When I was pregnant with my first baby, people would say to me, “Does your back hurt yet?” I was shocked by this question because it was assumed that back pain was a symptom that I was definitely going to develop. I was already a physical therapist at the time and I knew that I didn’t have to develop back pain just because I was pregnant. This opened my eyes to the issue of posture during pregnancy and I observed that the majority of pregnant women had horrible posture and therefore the majority of pregnant women have back pain. It was around this time that I started treating more pregnant women in the clinic and I found that pregnancy related back pain could be changed by some simple patient education tips and exercises that focused on the muscles that support the back and pelvis. Many women think that it is not safe to exercise your core muscles while being pregnant and not only is that not true but in fact, there is never a more important time to activate these muscles. The easiest way to explain the correct posture in pregnancy is to look at a picture.
Here is the typical pregnant posture. The most obvious to recognize is that her belly is pulling her forward, creating an exaggerated arch in her low back. This is the main cause of general low back pain in pregnancy. Working our way up, her chest is dropped with her breasts resting on top of her belly. Her upper back is rounded with her shoulders rolled forward, which causes her head to move forward, increasing the arch in her neck. This upper body posture can be the cause of headaches and neck/shoulder tension. The poor position of her upper back/shoulders/neck is due to the poor position of her low back and pelvis. When one part of the body is not in correct alignment, the rest of the body compensates to balance us out so we don’t tip over.
Now lets look at the correct posture.
The first thing is that her knees are unlocked (hard to see in this picture). Moving up to her pelvis and low back; she is activating her pelvic floor by lifting the muscles up, like she is trying to stop urination AND GAS (different from a traditional kegal, which is squeezing the vaginal muscles closed). This action slightly tucks her tailbone between her buttocks, but does not tuck her whole pelvis. The pelvic floor like the foundation of a house: it stabilizes the body at the deepest level. Next, her baby belly is drawn up and in. This is done by activating the deepest abdominal muscle, called the transversus abdominis, which wraps around the pelvis and low back like a corset. With these two muscles active, the low back and pelvis are now stabilized; the belly is no longer pulling her center of gravity forward and she has decreased the compressive load through her low back by decreasing the arch. This is the part that usually immediately relieves the complaint of low back pain in pregnancy. Moving up, her breast bone is lifted towards the ceiling, without her ribs flaring forward (rib flaring will increase the low back arch). With the breast bone lifted, her neck can float back in line with her body to decrease the forward head posture.
Standing in correct alignment is hard work. It takes body awareness and the ability of the brain to correctly activate the core muscles mentioned above, which is a challenge for many women, whether pregnant or not. Only once the brain can correctly find these muscles, can it use them to stabilize the body.
I really recommend that all pregnant women get in front of a mirror and notice how they are standing so you can make the appropriate changes. If a woman is experiencing low back pain, or any other ache/discomfort associated with the physical changes during pregnancy, I recommend making an appointment with a physical therapist that has experience working with the pregnant population. These are small adjustments that can make a really big difference. Low back pain does not have to be a symptom of pregnancy!
Alicia Willoughby is a physical therapist in Corte Madera, California, whose passion is working with women during pregnancy, postpartum and beyond. Alicia graduated from UCSF with her Masters in Physical Therapy and quickly became interested in working with the pregnant/postpartum population. Now after being pregnant, giving birth and experiencing a postpartum body (twice), Alicia is even more passionate to help women gain knowledge and empowerment about their own bodies so they can go through motherhood without pain and injury. To contact Alicia: firstname.lastname@example.org