Reaching for a plate in her kitchen one July morning, Rachel M. (32) suddenly found herself frozen in place, a pain radiating from her lower back down the back of her right leg. At six months pregnant, she was by then used to the myriad new sensations her body had experienced while preparing for motherhood, but this pain was different. Its severity scared her and made her wonder what had changed.

After seeking medical help right away, Rachel learned that she had lumbar radiculopathy, a symptom she was experiencing that was likely made worse by the pressure of her growing uterus during pregnancy, postural instability and weak core muscles. A disc in her spine had shifted, causing the impingement of a spinal nerve. Often, this is referred to as “sciatica” because it’s the pinching of the large sciatic nerve running from the spine down the back of the leg that can lead to the severe pain Rachel experienced.

Pregnancy is a complex phenomenon and, for many women, one of the most beautiful, gratifying times in their lives. So when this experience is marked with back pain, it can be difficult and worrisome. Thankfully, Rachel acted quickly and was able to take steps that spared her major discomfort in that final stretch of her 9-month journey. Her key to success was both understanding what was truly happening in her changing body to cause the pain, and knowing the different treatment options to tackle it.

How Pregnancy Impacts the Body’s Ligaments and Spine

As a pain management specialist with a focus on women’s health, let me start by saying that it’s actually not uncommon for women to experience back pain during pregnancy, especially for first-timers whose bodies are going through changes they’ve never encountered before. Many studies show that over 50 percent of pregnant women deal with back pain at some point in their pregnancies. Let’s face it: there are times when you might feel even alien as your body metamorphoses. Some effects – thicker hair/nails and glowing skin – are welcomed, while others – that nagging back pain – not so much.

When a woman is pregnant, the body releases higher levels of progesterone. This hormone must remain elevated throughout the entire gestation in order to facilitate changes in the female reproductive organs such as growth of the uterus to accommodate the fetus, and maintenance of the placenta. Progesterone also helps relax the pelvic floor area so it can work its magic. While this is obviously helpful in the preparation for birth, high progesterone levels can also lead to laxity of ligaments that are crucial for holding our joints and spine in place. As a result, these ligaments may cause you pain when they are feeling over-stretched or not as stable.

In addition, the sheer increase in weight and volume of your beautiful, yet growing belly puts stress on anatomical structures that bear this new load. This means that if a woman already has a disc herniation (a slipped disc in her spine), she may manifest more pain from a nerve impingement during her pregnancy, as it is difficult to offload this additional pressure onto her spinal column.

Which Part of the Back is Most Susceptible to Pain During Pregnancy & When

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The lower spine, or the lumbar spine, is most susceptible to pain during pregnancy. In fact, it is the most prone to pain and injury in general given that this mobile part of the spine bears the weight of most of our lower-body movements. During pregnancy, the weight of the growing belly adds extra strain not only on the lower spine, but also on the joints that attach the spine to the hips. For some women, like Rachel M., this added strain can manifest as severe pain, leading them to seek professional medical care. 

Throughout the pregnancy journey, women often will experience “growth spurts,” which are a normal, natural way to accommodate the growing fetus. However, it is during these times – perhaps when they’ve realized they’ve gained several pounds in just a week – that women may experience the onset of new pain and discomfort.

What You Should Do if You Experience Back Pain During Pregnancy

Regardless of how or when it happens, expectant mothers with back pain should speak with their physicians early to understand what they’re dealing with, and develop a treatment program as needed. In other words, don’t be afraid to be your own advocate and ask questions. A simple understanding of the root cause can often help you navigate your activities, diet and daily regimen in a way that minimizes or – even better – alleviates back pain throughout the rest of the pregnancy and beyond.

Mild stretching and heat will often help treat muscle strains, while yoga can help maintain the fundamental posture that assists the growth changes associated with pregnancy. Yoga is also a healthy adjunct helping moms-to-be stay mentally in touch with the changes to come, remain centered, and allow for a healthy outlet for new stressors. Yoga enhances blood flow to vital organs, which is especially important during a time when these organs are going through crucial changes.   

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If a mom-to-be is suffering from a ligament that is over-stretched or a spinal nerve that is causing issues due to impingement, the treatment protocol may be more in-depth. Often, a pain management physician, like me, will consult with a patient’s obstetrician to develop a multi-modal treatment plan that includes an anti-inflammatory nutrition guide, medication (only that are safe for the expecting mother and fetus), a gentle stretch and exercise regimen, and – if needed – injections to target the pain generators. The idea is to find the most wholesome approach for mother and baby alike.

But, most importantly (and I cannot stress this enough!), any pregnant woman concerned with harm to the fetus after an injury or accident should seek medical care right away. She should also seek care immediately if she has a sudden loss of feeling in her lower extremities, or pain so severe it is hard to be mobile.

What Women Should Know About Back Pain After Childbirth

So, what happens to your spine once you’ve had the baby and are now staring down at your little bundle of joy? A woman’s body goes through an incredible amount of changes after childbirth, whether it is a natural delivery or a cesarean section. In fact, it is quite miraculous how naturally the female organs seem to know how to transition back to their pre-pregnancy state, though it all takes time. Muscles and joints, in particular, may take longer to adjust to the whirlwind journey they’ve just encountered.

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This is why pregnancy teaches many women the art of patient observation, and the approach to back pain is quite similar. It’s especially important that new moms take care in the post-partum period to allow their bodies to heal. When your obstetrician clears you for exercise, start with gentle stretching first before building up to a gentle cardio and weight training program. As always, yoga will continue to be a wonderful meditative outlet for new moms while providing the structural integrity you will desire as a new mother. Like anything else, use your own body as a guide to know your limits – you know it best, after all! And, finally, never feel scared to check in with your physician about developing a personalized wellness program to achieve nutrition, fitness and functional goals that can help keep you pain free, and on a healthy motherhood journey.