Back pain during pregnancy is a very common discomfort among pregnant women, and can appear either from the beginning of pregnancy (first trimester), or worsen over time and appear in the second or third trimester (as happens more frequently).

Lower back pain during pregnancy is medically defined as '' lumbago '', that is, pain (algia) in the lower back (lumbar region).

In the vast majority of cases, back pain during pregnancy is caused by an overload of the lumbar muscles due to the great postural change that the mother undergoes during the sweet wait.

Only by making a correct diagnosis of the muscles and joints that cause back pain, can it be effectively treated without resorting to drugs , thanks to osteopathic treatments and a good pregnancy pillow.

Before seeing which muscles and joints cause back pain during pregnancy and how to solve it, it is important to understand the cause why the mother suffers more frequently from lower back pain during this delicate period.

Just a few weeks after conception, a woman's body begins to evolve.

This change is due to the variation in the values ​​of some hormones (estrogens and relaxin) which promote muscle, joint and ligament relaxation .

The purpose of these hormones is to make the pelvis and all the mother's muscular-articular structures more mobile, which will have to leave room for the baby's growth and allow for a functional birth.

In addition to the hormonal factor, it is essential to consider that, month after month, the size of the uterus and the baby increases , leading to inevitable adjustments to the spine and posture.

In fact, as the belly increases, the center of gravity gradually moves forward causing a physiological (but burdensome) increase in the curves of the spine , especially in the lower back.

The onset of back pain at the beginning of pregnancy and, more generally, in the first weeks and in the first trimester of pregnancy, often has a hormonal and uterine cause .

Let me explain better.

The lumbar area, in fact, can report pain due to the uterus that, following a strong hormonal change, contracts and prepares for the growth of the baby; we often take it for granted but the uterus prepares for an incredible change in shape and volume in the space of just a few months.

Another evidence that back pain at the beginning of pregnancy or in the first trimester may be due to uterine activity is the fact that one of the first symptoms of pregnancy may be a slight back pain , also caused by the contractile activity of the uterus, which reacts and adapts to the implantation of the embryo in the thickness of its mucosa.

Anatomically, the uterus is located anterior to the spine and its ligaments come into close contact with the iliac bones and pelvis, altering its posture and causing possible referred pain to the lower back .

It is also important to underline that even the back pain that a woman reports in the first weeks or in the first trimester of pregnancy can be caused by a worsening of the muscular contractures of the lumbar region , caused by hormonal relaxation and uterine activity.

In this case, an osteopathic visit and a pregnancy pillow are highly recommended, to take care of your health and that of your baby from the first weeks of pregnancy.

NB: if you have severe back pain at the beginning of pregnancy or it appears during the first trimester, associated with deep twinges, discharge or worsening pain, you should contact your doctor or midwife in order to exclude more serious problems.

While back pain in the first trimester could be more easily caused by a sudden hormonal change and uterine contractile activity, back pain that the mother presents in the second and third trimester is more frequently caused by a muscular-articular overload of the lumbar region (and not only).

In fact, in the second and third trimester, the explosive mix that causes back pain during pregnancy is made up of the bodily effects of hormones (estrogen and relaxin which have already had a significant impact on joint and ligament elasticity) but above all by the growing belly (which alters the mother's posture ).

While on the one hand estrogen and relaxin allow muscles and joints to relax to allow more space for the baby in the womb and its future passage through the pelvic floor and pelvis, on the other hand they reduce the capacity for lumbar , abdominal and pelvic support.

Due to the elasticity of the tissues and the increase in weight and volume of the baby in the mother's womb, from the 12th to 16th week of pregnancy onwards, the centre of gravity gradually moves further and further forward, causing a physiological (but burdensome) increase in the curves of the spine , both the lumbar lordosis and the dorsal kyphosis.

The back is looking for a new balance and, to do so, it accentuates the curve of the lumbar spine by pushing the pelvis forward ( lumbar hyperlordosis ).

At the same time, hormones and the progressive enlargement of the uterus cause the abdominal muscles to lengthen and thin, reducing their fundamental role in supporting the spine.

These enormous postural changes risk creating pain in the lower abdomen (especially when the abdominal muscles are not sufficiently elastic), sacroiliac pain , gluteal pain and back pain (both lumbar and dorsal).

Very often, it is not only the lower back that is affected but also the dorsal region .

Don't worry, a good osteopath and a pregnancy pillow will help you a lot to solve your back pain .

Diagnosing "back pain" is simple ; much more difficult is to diagnose the real cause of your back pain in order to treat it effectively.

Even more so if the woman is pregnant, has a huge belly and it is not advisable to take anti-inflammatory drugs (which would be useful especially for the acute phase of lumbago).

Below I list the most frequent musculoskeletal causes of back pain during pregnancy :

• muscle contractures of the lower lumbar back (paravertebral muscles and quadratus lumborum) that worsen month after month, due to the strong postural changes that the pregnant woman undergoes during pregnancy.
  
  Often, contractures are not limited to the lower back region but often travel up the lower dorsal and upper dorsal spine.
  
• joint stiffness and hypomobility : limitation of movement of the joints of the lumbar spine but also of the pelvis and pubis;
  
• sacroiliac pain : caused by capsular-ligamentous stress of the posterior sacroiliac joints which causes an inflammatory condition with point-like pain in the sacral/gluteal region .
  
• contractures of the gluteal muscles and pelvic floor that cause pain radiating to the hip;
  
• stiffness of the hip joint manifested by deep pain in the buttock, stiffness in hip movement and possible joint clicking;
  
• vertebral arthrosis : following a muscular-articular overload, the joints of the spinal column can become damaged and undergo a degenerative process called vertebral arthrosis.
  
  Nothing irreparable but we must be aware that vertebral arthrosis limits joint movement and predisposes to muscle contractures.
  
• Back pain during pregnancy can be caused by referred pain from intestinal disorders such as constipation or it can be caused by muscle contractures that are worsened by anterior visceral tension (caused by constipation or intestinal disorders).
  
• disc protrusions : The intervertebral discs are cushions composed of a soft internal part (nucleus pulposus) and a fibrous external covering, called the annulus fibrosus.
  
  The function of the intervertebral discs is to support and allow correct movement of the spinal vertebrae, without allowing them to come into contact with each other or "scratch".
  
  However, due to prolonged overload over the years or trauma, the intervertebral disc can become thinner and become painful.
  
  When this happens, it can cause generalized low back pain; it usually manifests as deep, moderate to severe pain .
  
  During pregnancy, it occurs when the mother remains seated for a long time and then gets up , struggling to get back on her feet, or when the mother lies down in bed and struggles to get up.
  
  Disc pain is often associated with back pain also caused by contractures of the paravertebral muscles.
  
  
• herniated disc : A herniated disc is a worsening of disc pain and disc protrusion.
  
  When the intervertebral disc becomes thinner, the internal nucleus pulposus is compressed and is at risk of herniation, that is, protruding posteriorly with the risk of nerve compression of the spinal cord or spinal nerves.
  
  In the acute phase , the pain from a herniated disc is sharp and strong, often worsening; it occurs both at rest and during movements, which risk worsening the back pain.
  
  Following the course of the acute phase, it is essential to treat the back muscles to relax them and improve the joint mobility of the spine itself to prevent a relapse.
  
• back pain from sciatica during pregnancy : another cause of back pain during pregnancy is certainly represented by the irritation of the sciatic nerve, from which what is commonly called ''sciatica'' derives.
  
  The sciatic nerve originates in the lower back, in the lumbar region, runs in the buttock and follows posteriorly along the thigh, calf and foot.
  
  There are various causes of compression and irritation of the sciatic nerve during pregnancy which we will examine in more depth in the next paragraph.

The term Lumbago indicates pain in the lumbar region (lower back).

Lumbosciatica (or commonly known as " sciatica ") is defined when back pain radiates to the lower limb due to involvement of the sciatic nerve, often caused by a herniated disc but not only.

Very often, sciatica in pregnancy is defined as that pain which, in conjunction with back pain, radiates to the buttock or leg but is not caused by nerve compression of the sciatic nerve but rather by simple muscle contractures of the buttock and posterior thigh (easily resolved with muscle treatment).

The diagnosis is a medical one, but osteopathic treatments will certainly help you resolve back pain and sciatica during pregnancy .

Below I will explain how to understand if sciatica during pregnancy is caused by nerve compression or muscle contractures (and how to treat it).

Sciatica during pregnancy caused by irritation of the sciatic nerve is one of the most difficult (but not impossible, in fact) and most painful symptoms for the mother to resolve.

In this case, sciatica presents with lower back pain caused by irritation/compression of the sciatic nerve which causes sharp and deep back pain, with pain radiating to the buttock, posterior thigh, calf or sole of the foot.

Why does the pain occur in both the back and the leg?

The sciatic nerve originates from the lower back, from the last two spinal roots L4-5 and the first three sacral nerve roots S1-2-3.

The union of these 5 nerve roots gives rise to the sciatic nerve which runs in the gluteus maximus, below the piriformis muscle, and continues posteriorly along the thigh, behind the knee, along the calf and under the foot.

There are various causes of compression and irritation of the sciatic nerve during pregnancy which we will examine in more depth in the next paragraph.

In most cases, sciatica during pregnancy due to nerve compression is caused by a herniated disc that compresses the spinal canal or spinal roots.

In this case, it is necessary to carefully evaluate the situation and understand if there are associated symptoms of radiculopathy .

The symptoms to understand if sciatica is due to nerve compression are:

• severe, acute and disabling lower back pain
• pain in the buttock or radiating to the leg from behind
• changes in sensation in the leg,
• tingling along the course of the sciatic nerve,
• shock along the leg,
• weakness or loss of muscle strength in the lower limb;

After making a diagnosis of sciatica during pregnancy caused by nerve compression, it is important to resolve the acute phase as soon as possible (usually lasting 3-7 days) in order to then be able to treat the lumbar muscles , those of the lower limb and improve the patient's posture which has caused a lumbar overload and consequent disc/radicular suffering.

Only in this way can you truly resolve sciatica pain during pregnancy and prevent relapses.

After talking about sciatica during pregnancy caused by compression of the sciatic nerve, let's talk about sciatica caused by muscle contractures of the back and leg .

Fortunately, in most cases, sciatica during pregnancy (i.e. pain radiating to the buttock, back of the thigh, calf and foot) is not caused by a herniated disc or nerve compression but rather by "simple" (albeit painful) contractures in the muscles of the lower limb and back.

The posterior chain of muscles in the body represents a group of muscles that work synergistically with each other and influence each other.

The posterior muscle chain originates from the plantar fascia, goes up into the calf and the back of the thigh, into the gluteus maximus and continues along all the paravertebral muscles of the back (from the lumbar to the cervical).

When a person, in this case a pregnant woman, has low back pain, the contractures will be in the lumbar muscles but probably also in the adjacent body regions (dorsal, gluteal, thigh, etc.).

This explains why, even in the absence of compression of the sciatic nerve, back pain during pregnancy can present itself as ''sciatica''.

To treat back pain and sciatica during pregnancy , it is therefore necessary to deeply relax all the muscles of the back and also those of the lower limbs, in addition to improving the joint mobility of the spine, pelvis, hips, knees and ankles.

This is the work done by the osteopath and a good pregnancy pillow placed between the legs and under the belly during night sleep.

Before explaining in detail how to solve back pain during pregnancy, I want to anticipate that it can be prevented.

Yes, you understood correctly.

Keeping the muscles of the lower limbs loose, a relaxed back and other fundamental precautions during sleep and during the day, can help you prevent back pain during pregnancy.

Look for an osteopath specialized in the treatment of pregnant women who can begin a path of support from the first months of pregnancy, when you have no back pain or it is light.

During pregnancy, take care to maintain a healthy and balanced diet, rich in fiber and nutrients for the development of your baby.

This allows you not to gain too much weight and to better nourish the health of your baby already in the womb.

Another tip is to maintain an active lifestyle, not by giving up physical exercise but simply by doing it in an intelligent and functional way.

Do moderate physical activities, without the risk of joint trauma and that do not require excessive physical effort.

Stay moving, because regular physical activity keeps your back muscles trained, improving tone, stability and joint mobility.

Recommended physical activities are simple walking, water aerobics, yoga or pilates during pregnancy.

Yoga and Pilates are fantastic activities because they combine diaphragmatic breathing with light muscle activation, stretching and mobilization of the main body joints.

These disciplines are perfect for both those who already do them and those who have never done so.

As for aquatics during pregnancy, it is a perfect physical activity because it allows the pregnant woman to exercise in water, that is, in the absence of gravity that weighs on the spine.

During water activities, the mother improves muscle tone and improves flexibility without overloading the back and joints; water activities are a perfect activity that the mother can do until the last weeks of pregnancy.

Below I suggest other useful tips to prevent back pain during pregnancy.

First of all, wear comfortable clothes that do not compress the belly and allow plenty of freedom of movement for the back and legs.

Wear comfortable, low-heeled, well-cushioned shoes; I'm talking about sneakers or gym shoes.

Avoid high heels or shoes with hard soles; they overload the ankles, knees, hips and back; in addition they worsen the impact on the articular discs of the spine.

If your job is sedentary, make sure you have a chair with good lumbar support; if your chair doesn’t have it, use a pillow behind your lower back to keep it aligned (not flexed).

Try not to sit for too long and, if you can, take 4 steps at least every 45-60 minutes of work.

Sitting for too long strains the lumbar muscles and promotes the onset of back pain and neck pain, as well as straining the circulatory system and worsening drainage of the lower limbs.

Avoid sudden movements and sudden strains; if you have to get out of bed, turn onto your side and use your hand to lift your back.

Avoid lifting heavy objects and, if you have to do it, bend your knees and hips to avoid overloading your back.

Finally, make sure you sleep on a comfortable mattress that is not too hard; sleep on your side (preferably your left) and use a pregnancy pillow designed specifically for your needs.

Night sleep is a fundamental aspect for a healthy pregnancy and to prevent back pain; the pregnancy pillow is therefore a very important investment for you but you must choose it well.

Here you will find how to choose the best pregnancy pillow.

To effectively treat back pain during pregnancy and prevent it from returning, you need to make a correct diagnosis and act accordingly.

As I explained earlier, back pain during pregnancy is often caused by muscle contractures and joint stiffness in the spine and lower limbs.

This is why I strongly advise you to consult your doctor and immediately contact an osteopath specialized in the treatment of pregnant women.

This advice is even more valid during pregnancy than not, because when you are pregnant, medications should be taken as little as possible to avoid the risk of adverse effects on the fetus.

In cases where, after consulting with her trusted doctor, the mother should be told that it is necessary to proceed with pain therapy, paracetamol would be the first choice option.

Warning: this drug represents the main point of reference when talking about painkillers during pregnancy both in the case of persistent painful symptoms and in the case of acute pain.

Having clarified the need to limit drugs as much as possible during pregnancy and, at most, use paracetamol for back pain during pregnancy as a first-choice drug, I would like to remind you of the existence of drugs that, as can be read in the official guidelines of the AIFA (Italian Medicines Agency) , are defined as "second choice".

These are acetylsalicylic acid, the active ingredient in aspirin, ibuprofen and indomethacin, an active ingredient belonging to the NSAIDs (nonsteroidal anti-inflammatory drugs).

Always based on the recommendations of AIFA experts, they should be used, if you are pregnant, for short periods and with low dosages.

They are indicated in cases where there is resistance to pain therapy with paracetamol.

They should be avoided – the reference is always the guidelines mentioned above – in the third trimester of gestation .

Why? The reason is related to their potential negative effects on fetal circulation.

Osteopathy during pregnancy accompanies the postural development of the expectant mother from the first weeks of life and helps her prevent or resolve back pain during pregnancy.

Thanks to gentle and effective manual treatments on the musculoskeletal system, the osteopath supports the evolution of the center of gravity and the curves of the spinal column, relaxing the muscles and improving joint mobility in the various body regions.

Osteopathic treatments (specific massages and joint mobilizations) offer numerous benefits to pregnant women; massage has a decontracting effect, relieves back pain (and not only), stimulates tissues, improves microcirculation and lymphatic drainage.

During treatments, the osteopath not only evaluates the lumbar region but also performs a complete and in-depth postural assessment of the patient's posture.

The treatment will be aimed not only at resolving the back pain, but also at improving the posture that created the lumbar overload and the resulting lumbago.

In fact, during the treatments the osteopath will also evaluate and treat the legs, calves, feet, the entire back, the abdomen, the diaphragm and the main body joints (both of the lower limbs and the spine).

In this way, thanks to targeted osteopathic treatments, back pain during pregnancy can be effectively resolved within 4-6 osteopathic sessions and prevented from recurring.

NB: Osteopathy is both a remedy and an effective preventive method for the most frequent pains during pregnancy:

• backache,
• sciatica
• buttock pain,
• sacroiliac pain,
• lower abdominal pain,
• pubalgia,
• leg cramps,
• neck pain
• headache during pregnancy.

This explains why it is advisable to undertake an osteopathic path whether you suffer from back pain (or other pains), or to prevent it.

You can see an osteopath from the beginning of the second trimester of pregnancy or even earlier if you wish.

Another reason to start an osteopathic path during pregnancy is that, by treating the pelvis and the pelvic region, the tissues (muscles and joints) of the future mother are prepared for the birth itself, resolving the possible rigid and contracted areas that would make it more difficult.

It has been shown that some obstetric complications requiring episiotomy, ventouse, or other obstetric interventions during labor and delivery may be caused by joint stiffness and musculoskeletal tension in the woman's pelvis.

Please remember to always choose an osteopath with experience in treating pregnant women for an initial assessment and treatment visit.

Sleeping well during pregnancy and having restful sleep is essential.

Sleep is an essential regenerative process for both the body and the brain.

During pregnancy, sleep becomes even more crucial for the mother's health and the well-being of her back.

However, due to the great postural changes that pregnant women undergo (muscle overload, large belly and decreased drainage of the lower limbs), we know well how many women suffer from back pain and insomnia.

This is why, to prevent and/or resolve back pain during pregnancy, it is highly recommended to use a pregnancy pillow to be placed between the legs and slid under the belly.

1. The pillow between the legs has the function of distancing the legs, keeping them aligned with each other and relieving the tension that is created on the pelvis and back (lumbar).

2. The belly pillow is the other half of the apple for an effective pregnancy pillow.

The three-dimensional lines of the pillow must be designed to adapt to the mother's belly like a delicate glove placed between her and the mattress.

In fact, when the belly grows, its weight begins to be felt, both in an upright position and when lying on your side.

The reason is simple, when the mother lies on her side, the force of gravity and the weight of the uterus creates a rotation of the dorsal and lumbar spine, resulting in tension on the back muscles.

Thanks to its enveloping lines, the Dr-Silva pillow slides delicately under the mother's belly to best support her as she grows, month after month.

Thanks to a customized support, the pillow perfectly supports the belly and prevents its weight from stretching the abdominal tissues, rotating the spine and creating tension on the back and pelvis.

Back pain is a very common problem in pregnant women which, in most cases, is caused by contractures and stiffness of the lumbar spine.

In this case, although painful, there is no need to worry about imminent dangers to the health of the baby or the mother.

Certainly, back pain is an important symptom that should not be underestimated and should be resolved together with your doctor and osteopath.

When you suffer from back pain, always consult your doctor or gynecologist to make sure it is not a symptom of a serious problem that you should worry about.

I'll give you some examples that will help you understand when to worry about back pain during pregnancy .

It is rare that severe back pain in the first weeks of pregnancy can be one of the symptoms of miscarriage; in the third trimester back pain can be a symptom of preterm labor.

There is cause for concern when back pain during pregnancy presents itself as a continuous pain, not recalled by movement, very deep or throbbing.

Back pain during pregnancy can also be a sign of an infection or other problems with the urinary tract (kidney problems or simple cystitis ).

If you suffer from back pain, it is always advisable to contact your doctor but especially if you also have fever, bleeding or other vaginal discharge, uterine contractions, pain during urination and the pain does not go away even if you rest lying down.

Please remember, never underestimate back pain during pregnancy and take care of yourself.

Happy pregnancy and see you soon,

Dr. Silva