Back pain is one of the primary complaints of women during the second and third trimester, and often after pregnancy as well. As the weight of the uterus and baby increases and the body's center of gravity shifts to the front of the body, the lumbar spine (lower back) is pulled forward. At the same time, the abdominal wall is weakened as it is stretched, and the joints of the pelvis (especially the sacroiliac joint) are relaxed. These changes place extra stress on the joints and ligaments in the lower back, and the muscles in that area must work harder to maintain the vertical line of the spine. By taking the following steps beginning in early pregnancy, you can reduce your risk of back injury and improve the health of your spine.
Of course, if you are currently experiencing back pain or have a history of back pain, you should consult with a health professional. Self-care is a powerful tool to maintaining your health, but it doesn't replace the advice and services of a trained professional.
1. Regularly assess your posture as your body changes.
Awareness of your posture and working to maintain good posture as your belly grows can help to mitigate the stress on the lower back. On at least a weekly basis, spend a few moments in standing (mountain pose) or seated (siddhasana) positions, observing how your body feels, and activating the muscles that support your spine. Utilize the muscles of the pelvic floor as well to improve stability through the pelvis and sacroiliac joint. Many women find it helpful to wear a support belt under their bellies in the second half of pregnancy to help them maintain proper posture.
2. Avoid prolonged activities or positions that strain the back.
Activities that strain the back include the obvious, such as repetitively bending over and lifting heavy objects, but they also include activities which enforce poor posture habits, such as sitting on an ill-fitting or thickly cushioned chair.
Sitting is one of the most strenuous activities for the lower back, especially if your pelvis is not well supported. If you are required to sit for long periods of time, make sure both of your sit-bones are grounded evenly and the lower back is neutral, not curving forward excessively. You may find relief by changing positions frequently, and leaving your seat to stand or walk when possible. Try to avoid spending a great deal of time sitting deeply-cushioned couches; it is much easier to keep the pelvis balanced sitting on a firm surface.
Lying down for sleep can also be troublesome, especially during pregnancy. Normally, lying on one's back is the best sleeping position for the health of the spine. However, about halfway through pregnancy, most women feel discomfort or nausea or become lightheaded in this position as the weight of the uterus press down on the inferior vena cava, causing blood pressure to drop. Most women end up sleeping on their sides to avoid this problem, but lack of support through the side of the torso and top leg can lead to back pain or sciatica. Placing a pillow under the top leg to keep it level with the top hip, and a small pillow or folded towel under the belly and the waist can help to keep the spine straight while sleeping.
3. Continue to move the body throughout pregnancy and the postpartum period.
Especially during the first and third trimesters, when many women experience fatigue, the idea of exercising is not an appealing one. But exercise, when performed at a safe level, helps to maintain the body, improving our general health and well-being. Of course, you should talk to your doctor about the appropriateness of fitness activities during your pregnancy, but health professionals agree that the majority of women can continue their regular activities, modifying them as needed. Even simple activities like walking can be very healthy for the body, promoting better circulation, digestion and muscle tone.
Most yoga poses are designed with the aim of improving back flexibility, tone and health by moving the spine in its six directions: bending forward and backward, from side to side, and twisting to each side. Moving the spine in these six directions on at least a daily basis balances the spine and maintains its mobility. I've posted before on the anatomy of the spine and easy ways to keep the back healthy. Here are some yoga poses that address concerns particular to pregnancy.
For general toning of the core: Begin on hands and knees, then extend your opposite hand and foot. Hold this position for a few breaths, then repeat on the other side. Concentrate on lengthening through the spine, using the muscles of the core to lift through the lower back.
For sciatica and sacro-iliac discomfort: Warrior I, then transition to Warrior II, holding each for 5-10 breaths. Both poses open through the front, side and back of both hips. Flexible students have a tendency to exaggerate the curve of the lower back, so take extra care in these poses to lengthen that space by drawing your tailbone toward the earth.
For low back strain: A few poses that release tension in the back include puppy pose, legs-up-the-wall and low squat.