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Management of Back Pain of Pregnancy

Updated: Nov 26, 2020

The treatment of back pain in pregnancy depends on the stage of pregnancy, underlying cause, aggravating factors, and the presence of other medical conditions, such as diabetes or heart problems.

Both medical and psychological treatments may be warranted in some cases when the ability to perform daily activities and participation in social events is significantly affected, impairing the quality of life.

After the warning signs and symptoms are ruled out, treatment options typically include postural correction, physical therapy, medical management, and/or surgical intervention.

Postural Correction Helps Relieve Pregnancy Back Pain

Maintaining an ergonomically supported posture throughout the day can help take a considerable amount of stress and strain off the lower back tissues. Doctors also advise taking rest, limiting strain and high impact activities, and performing stretches and exercises to build strength in the pelvis, hip, and lower back. Pain-relieving medications such as NSAIDs are not considered safe during pregnancy and must be avoided.

Ergonomically supported sleep positions reduce mechanical strain in the lower back

A side-sleeping posture with the use of appropriate supportive pillows is recommended in pregnancy.

  • Using a pillow between the knees and ankles while sleeping brings the top of the knee at the same level as the hip, reducing strain on the lower back.

  • Placing a vertical pillow near the abdomen and upper body can help support the top arm and chest area.

The head and neck may be supported by a small rolled-up towel placed under the neck inside the pillowcase.

Using a lumbar roll helps avoid pregnancy back pain while sitting

Using ergonomically supported posture while sitting for extended periods can help decrease the frequency and intensity of back pain.

  • Sitting up straight and aligning the ears, shoulders, and hips in a vertical line is recommended.

  • Using a lumbar roll in the small of the back can help support the spinal curvature.

  • This roll may also help reduce pelvic pain that occurs from a sit-to-stand position.

  • Inflatable lumbar rolls are best suited for pregnant women to accommodate the change in body size and posture.

Taking short breaks every hour and briefly stretching or walking a short distance (without pain) is typically recommended.

Limiting standing and walking reduces the occurrence of back pain

If standing and/or walking causes or aggravates pregnancy back pain and leg pain, a maternity brace and comfortable walking shoes that provide shock-absorbing properties may be used. In general, any activity that includes long periods of standing and/or walking must be avoided and intermittent sitting must be performed.

Taking Rest and Applying Heat Therapy Can Help Heal Sore Tissues

Taking short periods of rest during the day helps ease muscle spasms and relieves acute pain. While taking rest, keeping both feet elevated can help bend the hips and decrease the curvature in the lower spine.

Using a heat patch in the lower back area and/or rear pelvis can help reduce soreness, decrease muscle spasm, and improve blood circulation. The heat source must be used for 15 to 20 minutes at a time and be of a tolerable temperature. Placing a barrier, such as a towel, is advisable to avoid burns.

Physical Therapy and Exercise Builds Lower Back Strength and Endurance

Maintaining an optimal level of function throughout your pregnancy and having the least amount of discomfort are the main goals of treatment for back pain during pregnancy.

Physical therapy encompasses postural modifications, back strengthening, stretching, and range-of-motion exercises. Appropriate physical therapy and exercise for pregnant women instructed by a trained therapist can help strengthen the soft tissues and muscles around the lumbar spine (lower back).

  • Flexion exercises (bending forward) help make the abdominal muscles stronger, improve core strength, and decrease the lumbar curve.

  • Extension exercises (bending backward) help increase strength in the paraspinal muscles that provide stability to the spine.

Physical therapy and exercise to reduce back pain in pregnancy include low-impact options, such as pelvic tilts, knee-to-chest stretch, straight leg raise, curl-ups, side-lying leg raise, and the Kegel exercises.

Choosing Safe Pain-Relieving Medication Avoids Fetal Complications

Any form of medication is used with caution in pregnancy to reduce the risk of potential harm to the developing fetus. Only a specific group of drugs are considered safe in pregnancy and within this group, certain drugs must be avoided in the first trimester and are only prescribed in the second and third trimesters.

  • For back pain and pregnancy pelvic pain, acetaminophen is considered relatively safe and used as a first-line drug.

  • For nerve pain, such as in sciatica or radiculopathy, anticonvulsants (gabapentin) or antidepressants (amitriptyline) may be prescribed with caution for short term use.

  • For debilitating or severe pain, opioid medications may be recommended, but the dosage and regimen are prescribed with caution to avoid opioid withdrawal in the newborn.

As a general rule, it is always advisable to consult a physician before taking any medication, including supplements, over-the-counter (OTC) medication, ointments, and/or inhalers, while pregnant.

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