Q&A 3rd trimester

I am 30 weeks pregnant and have severe lower back pain. What causes this, and what can I do to manage the pain? How can I strengthen my back?

DR MICHELLE BRITS ANSWERS:

Low back pain is extremely common and typically affects more than twothirds of women during pregnancy. There are many contributing factors, which predominantly include hormonal and postural changes. It is important to note that every woman is unique, and any one, or a combination of these factors, should be considered when searching for the cause. During the first trimester, levels of progesterone increase expeditiously. Higher levels of this hormone help the muscles and ligaments located near the pelvis relax, and this can affect the stability and alignment of the joints in this area. Relaxin is another hormone that is present during pregnancy. It plays a vital part during the early stages by helping the egg implant in the uterus wall and also prevents contractions of the uterus. In preparation for birth, relaxin also makes ligaments and joints in the pelvis relax, so that the birth canal can expand during delivery. Unfortunately, this hormone is also responsible for the instability, postural shifting and pain in the lower back because of its effect on the ligaments that stabilise the spine.

During the second and third trimester,

your uterus will continue to grow bigger, as the foetus grows rapidly. Weight gain, muscle separation, postural changes and stress all contribute to the presence of back pain during these stages and will typically occur where the pelvis meets the spine, at the sacroiliac joint.

You generally gain between 11 and 16kg during a healthy pregnancy. The weight of the growing baby and uterus puts pressure on the nerves and blood vessels located in the pelvis and back, and all of this needs to be supported by the spine, which could lead to back pain.

As your uterus expands, it may cause your tummy muscles to separate, which may also aggravate back pain. These muscles are composed of two parallel sheets that run from your rib cage to your pubic bone. They stabilise your spine and support your back.

During pregnancy, your centre of gravity tends to shift to the front of your body, as your baby and uterus grow in weight. In order to stabilise the body, most women tend to lean back to regain their balance, thereby putting additional strain on the back muscles. This can lead to muscle stiffness and lower back pain. Pregnancy introduces new sources of stress that may be experienced as physical symptoms. Emotional stress can also be the cause of muscle tension in the back, which may be felt as back pain and/or back spasms.

Back pain during pregnancy can be alarming and inevitable, but there are several things that you can do to treat it. Strengthen the muscles and increase your flexibility in order to decrease the stress on the spine. This can include activities such as walking, swimming and pregnancy yoga or Pilates.

If your healthcare provider agrees, you can apply heat or cold compresses on the painful area several times a day. This will help with inflammation and muscle tension. But never apply heat to your tummy during pregnancy!

Avoid slouching when sitting and walking. Place a pillow between your knees when you sleep, as this will take the stress of your back. Place a rolled-up towel behind your back when you sit. You can also wear a support belt to help carry the load. A chiropractor can manipulate your spine, which can be very beneficial during pregnancy. It’s natural and safe. But it is important to find someone who specialises in pregnancy and birth.