cause of back pain during pregnancy

Dr. Morgan Massingale is a naturopath who specializes in sports medicine and women’s hormones in Scottsdale, Arizona. In this post, she speaks with doctor of physical therapy and Scottsdale clinic owner Dr. Tom Padilla about the real cause of back pain during pregnancy and some of the best, but often overlooked, solutions for long-term, root-cause-focused relief.

Dr. Massingale

You told me this once, “Just because something is common doesn’t mean it’s normal.” 


I see this all the time in my practice. Patients come in, and they’ve been dealing with a symptom for ages, and because their mother has it, and their grandmother had it and since they all experienced the same thing, they think it must just be a part of life. But it’s not. You don’t have to live that way. 


This series is dedicated to taking charge of your health during pregnancy, knowing what questions to ask, being able to be more proactive, and not having to deal with these things that are common when they’re not normal. 


What Is The Actual Cause of Back Pain During Pregnancy?

I met you, Tom, after my first pregnancy. I had suffered with pretty significant back pain through my first pregnancy and afterwards. I started working with you and the doctors here at The Doctors of Physical Therapy in Scottsdale. 


Then I became pregnant again, and it was a completely different experience. I didn’t suffer from back pain. And when things pop up, I was actually able to come in and say, “Hey, this doesn’t feel right. Let’s address it.” Right away, with some manual therapies and cognitive exercises, that pain was resolved. That’s hugely powerful. So it’s really special to have you on this first piece.


Dr. Tom Padilla  

Well, thanks for having me. Absolutely, we can do a lot to make pregnancy less miserable or almost enjoy it.


Dr. Massingale

So I just want to start off by talking about low back pain. It happens in 50 to 80% of women during the course of their pregnancy. Can you talk to us kind of about what joints are most affected during pregnancy? And kind of why we see back pain pop up at this phase of life?


Dr. Tom Padilla  

The number one joint most affected during pregnancy and low back pain is your SI joint, right. So your SI joint is made out of your sacrum, which is your tailbone and your ilium, which is your pelvic bone. 


These bones have a few degrees of freedom, so they should move a little bit. But the problem with the joint, because it’s so irregularly shaped, is that it can actually get stuck out of place. And when it gets stuck out of place, that creates different muscular patterns and different instability issues, which your brain interprets as looseness or instability. 


To compensate, it starts to tighten up all the muscles around the area. But now you’ve got a loose joint that has tight muscles around it. So you have a lot of compression and grinding, which starts to cause inflammation, and overtime, that causes pain. 


One of the reasons this happens more often during pregnancy is because your body is releasing hormones that are preparing it to pass a child by loosening the ligaments so that the pelvis can open. 


A lot of people are at work for eight hours a day sitting and putting pressure on the bones, slowly shifting their position throughout the day and stretching those ligaments because the hormones being produced are allowing those bones to be shifted out of place. 


And then the bone just gets stuck like that. 


So over time, that’s exactly why you start to have SI joint pain. Or it can even be from an injury or dysfunction that you had three or four years prior. Right. So in your case, when we first met, right you’d already been through your first pregnancy. And in theory, this may have happened during your first pregnancy, but you start having pain that lasts well into your second. So you can have that pain that crops up because of something that happened two years prior as well.


What Do Hormones Do To Your Body During Pregnancy?

Dr. Massingale

So you kind of touched on the hormonal aspect, and I think one of the things that’s causing most of the problems here is relaxing, right, which does exactly what its name implies. It’s relaxing all of those ligaments to, as you said, allow for the pelvis to expand and allow for vaginal delivery and childbirth.


I think people assume that that hormone isn’t released until right before we deliver. But that’s not the case. Rapid expansion of those segments would cause a lot of irreparable damage.


The production of that hormone actually peaks in the first trimester. And it has a bunch of other things that we don’t need to get into. But women start experiencing pain and this laxity kind of in that second trimester, and then into the third, which is then compounded by this shifting body habitus that we have, right? So you’re carrying a bowling ball on the front of you, which necessarily changes your center of gravity. Can talk to us a little bit about how that affects that kinetic chain and how that’s a contributing cause of back pain during pregnancy?


Dr. Tom Padilla  

Aside from having this weight that you’re carrying, when your abdomen is expanding, you have a child that you’re growing in your uterus, clearly. And that’s pushing your transverse abdominus, which is one of the deeper muscles in your core, into a wider and wider position.


Now one of the things that we know that happens with muscles is as muscles get stretched, they actually become a lot weaker, just naturally. So if you’re not doing things to actively try to maintain that muscular strength, what that’s going to do is create not only imbalances from being thrown off, but your core can contract in a way that keeps your center of mass over itself.


So what ends up happening is your back starts to extend a little bit more, and more muscles start being used in order to keep you in an upright position. So you start to develop pattern dysfunction, which means that you’re using the wrong muscles to do things because the muscles that normally do that job aren’t capable of doing it anymore. Basically, you can’t actively use your core.


Dr. Massingale

Yeah. Pregnancy is like running a marathon, and then having a really intense sprint event at the end. I think one of the things that we don’t consider is being conditioned for that. So we go from this sedentary lifestyle where we’re kind of sitting a lot of our days, and then we get pregnant and put all of this added demand on the body and expect it to just kind of happen. This is another big cause of back pain during pregnancy. So when should a woman seek help? Should they wait until they’re having pain? Or should they be a bit more proactive about that?


How Can I Relieve Back Pain During Pregnancy

Dr. Tom Padilla  

Absolutely. One of the things that’s interesting to consider is that people have to go through physicals for a job where they have to lift like 30 to 40 pounds, right. But there’s nothing for this job that’s nine months long, continuous, and requires you to carry this weight around with you. So a lot of the time, even getting your structure evaluated early on in pregnancy, or getting your muscular function and weakness and range of motion checked out would be a logical thing to do. 

But that’s not very common. So I think the most important thing to do if you’re planning on getting pregnant and you do have any sort of back pain or hip pain is to get these things checked out and addressed so you can treat the real cause of back pain during pregnancy. Get on some sort of strengthening program to carry you throughout your pregnancy with as few issues as possible. Maybe even resolving those issues completely so you’re not having any issues throughout your pregnancy.


Other Free Resources For Women Suffering From Back Pain During Pregnancy