Lower Back Pain During Pregnancy: First Trimester
Written by Dr. Karah Charette, PT, DPT, RYT
Lower back pain during pregnancy can be common, but that does not mean it is normal.
Addressing back pain early on in the first trimester can be crucial for a better birth experience and better postpartum recovery.
In this blog, you will learn what causes different types of back pain during pregnancy and how to help heal it effectively with quality pelvic floor physical therapy!
Understanding Lower Back Pain in Early Pregnancy
One of the biggest misconceptions of back pain during pregnancy is that the pain is coming from your spine. Sometimes the pain can truly be coming from there. Other times, the pain can be coming from a joint called your sacroiliac joint. You can read more about this joint here.
The sacroiliac joint, or SIJ, is considered a pelvic joint and this pain would be classified as pelvic pain. This is important because if your pelvic floor and hip mechanics have not been assessed to treat this pain, you may not see significant changes.
The SIJ is a highly sensitized joint in the body. During the first trimester of pregnancy, your brain cares A LOT about what is going on in and around the pelvis as you grow your body. Because the brain, and therefore nervous system, are invested in keeping this area safe and protected, it is actually being shown in newer research now that the nervous puts down more receptors sensitive to pain and other input so it can be extra sure of what is going on. It is akin to putting more metaphoric security guards around an area you want to protect.
What happens is that this area becomes more sensitive to stimulus, even if it is not truly a painful stimulus. Folks who have a history of pain at the back, chronic inflammation at the gut, hypermobility, or trauma can already have a more sensitized nervous system and so this area can be even more sensitive to pain than the “average” pregnant person.
This is important to understand because much of the rhetoric around back and SIJ pain in pregnancy is that something is “out” or “unstable” due to hormones and weakness. Though aspects of that may be true, it is not the full story. And walking around with images of feeling weak and “out” of place are not helpful for the nervous system to feel safe and resilient.
This is why a somatic approach to pelvic floor therapy matters. If your nervous system is the component driving your symptoms the most, this needs to be addressed through bottom up regulation techniques and approaches to exercise. Read more about our somatic approach to pelvic floor physical therapy here.
Common Causes of Lower Back Pain in the First Trimester
Beyond the sensitization that can occur at the low back and SIJ during pregnancy, postural changes can also occur. Though your body needs to make certain adjustments and accommodations for the change in your center of mass, if these postural changes go unchecked they can accumulate and add more tension to your back and compression to your spine.
Similarly, you can start to develop compensations and coordination deficits at important muscles such as the glutes and core. If these muscles become too tight or too weak (or both), they can cause other muscles such as your hip flexors and back muscles to over-work. This can lead to inefficient movement strategies that contribute to pain patterns in the long run.
How to Manage Lower Back Pain in the First Trimester
Proper Body Mechanics
When possible, you want to reduce strain and breath holding when performing any type of lifting, pushing, or pulling tasks. One of the most important elements to reduce strain and compression at the spine is to try to maintain a neutral spine when lifting or squatting. This may look and feel a little bit different for every body, but generally speaking you want your ribcage to be stacked over your pelvis. You want to avoid flaring your ribcage and arching your back. You also want to avoid overly tucking your ribcage or tailbone and flexing your spine which is just another form of compression. If you are unsure, having an individual assessment can be extremely informative to ensure you have good posture and mechanics.
2. Take More Frequent Movement Breaks
In general, you should not sit in the same position for more than one hour. Especially when dealing with pain, it is important to have variety in the positions you are in throughout the day. This ensures that muscles do not stay too tight, fascia can stay flexible, and blood flow can improve to the nerves and tissues in areas it might otherwise be getting irritated in. One simple movement you can try throughout the day is a cat cow stretch. You can do this on hands and knees, and if getting on the floor is not an option you can do a modified version with your hands on the wall. This range of motion exercise gets your spine moving and lubricates the joints after getting stiff from being in one position too long. Try doing this 2-3x a day, 10 rounds each time.
3. Pelvic Floor Awareness
It is important to bring awareness to your pelvic floor during pregnancy and when dealing with back pain. Your pelvic floor muscles are an essential part of your core and play a key role in shock absorption. Oftentimes these muscles get too tight and over-recruited, and a tight muscle is not a strong muscle. People mistakenly think to have a healthy pelvic floor you need to do 100 kegels a day, but the reality is that if those muscles never get to stretch or relax, they can actually cause some of your pain patterns and dysfunction. It is important to remember to let your pelvic floor relax after contractions and in general throughout the day.
4. Breathing Techniques
Wondering how to get your pelvic floor to relax? Breathing! When good quality diaphragmatic breathing occurs, the diaphragm expands and lengthens. The pelvic floor muscles generally follow what the respiratory diaphragm does. So when you breathe into your diaphragm effectively, the pelvic floor muscles can begin to lengthen and regulate. One quick way to begin having a diaphragmatic breathing practice is to breathe into your ribcage. Not your belly, not your chest, but your ribcage. Your diaphragm lives right underneath that structure and when you allow you ribcage/ribbasket to expand, the diaphragm has more room to expand as well.
5. Proper Support
In general, you can do all the best exercises for your back and pelvic floor, but if you continue to sit, standing, and sleep with less than ideal postures and positioning, you will plateau in your progress. It is important to address the movements you are in for many hours throughout the day. When sitting, consider using lumbar support so you are not collapsing into your low back and sitting on your sacrum. For sleeping, if you sleep on your side make sure to have pillows between your legs and underneath your sidewaist. Sleeping on your side puts your spine in a relative side bend that can irritate the back and pelvis. When standing, try to avoid overly tucking your tailbone and/or flaring your ribcage out.
These tips are just the beginning of explorations to address your pain. If something does not work or you are confused, it is best to reach out to a professional physical therapist who can individually assess you and tailor this advice to your needs.
When to Seek Professional Help
If you have tried all the tips, tricks, and techniques and are still not seeing consistent changes in your symptoms, it is time to reach out to a professional.
If your pain is worsening, severe, or even affecting your ability to move and walk, it is time to reach out to a professional.
Pelvic floor specialists are the gold standard for low back pain during pregnancy because we can be comprehensive in our assessments. We are still trained in assessing and treating the whole body, and we have the extra training to assess and treat the pelvic floor. Individualized treatment plans that include manual therapy, somatic therapeutic exercise, and comprehensive education is what you can expect at Bodyful Physical Therapy and Wellness.
Mild back pain during pregnancy and the first trimester is common and manageable.
If you are pregnant and want to be proactive about your pelvic floor health, consider reaching out to Bodyful Physical Therapy today for guidance and support.
You can book a free 15 minute discovery call here, right now.
Bodyful Physical Therapy and Wellness is located in Oakland, CA and can help anyone in the Bay Area with an in person visit. Telehealth is a great option for those in the state of CA who cannot come in person. Virtual Somatic Wellness visits are available to folks both in and outside of CA.
Want to learn more?
Read here to learn more about how to prevent leaking urine during your third trimester!
