POSTPARTUM BACK PAIN
Back pain after giving birth can be quite common some evidence suggests that up to 20% of women experience postpartum back pain. There are a number of reasons for this including:
- lengthy/difficult/intense labour
- hormones
- strained/weak/inhibited abdominal muscles or diastasis recti abdominal muscle separation
- overworked & tired back muscles
- weight gain
- epidural
- breastfeeding
- caring for a growing baby
Labour
Giving birth is quite a trauma to your body, whether its vaginal or via c-section. But if you have had a prolonged or intense pushing phase it is possible to strain/ overuse or injure muscles in an attempt to push the baby out. This strain may result in spasm and pain after birth which can be quite intense. Your doctor may prescribe some pain medication or advise you to take some over the counter pain relief such as ibuprofen. A hot pack or ice pack (if you prefer a numbing effect) can be applied to the area ensuring not to damage your skin. Appropriate massage and release techniques can be used but should be done by a professional if in the first couple of weeks post birth. Gentle exercises and stretches such as those seen in our video can help get the blood pumping into these muscles and get them to relax off.
Hormones
The change in hormones from pre-pregnancy to pregnancy to postnatal is extreme. At the point of birth your oestrogen levels, for example, are about 1000 times their normal level. About 3-4 days after birthing the placenta that plummets. If you are breastfeeding that will continue to decline. This hormone has an effect on the tissues in your body. For pregnancy it helps you prepare for birth by softening the ligaments and other tissues to facilitate pushing a baby out. Irrespective of what type of birth you had you will have these hormonal changes. These hormones are not just focused on your pelvic area but have a more global effect. For some women with a history of back pain the increased laxity actually improves their back pain during pregnancy unfortunately it returns as the hormones decrease.
The increased joint mobility also can cause the muscles that support the joints to work a little harder to give them more stability which results in tired overworked muscles that can tense or spasm up. Once you have completed breastfeeding if you choose to do it, and your hormones return to pre-pregnancy levels this effect reduces. While you cannot alter the hormones for back pain, you can treat the muscles with appropriate massage and release, a heat pack or ice pack if you prefer (always taking care to ensure you don’t burn yourself); gentle and appropriate exercises and stretches – such as seen in our video.
Weak Abdominal Muscles, Diastasis of Recti Abdominus Muscle (DRAM) & Overworked Back
As your baby and bump grow throughout your pregnancy, the muscles in your abdomen area become more inhibited or “switched off a bit”. This is to allow your uterus and baby to grow outwards. All women develop a DRAM or separation of the recti abdominus (six pack) muscles along the linea alba (connective tissue between the muscles). This is normal and needs to happen. Your body does its own healing for up to 8 weeks after you have given birth but some weakness may persist, your DRAM may still be evident and as a result your posture too may appear that as though you are still pregnant. The back muscles will try to compensate for the lack of strength around the abdomen and can become over worked tired and achey; especially if you have not been able to be active or keep up your strength during pregnancy. Your back muscles like any other muscle group will start to tighten up when weak and may spasm if overworked. Just as suggested before, heat or ice as you prefer; appropriate massage and release and critically for this is appropriate exercise. See our Abs Fab programme for how to progressively get back your strength and reduce your DR.
Weight Gain
Unfortunately the weight gained during pregnancy does not immediately fall off as soon as you have given birth. This is because the weight gain is not all baby. You have baby, amniotic fluid, placenta, increased volume of blood and other fluids as well as increase in fat deposits. It is unrealistic and unfair to expect anyone to immediately loose their baby weight it needs to be undertaken in a progressive and appropriate manner. The problem is that the increased weight can contribute to back pain as it can to all weight bearing joints – ie hips, knees, ankles. As your weight decreases and your body gets stronger so should any associated back pain.
Epidural
There is a common belief that an epidural can cause back pain however the evidence does not support this. What you can get is tenderness at the site of injection and rarely the muscles around the area where you received your spinal block or epidural may spasm up after giving birth. This generally eases off after a few days & can be managed as above.
Breastfeeding
Breastfeeding can be an exceptionally challenging time in any new mother’s life. It can be difficult to get right & can be very painful, from engorged breasts to sore and cracked nipples and painful upper back, neck and shoulders from prolonged poor positioning or lengthy feeding. We always recommend you seek out a lactation consultant sooner rather than later, if you are having any issues with breastfeeding or latching. While you do want to build up your strength and endurance for holding the baby while feeding, if your muscles are too overworked and you are in pain then it is important to help alleviate your pain with appropriate support from pillows, seating arrangements or if you can feed in side lying this allows a lot of alleviation from gravity weighing you down. Like with any muscular pain the above treatments are helpful: heat or ice pack; massage and again critically movement, stretches and exercises. See our video on supportive positioning as well as some stretches and exercises to build up strength in your upper body.
Caring for a growing baby
Your baby will continue to grow in size and weight sometimes quite rapidly. If you haven’t been able to be fit an active during pregnancy or you didn’t build up the upper body strength you may struggle as your baby gets larger and stronger. This can be true especially around times when your baby may get more clingy – ie baby is sick or after vaccinations when they want to be held more.
- If your struggling try holding your baby in a supported seated position with your feet on the ground, if they want more movement try a rocking chair or briefly bouncing on a swiss ball.
- Instead of just standing try walking around a bit & sitting for brief periods with as much support as you can.
- If you can try reclining with baby on you to maintain closeness but not having to support full body weight.
- Change the baby’s nappy on a raised surface – never leave a baby unattended on an elevated surface as they may roll off.
- Try and lift more with your legs than your back – gently brace your tummy and try and use your leg muscles more.
- Ensure when you’re pushing a pram it is easy to manoeuvre and is light.
- If you are using a baby carrier, ensure it is well fitting and supportive.
- And again try and increase your strength as possible as this will also increase your endurance for holding the baby.
WHEN YOU SHOULD SEE A HEALTHCARE PROVIDER
- Your back pain is severe, constant or worsening
- Your back pain started after a trauma
- You loose feeling in both your legs or are suddenly weak
- You are unable to pass urine or lose control of bowels
- You lose sensation around your groin area
