Expecting changes: ten ways to fight lower back pain during pregnancy

American Fitness, Nov-Dec, 2003 by Rick Olderman

Approximately 50 percent of all pregnant women experience low back pain (LBP), mainly resulting from mechanical changes in the body. As the fetus grows, spinal alignment alters, causing stress to ligaments, joints and muscles. Here are a few tips to help reduce or prevent LBP during this exciting time. The listed stretches should be performed in a pain-free manner and as often as needed throughout the day. Stretches should be held for 10 to 30 seconds without bouncing or holding your breath.

1 Quadratus lumborum (QL) stretch. Often associated with LBP, the QL runs from the hips to the lower ribs and attaches to the spine. To stretch the left QL, sit on the edge of a chair and lean forward with your back straight and elbows on your knees. Keeping your weight on your right elbow, raise your left arm over your head and sidebend to the right. You should feel a stretch in your left lower side and/or back. To reach the QL's potentially tight rear fibers, reach forward. You should feel the stretch in your low back. Stretch the opposite side by resting on your left arm and sidebending to the left.

2 Piriformis stretch. Tight hips can ultimately lead to LBP. To stretch the left piriformis, sit on a chair, put your left ankle across your right knee and bend forward, keeping your spine straight, from your hips. You should feel a stretch in your left buttock. Putting downward pressure on your left knee enhances this stretch and can also relieve sciatic pain. Since one side is usually tighter than the other, be sure to stretch both hips.

3 Standing hamstring stretch. Tight hamstrings can limit pelvic motion and, thereby, put the spine in a flexed position and create uneven stress on the intervertebral disks. This stretch efficiently targets all hamstring muscles. While standing, place one foot on a chair's seat and hands on your hips or stable surface if you feel wobbly. Keep your back straight and point the propped foot's toes to the ceiling,. While looking ahead, bend forward, keeping the spine straight, from the hips until you feel a stretch in your hamstrings. Do not touch your toes or bring your nose to your knee because this involves spinal flexion. Then, keeping the stretch, move your foot from side to side. You should feel different areas of the hamstrings stretch. To stretch your outer hip area, move your foot in and trunk out.

4 Railing stretch. Hold onto a sturdy railing with both hands and lean back with either bent or straight knees. This stretch targets the shoulders and rhomboids.

5 Chest stretch. As the breasts enlarge, the shoulders and head will often be pulled forward, thus shortening the chest muscles. Stretch your chest muscles by placing your arm at shoulder height with elbow bent 90 degrees on a doorway. Then, turn your head and torso away from the arm to stretch your chest. This helps re-establish proper shoulder and head alignment.

6 Pelvic tilts and circles. To perform a pelvic tilt, sit towards the end of a chair. While maintaining an upright posture, roll your sit bones forward. Then, roll them toward the back of the chair. Repeat this motion, generating the movement from your pelvis, not your legs. It is better to use a fitball to perform pelvic circles. Sitting on the ball, perform pelvic tilts and then move into a side-to-side motion while keeping the trunk steady. Those are the borders of your circle. Now travel from one side, into the forward motion of the pelvic tilt, to the other side and into the back motion of the pelvic tilt, thus completing the pelvic circle. This helps loosen the lumbo-pelvic junction, relieving stress and pressure.

7 Cat stretch. Start this stretch with your hands and knees on the floor or bed. With elbows straight, round your spine toward the ceiling. Then, slowly allow it to drift back down, as if trying to touch your navel to the surface beneath you. This mobilizes the low back as well as stretches tendons and ligaments.

8 As center of gravity and weight change, foot/ground contact changes as well. Usually, this results in increased pronation (i.e., flat feet). Purchase a comfortable pair of shoes with good arch support to re-establish proper foot mechanics.

9 When in your living room, try sitting on a padded, straight-backed chair instead of a soft couch. This will help you maintain proper spinal alignment while watching TV or reading. Sit on the chair for 10 to 30 minutes, then switch to a more comfortable chair, as needed.

10 Include pool walking/jogging, calisthenics or swimming in your workouts. If your exercise regimen is completely land based, create a ratio of land: water workouts, such as 5:1, and modify it as your pregnancy progresses.

Although there are many other ways to target LBP, the above tips are a good foundation for any program unless contraindicated by your physician. If pain persists, see your health-care provider for assistance.

Rick Olderman, MSPT, CSCS, is a physical therapist, personal trainer and certified Pilates instructor. He owns AMP Fitness in Denver, Colorado, and can be reached at olderman23@yahoo.com.