Back and Pelvic Girdle Pain in Pregnancy and Postpartum Blog
Deborah B. Riczo, PT, DPT, MEd, Author
You are not alone
The vast majority of women by the third trimester of pregnancy will have back or pelvic girdle pain (up to 75%!). That doesn't make it OK, I know. But it is a reason many healthcare providers do not address these complaints, because "it comes with being pregnant" and will "get better after the baby is born."
But what about for RIGHT NOW? And what if you have had your baby and you STILL are having pain??
Here I talk about exactly what is pelvic girdle pain.
You can have pelvic girdle pain along with other problems, like pressure or bulging in your pelvic floor (indicating POP or pelvic organ prolapse), leaking urine/feces/gas, painful intercourse, bulging or doming in your abdomen (indicating diastasis recti abdominis or DRA). I will refer to these below in the exercise section.
I am a physical therapist who has concentrated in women's health for my career. You can see my biography profiled at my publisher, OPTP.com here. (https://www.optp.com/blog/PROfiles-Deborah-Riczo)
What can You do?
Here is my LIST which is definitely NOT in order of importance. How important each one depends on you, your situation, your body, and your life up to this point. There are links to give you more info, some of these links go to my Instagram account, @pelvicgirdlehealth. Follow me for ongoing info!
2️⃣Change your positions often during the day
3️⃣Wear shoes with support. Even when in your home!
4️⃣Pain with sleeping? Check out the age of your mattress
5️⃣Wear a supportive bra!
6️⃣Try a maternity and/or sacroiliac belt or compression shorts
7️⃣Eat healthy and be aware of pregnancy "no-no's"
8️⃣Take care of yourself
Exercises during pregnancy and postpartum are so important, and even more important is that you are modifying your exercises depending on what stage you are on this incredible journey. For example, during the last half of pregnancy, avoid positions lying flat on your back as this position can cause some compression on your arteries and veins, and result symptoms from light-headedness, migraines, to medical emergencies. (This has been documented during some medical procedures when a woman is flat on her back for a prolonged time.) Simple remedy--get off your back or put a rolled towel under the right hip when lying flat!
Breathing rhythmically and avoiding any breath-holding is always important, during exercise and also in our day-to-day functioning. The general rule is to exhale just before and during the effort, which reduces excessive pressure in your abdomen in all directions, including your pelvic floor and abdominals. This is extremely important if you are experiencing any leaking urine, bulging or heaviness in your pelvic floor and if you have a diastasis recti abdominis.
I am going to start with the exercises that can make you feel more comfortable and can effectively decrease pain. Here are my top 4️⃣that are great during pregnancy and postpartum. That includes those women who have had a Cesarean delivery also.
You can find more valuable information and exercises in my handout "Exercise and More." Of course, there are plenty more exercises that are beneficial and are included in my book‼︎
I am describing more about this book here: Back & Pelvic Girdle Pain in Pregnancy & Postpartum
The links in the exercises below will give you more details and take you to my Instagram account, @pelvicgirdlehealth. Follow me for ongoing exercises‼︎‼
1) Activating your deep core muscles. (link)
This is a great exercise to start during pregnancy and continue throughout your life because it works on your deep core and the coordination of these muscles. When your core is not working properly it can contribute to organ prolapse (of the bladder, uterus or rectum), problems with incontinence (urine and feces), and painful intercourse.
This is a good exercise also if you have a diastasis rectus abdominis, or DRA. If you have a DRA you will notice a bulging or doming of your abdominals especially when you lift your head. If you have a DRA and this feels uncomfortable/too stressful on hands and knees then do it on your side, sitting, or standing.
If you are having symptoms of bulging/heavy sensation in your pelvic floor, incontinence, painful intercourse, bulging or doming of the abdominals, please seek out help from a pelvic floor therapist (see last section below). I do go into more detail in my book with advice on beginning steps.
2. Pelvic tilts in various positions (link)
Whenever you are in one position too long you have not been moving your low back, pelvis and hips. Keep this exercise in mind as you can usually find a position to do it and your muscles will thank you!
When you do this exercise with focus on your breathing and "toes in, toes out" patterning it encourages your hip muscles to relax. These muscles when tight often cause pain and discomfort, usually more on one side than the other.
Although this is called a stretch, if you tighten your buttocks muscle on the side you are standing or kneeling on, you will get added benefit of strengthening your buttocks. Progress to using your hands as little as possible for balance which will engage your core more and be more challenging. Even switching sides without holding on is a great progression. Pay attention to your breath and remember to breathe during the challenges!
Change your positions during the day. . .
Excessive sitting is not only linked to increasing your risk of cardiovascular disease and cancer, as well as other health conditions, but too much sitting also weakens your gluteus maximus muscle (buttocks muscle) and tightens your hip flexors. We need a strong gluteus maximus muscle and flexible hip flexors (see stretch above) for a healthy back and pelvic girdle. And the endurance for when the baby is here 24/7!
1️⃣Try to alternate between standing and sitting during the day if possible.
2️⃣Stand or walk when talking on the phone.
3️⃣Walk or stand during your lunch break if you have been sitting a lot.
4️⃣Use a standing desk and alternate your positions or put your computer on a high counter. 5️⃣Don't avoid the stairs! They are your friend as long as it is not causing you pain. Use the rail for safety, and only what you need for support! Walking up the stairs "lop-sided" is hard on your body.
6️⃣When sitting you may feel better using a small pillow or lumbar support behind your back. When sleeping on your side try using a pillow or two between your legs and a small folded towel under your belly or in your side by your waist.
Wear the right shoes (link)
Choose good supportive shoes especially when you know you are going to be on your feet for a while. Flip flops DO NOT FALL INTO THIS CATEGORY‼︎ Avoid walking barefoot, especially on hard surfaces. (This means inside your home too!) The extra weight of pregnancy and postpartum (still carrying the baby!) and your relaxing hormones can play havoc on the ligaments of your feet.
Being uncomfortable while sleeping does come with the territory of late pregnancy. BUT you may be more comfortable on a different mattress. See this post for more info!
Wear a supportive bra
Your breasts are naturally getting larger during pregnancy and will continue if you are breastfeeding. Now is not the time for stretchy, lacy bras! Choose non-elastic straps and bras that give you good support. Your back and neck will thank you for it. Nursing bras work well in that last trimester and then you get extended use of your purchase.
Try a maternity support, sacroiliac belt or compression shorts
Because your muscles and ligaments are stretching during the growth of your baby (or babies!) and take a while to resume their normal, you may feel "loose" or "not held together." That is the purpose of the core and hip exercises. Many women enjoy the compression of a maternity support, sacroiliac belt or compression short during their pregnancy and postpartum period.
If you are pregnant and walking around always giving your lower abdomen support, it is a good indication that a maternity support or maternity compression short/legging that does just that . . . give those abdominals extra support . . . will feel WONDERFUL!
Other women during pregnancy and postpartum feel they need the compression lower around their sacroiliac and pubic joints. If that is you, make sure the support you select does that. Not all maternity or postpartum supports provide that compression. You can get that compression from a sacroiliac belt, maternity compression short or legging or postpartum compression short or legging that does provide that sacroiliac compression as the one pictured below.
If compression does not feel good, you may need some special exercises that are in my book "Back and Pelvic Girdle Pain in Pregnancy and Postpartum." You are guided step by step to determine the correct exercises for you. After the muscles in your pelvic girdle are balanced, the compression most likely will feel wonderful!
It is more important than ever that you eat healthy during your pregnancy and postpartum time. In addition, your healthcare provider will recommend prenatal vitamins so you receive enough folic acid, iron and calcium which your body needs.
Research has shown that some foods that we eat can help control inflammation, so if you are having pain you want to be aware of these foods. The Mediterranean diet is considered an anti-inflammatory diet and is often recommended for heart health. You can find plenty of further info online. For this type of information make sure you are going to a reputable source, with a .org, .edu or .gov ending.
Here is info on the Mediterranean diet regarding heart health from the Mayo Clinic. This diet does recommend fish, just be aware that during pregnancy you should stay away from fish that have high levels of mercury, such as bigeye tuna, king macherel, marlin, orange roughy, shark, swordfish, or tilefish (ACOG.org).
For other important tips on handling food and foods to avoid see ACOG.org patient information Nutrition during pregnancy.
Take care of yourself
“Take care of yourself” may sound rather obvious however women are known to put themselves last. In fact, less than 50% of women attended their follow-up postpartum visit in a study done by John Hopkins.
ACOG.org in 2016 changed the recommended frequency of postpartum follow-up visits from only one visit at 6 weeks to multiple visits, depending on a woman's individual needs. They recommend the first visit be within the first 3 weeks postpartum and a comprehensive assessment occur by 12 weeks with services and support provided and tailored for each woman, including transitioning to well-woman care. This allows for early intervention and can make a difference in a woman's health for the rest of her life.
So . . . make sure you take care of yourself and schedule that postpartum follow-up within the first 3 weeks!
It is also important that you destress as much as possible, know when to say NO, so you are not taking on too much. Practicing mindfulness, reflection and being present can help with all of us. Stress can make any pain that you are feeling worse. If you are focusing on something you can't change, it can affect EVERYTHING! Focus on what you can change!
Ask for help from family and friends. Surround yourself with a support system. This is hard for some people, I know. Do it for yourself!
Get A Pelvic Health Physical Therapist on your healthcare team!
Pelvic health physical therapists are specially trained to help women during pregnancy and postpartum and long afterward in areas of pelvic health. If you need help finding a pelvic floor PT, I would recommend The APTA Academy of Pelvic Health Find a PT resource to help you find a PT in your area. There is also a For the Public resource that you may find useful and good to keep in mind for the future. Good luck on your journey, and “Be the Change you want to see Happen” Mohandas Gandi.
Exercise photos from "Back and Pelvic Girdle Pain in Pregnancy and Postpartum" published by OPTP.com, 2020.
Deborah B. Riczo, PT, DPT, MEd Confidential Property of Deborah B. Riczo ©2020 Riczo Health Education. Not to be duplicated in any way without express consent of Deborah B. Riczo