Many women experience low back pain after childbirth and many in fact have the same low back pain they had during pregnancy. ( About 20-40% of those who had low back pain during pregnancy continue to have pain postpartum). The weight of the baby in the abdomen decreases postpartum. Still, the postural changes, muscle changes, hormonal changes, and the strain of delivery are present and those either continue to further the pain or create a new symptom. You should be able to enjoy all the new moments with your baby and not have them interrupted by low back pain. You should be able to get back to being active whatever that looks like for you to help not only heal your body but help your mental health.

These are some important reasons why it is important to address your low back pain after childbirth. The baby only gets bigger and faster and you should be able to lift and run after them without worrying about hurting yourself. In this blog we will go over some of the causes of low back pain after childbirth, how physical therapy can help, how to get back into exercise and ways to help prevent symptoms from occurring again

Common causes of low back pain after childbirth

Hormonal changes

Our hormones change significantly during pregnancy as well as early postpartum and this can contribute to low back pain after childbirth. Relaxin is a hormone that is released to help make it easier for your muscles, ligaments and joints to stretch. It is a well known hormone during pregnancy and gets a bad rap for contributing to pain. It used to be thought that the increased laxity produced by relaxin caused joints to be unstable resulting in pain.. However more recent studies have found that relaxin actually does not play a big role in joint instability and is therefore not contributing to pain. The changes in the balance of estrogen, progesterone and testosterone play a bigger role in pain and symptoms postpartum. 

When we are in the fourth trimester, the hormone change that does make a big difference is the lack of estrogen (this will change depending on the length of breastfeeding). Estrogen is vital for muscle and tendon strength and vaginal tissue integrity. Making sure the vaginal environment is ideal helps with core control to help decrease pain and adequate strength is important for core control and pain control therefore when we are in a deficit state the same strength may not be present. 

Postural changes during pregnancy 

The extent of posture changes varies with each person but some of the most common changes we see are:

• Increased lower back curve

• Increased thoracic flexion curve

• Stretching of abdominal muscles

• Tightening of lower back muscles

• Tightening of glute muscles

• forward or backward rotation of pelvis

• Widening of ribs 

• Flattening of diaphragm

• Widening of the pelvis

All of these changes during pregnancy can lead to increased stress to our lower back however everything does not go back to where it was before after the baby is born. The body needs guidance on getting back to its “normal” positioning. Therefore starting to build a solid foundation of mobility core and pelvic floor connection, breath work and strength is vital to decrease postpartum low back pain.

Weakened Core Muscles

I think most moms know that their core will be weak after having a baby but it is more than just your abs are weak and that is why you have back pain. 

 Your core, or your core canister, includes your diaphragm, your pelvic floor, your abdominal muscles and then your back muscles. Think of a canister in front of you; the top is your diaphragm and bottom is your pelvic floor, the front and sides are your ab muscles and the back is your back muscles. 

During pregnancy your diaphragm becomes flattened, abs get stretch, usually the multifid get shortened and the pelvic floor gets stressed. Ideally we want a balance between all these structures so they can all function together as a unit. When they are imbalanced the system does not work effectively (you have less core control/stability) but then you also stress different parts of the system which can result in pain. 

Think of that canister again.  If you are always standing holding your baby with the back part of your canister squished (think of leaning back and pushing your hips forward). You are compressing and tightening everything in your back and the back of your pelvic floor, your abs are stretched out in front; this imbalance makes it difficult for you to be stable. This may feel ok for periods of time but if it is the position you are always in it contributes to low back pain after pregnancy.

Physical Strain of Childbirth

What the body goes through during childbirth is extraordinary. It is amazing what our bodies can do but that does not discount the trauma the body goes through to make that happen. It is hard on your joints, muscles and ligaments and they may feel the effects of the trauma afterward contributing to low back pain experienced postpartum.

Understanding how to protect healing structures while being able to do what you need to do during daily activities can help decrease pain faster.

New postures postpartum

Daily tasks after a baby look a little different than they did before. There is a lot of bending forward for all of those diaper changes and bath time. There is more sitting on the floor playing with baby and more sitting during feeding and naps. There is a lot of standing and holding baby generally on one side. Increased frequency of these postures plus increased time spent in them combined with a decrease in core strength contributes to increase stress to our spine resulting in back pain postpartum.

Constipation

Constipation is common after childbirth, due to 

• hormone changes

• pain meds

• reduction  in activity levels

• pelvic floor changes

• Dietary and water intake

I know not what you would think would be in the list of things that would contribute to low back pain but constipation changes abdominal pressure, is related to pelvic floor dysfunction, which can contribute to low back pain.There is also referred pain from the intestines into the low back.

There generally is not one specific cause of low back pain and is usually a combination of all of the above that contribute to symptoms. That makes it even more important that someone is assessing all of you to give you the best plan to decrease and get rid of pain.

Postpartum Back Pain Recovery

 Immediate Postpartum Care

Understanding how to move your body after having baby can be very beneficial to decrease extra stress to your core and pelvic floor preventing low back pain postpartum. There is lots of bending, lifting, and getting up and down from the couch or the floor. 

Getting connected to your core and pelvic floor again with gentle exercises can help make these movements easier.

Working on hip and spine mobility can help decrease the tightness that was caused during pregnancy as well as help decrease postural tightness that comes from all of the bending and sitting that is done with a newborn

Gradual Introduction to Exercise

The important thing to remember when getting back into exercise is that is should be gradual. Moms are being cleared at 6 weeks and going back to doing what they were doing before. This type of transition into activity whether you have or have not had a baby generally results in issues.  The gradual return to activity is the same training principles that exist when returning from other injuries or getting back into activity after being inactive. We are doing a disservice to our moms by not giving them the same advice we would give to others. 

It is also important to know what to pay attention to when you are increasing activity. Some things indicate the progression was too quick.

Things you should not feel when you are increasing activity:

• Increase or return of bleeding

• New or increased complaints of leaking

• Lasting pelvic heaviness/pressure

• Increased pain at cesarean or perineal incision

• Lasting low back, pelvis or hip pain

 We recommend starting with a postpartum physical therapist as early as 2 weeks to get started in building foundations of strength and stability to decrease risk of developing pain or dysfunction. 

You should always consult a healthcare provider before beginning any exercise routine

role of physical therapy

Physical Therapists have been used consistently to help people decrease pain and get back to activity safely after experiencing any trauma (pregnancy and childbirth is trauma to your body!) Mamas should be given the same guidance not just left to figure it out on their own.

Effective Early Postpartum Back Exercises

Gentle core strengthening

These are some of our favorite exercises to reconnect to our deep core. Making sure you feel your deep core engage is key with these exercises.

supine transversus abdominis

hands and knees breathing

mobility

Making sure to incorporate mobility work for your entire spine, as well is to your pelvic floor is important after childbirth.

press up

childs pose breathing

cat-cow

whole body strengthening

Optimizing movement for functional activities we believe is important, especially early on to prevent low back pain postpartum.

Hip hinge

squat

low impact aerobic activities

We recommend picking a low impact aerobic activity you like to do, so that you will do it. Early on, walking is easily accessible and you can keep your baby with you which is ideal for a lot of new moms. Start with 20 minutes and gradually increase.

However, if walking is not something you enjoy possibly yoga focused on postnatal may be a good idea.

Gradual progression

There are many ways to work on increasing the difficulty of an exercise; some options are

• increasing weight

• increasing range of motion

• increasing reps

• moving the exercise from double-leg to single-leg

Here are 2 progressions from the above exercises

hands and knees breathing to bear plank

Double leg hinge to single leg hing

tips for managing and preventing low back pain

There is no perfect sitting or standing posture and no perfect way of moving; instead of thinking of creating balance within our bodies in how we move. This becomes really important in helping to manage as well as trying to prevent low back pain.

For example: if you were stuck sitting in a chair for a long time (causes a lot of flexion at your spine) while baby napped maybe think of doing a couple of stretches that move your body in the other direction (extension), like the above press up exercise, may good afterward to help balance out the stress we place on the spine.

standing

Take standing and holding a baby for a while as an example. Pushing hips forward and leaning torso backwards is a common way people stand to help make it easier on their bodies. Standing like this some of the time is usually fine but sometimes coming into more of a neutral position can help decrease the compression of your spinal joints as well as make it easier for your abs to help take on some of the work.

Working on getting balance to your core will also help with maintaining a balanced standing posture since the muscle pull on your body will be more even.

Check out this video on how to find that neutral or stack position to help your abs show up to decrease back pain when holding baby.

diaper changes

There are so many diaper changes and generally the position is just bent over the changing table with your spine rounded. Changing the motion to more of a hinge position some of the time can help decrease stress/strain to the muscles and joints of our low backs while making our glutes do more of the work. Varying how we do it also helps maintain some of that balance to our spine.

nursing/feeding

I am going to start sounding like a broken record, but there is no one great nursing or feeding position for everyone, it depends on what is comfortable for you. I remember coming home from the hospital with my second and being instructed to use 5 pillows to prop everything just right to nurse. How was I supposed to get all of these pillows where they were supposed to be while holding my baby and helping my toddler. It didn’t seem realistic for life and that is exactly what how we think at Empower. It needs to work for you so find that and then it goes back to finding that balance.

If nursing sitting and your are rounded through your mid back is what works best, then continue to do that. Let’s add a stretch at some point when you are finished to help your back move in the opposite direction to help balance out the forces on your spine. check out the video below for one we like to help.

If we start adding some stretching to balance out forces on our spine initially we can get ahead of any pain from starting to begin with!

Bath time

This is another time when we are generally bent over for a period of time. Here are some tips to think about to help decrease strain to your low back.

• the kitchen sink may be your best friend here (depending on how deep it is). In this position baby is a little more elevated to your level versus having to be so stooped forward which will help decrease extra stress

• go to your knees. This brings your center of gravity closer to the baby and you will have to go through less motion and therefore less strain

• make sure to move through that hinge movement. Even when you go to your knees think of sticking your butt back so your upper body goes forward versus rounding your back down.

Supportive belts/wraps

Supportive belts and wraps can be helpful depending on the source of the pain.

Sacroiliac belts

These can be very helpful for those who experience pubic symphysis pain, pain in the center of their pelvis, after birth as well as pain at the sacroiliac joint which is just below our spine. For pubic symphysis pain; walking, stairs, and turning in bed are usually things that are generally painful with pubic symphysis pain. The Sacroiliac belt can help balance out the forces at the pelvis to help provide pain relief postpartum.

Using one and seeing if it decreases your pain is one way to determine if they are helpful. If it doesn’t decrease your pain it is not doing anything to help. There are also special tests that pelvic floor physical therapists can perform to determine if we think this would be appropriate for you.

abdominal binder

Abdominal binders can be very helpful after giving birth. They can provide support to your core at a time when it needs some assistance to make functional activities a little easier.

They should not be overly tight. You should be able to breathe normally and comfortably. If they are too tight they will put more pressure downward into your healing pelvic floor.

Abdominal binders should weaned around 2-3 weeks. We want your abs to get stronger and re-educated to help you in function and if the abdominal binder continues to be worn your abs do not need to do as much and then do not get stronger.

when to seek professional help

We generally always recommend seeking professional help. It is easier to make quick changes in pain that has been around for a shorter period than pain that has been there for longer. However, if you are not the person who always seeks help here are some signs when you should seek professional care:

• persistent or worsening pain

• numbness, especially if it is moving further away from your spine

• difficulty walking

• changes in ability to go to thebathroom

• decrease in strength or feeling like you can not support yourself or you notice tripping over a foot

• plateaued or worsening symptoms. Symptoms should gradually improve if they are going to do so without any help.

Low back pain after childbirth is not something you just need to deal with because you were pregnant and had a baby. There are many ways to address your symptoms and let you enjoy your time with your new little bundle.

Moms read all of the books on how to care for a baby but there is little guidance given to the mamas, whose bodies just went through so much to birth that baby, on how to care for themselves! Understanding things you can do preventatively as well as what you can as soon as symptoms start can help prevent lasting pain. You have done an amazing thing at creating and growing another person, you deserve guidance to make sure you do not have pain.

If you are currently experiencing low back pain after childbirth and want the personalized care and support you deserve contact us.

Dig Deeper: Uncover More Secrets to Pelvic Floor Health

• link blogs

Hi! We are Dr.Aimee and Dr. Lauren

We are the owners of Empower Physical Therapy and Wellness. We are pelvic floor physical therapists who specialize in helping women from pregnancy, into postpartum and through perimenopause, menopause and then beyond! We believe all women deserve to do all of the things they love without symptoms!

You can contact us via our website, email at hello@weempowerpt.com or social media!

The information provided in this blog is for educational and informational purposes only and is not intended as medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or symptoms. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog.

If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. The opinions expressed in this blog are those of the author and do not necessarily reflect the views of any medical or healthcare institutions.