Spinal Health during Pregnancy: 4 Tips to Avoid Low Back Pain

Occurring on 16th Oct every year, World Spine Day highlights the diversity of spinal pain and conditions. With over 80% of Singapore’s adult population experiencing back pain, more can be done to raise awareness on spinal health. As the spine is involved in many daily tasks, it can be susceptible to increased strain as a result of poor posture, muscle imbalances or improper care. In this article, we will be focusing on spinal health during pregnancy and what can be done about it.

Having lower back pain is a common experience during pregnancy. It is estimated that about 50-80% of pregnant women may experience some form of lower back pain during their pregnancies or during the post-partum period.

Low back pain and spinal health during pregnancy

Through the full course of pregnancy, you may gain up to 11.6-16 kg as your baby grows.

In the first trimester, you may not feel much difference in your lower back. However, from the 2nd trimester onwards, it is common for ladies to experience that even standing, or walking for short periods of time may feel tiring, and may lead to back aches. The good news is that there’s a lot you can do to help yourself minimise or even prevent lower back pain! In this article, we’ll share more tips on how to keep a healthy spine.

What can I do to improve my spinal health when pregnant (or in preparation for pregnancy)?

Stay active.

Stay active! Some traditional beliefs suggest that physical activity should be avoided during pregnancy, due to fears that overexertion may endanger either mother or baby’s health. While these are real concerns, staying active through pregnancy can have many benefits for both mother and baby. In fact, in addition to preventing lower back pain, there are many proven benefits of exercise during pregnancy such as:

• maintaining cardiovascular fitness
• reducing complications during pregnancy
• improving ease of labour
• reducing risk gestational diabetes
• faster post-partum recovery

With a large body of research now completed in this area, experts now recommend that women without medical contraindications should participate in regular aerobic and strength conditioning during pregnancy. In fact, the amount of exercise that pregnant ladies should aim for is the same as the recommended amount for non-pregnant ladies! (With appropriate modifications, of course – more on this later).

How much exercise should I be aiming for?

In 2020, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommended that expecting ladies should aim to complete a total of 150-300 mins of moderate exercise a week. The recommendation works out to being 30-60 minutes of exercise 5 times a week.

Fix your posture.

Be aware of your posture. If posture makes a difference on a regular basis, this becomes even more important to pay attention to during pregnancy. Here are 5 things you should take note of regarding your posture to avoid poor spinal health during pregnancy

• Sitting posture: when working at a desk, make sure to have a supportive backrest, and that your feet are fully supported on the ground to reduce excessive lumbar “lordosis” or arching, which can increase stress on your lower back.
• Standing posture: avoid high heels, opt for flatter wedges or flats. Higher heels would increase lordosis of your lower back. Especially in the later trimesters, you’d want to trade those heels for a comfy pair of supportive flats, or even trainers.
• Sleeping posture: after your 1st trimester, sleeping supine (face up) is not recommended and you will be spending most of the time sleeping on your side. Invest time to find pillows and bolsters that help you feel more comfortable when sleeping.
• Pay attention to your lifting technique and home environment. If you are taking care of the household or young kids at home, make sure to engage your hips and glutes when bending or squatting down, instead of bending only from your back.
• If you are already caring for young kids at home, make sure to set up the height of your change table, cot and shower area to reduce strain on your back.

Start good self-care habits.

Practice good lower back self-care. It’s normal to experience an increasing amount of aches in your lower back, especially as you progress through the pregnancy. As soon as you start to notice this, start to dedicate some time at the end of the day to doing some gentle stretches for your lower back. Using heat packs and gentle self-massage methods can help to ease your symptoms and keep your back feeling comfortable and pain-free.

Take more breaks.

Life is busy and doesn’t slow down even when expecting. If anything, you might feel the weight of more responsibility and pressure on you. But it’s important to intentionally take more breaks and rest, as your body is going to need it. Break up periods of sitting or standing too long to do some stretches or gentle movements. Sit instead of standing on the train. Give yourself permission to ask for help, even if you may not usually like to. Remember that asking for help isn’t a sign of weakness.
Lastly, working to maintain a healthy weight and diet.

As you can see, there are many simple strategies you can employ to take care of your back during pregnancy. Especially if you are an expecting mum above 35, or have had a previous history of back pain, starting some of these strategies early would be strongly recommended.

Exercises to improve spinal health during pregnancy

Even if you have been active prior to your pregnancy, make sure to get medical clearance from your OB/GYN before beginning exercise. It is important to acknowledge that your body will be going through a large number of changes over the next 9 months, and the type and intensity of exercise you choose will need to take that into consideration.

For individuals who have been active prior to pregnancy, it is good to continue staying active. However, you may need to make some modifications to your routine to ensure it is safe for you and your baby. Suppose you are new to exercising and are looking to start getting active during your pregnancy. In that case, it is strongly recommended you seek advice from a physiotherapist before commencing a new exercise program.

Here are some general “do”s and “don’ts” below:

DO

• Choose safe low impact forms of aerobic exercise. Brisk walking, stationary bike cycling, swimming, and running are good options for cardio
• Monitor how hard you are pushing yourself. A general guideline would suggest you aim for exercise at a “moderate” intensity. *The “talk test” can be used to monitor for “moderate” exercise. Moderate = you can comfortably hold a conversation, vigorous = if you need to pause for breath during a conversation
• Include some resistance training to build muscle endurance. Other than cardio, it’s important to maintain good muscle endurance in major muscle groups, to keep your body strong and able to withstand the changes and stresses it will go through during pregnancy.
• It is recommended to aim for 2 days of strengthening per week on non-consecutive days, to target major muscle groups (lower body, core, upper body). You can use light dumbbells or resistance bands, with a resistance that allows you to perform 12-15 reps per set.

AVOID the following:

• Exercises that involve high abdominal pressure (eg: weight lifting)
• Contact/collision sports
• Sports that involve risk of falling or extreme balance
• Sports with significant changes in pressure
• High intensity training at altitudes
• Exercising in supine (face up) after your 1st trimester

As always, (but more so during pregnancy), it is important to pace yourself & listen to your body. The goal is to stay active and safe, and you should not be trying to maximise your sporting performance during pregnancy.

When should I see a physiotherapist?

Hopefully, with a combination of exercise and the strategies above to improve spinal health during pregnancy, you will have a smooth and uneventful journey with regard to back pain through your 9 months of pregnancy. However, if you are finding it difficult to manage even with these strategies and are developing worsening back pain that is impacting your daily activities, you should consult a physiotherapist for diagnosis and treatment of your condition.

If you are unsure about how to exercise safely, a trained physiotherapist will be able to design an individualised exercise program for you, taking into account your previous fitness level, stage of pregnancy and type of exercise. Our team of physiotherapists have experience in treating prenatal and postnatal musculoskeletal problems, book an appointment to speak to our women’s health physiotherapy team now.