues which allow them to become more pliable.
Remember, pain tells the muscles to stop firing because something is not working right. That’s why it is so essential to continue moving around rather than just resting it out. A dysfunctional muscle cannot help support a sore back! Back pain can actually shut down abdominal muscle activity which is why it is so important to keep moving. That said, there is a difference between being sensible after injury and returning to high level activity right after. Common sense applies, little and often is my motto.
Go-To Tips for postpartum back pain relief:
1. Do NOT sit with your legs crossed. This can sometimes cause slight rotation of the pelvis (Sacroiliac joint) causing pain in the low back or tail bone.
2. When lifting, always maintain a straight spine and bend your knees to perform the actual lift. A bent spine is weaker because the muscles are stretched and perform less effectively in an elongated or stretched position.
3. When lifting, get as close the load, or wriggling toddler, that you have to lift as possible. This decreases the amount of force you put through your joints.
Simple ways to strengthen & stabilize your back:
1. Abdominal strengthening should include relearning how to “zip up” your abdominal muscles which may have separated during pregnancy due to stretching out as your baby grows. This includes practicing without doing crunches, focusing on drawing in your belly button while tightening your abdominal muscles. This takes practice so be ready to put the time in to get it working! I like to start these in a kneeling position so that gravity helps tell you how to draw your lower abdominal muscles up and in to “zip up”.
2. Using a physio ball, lay with your stomach on the ball. Keep your abdominal muscles “on” or contracted and slowly raise one leg at a time off the floor. Start with 10 on each leg and build up to 3 sets of 10. To make this slightly more difficult as you gain strength, you can also raise the opposite arm at the same time as you raise the leg.
3. Child’s pose stretches. This stretch is a nice transition from the position in #2. Remove the ball from your stomach, sit back on your heels while allowing your knees to come apart and allow your arms to fully straighten out above your head. Stretch for at least 30-45 seconds.
Above are just a few of the exercises you can do for postpartum back instability. Dr. Nuket also demonstrates these positions in this video.
If you attempt the activities above and still feel significant pain, do not continue. Ask a physical therapist for additional guidance and or an evaluation to determine if your back pain is due to something other than instability. Dr. Nuket Curran, PT provides individualized outpatient therapy in Pittsburgh, PA. You can contact her through her website or email if you have any questions about this post or back pain instability.