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Is upper and lower back pain normal in pregnancy?

Back pain is quite common in pregnancy with most women experiencing mild to moderate pain in the lower [1] or upper [2] back area in pregnancy. Usually, it just signifies that your baby is growing inside you. But in some rare occasions, it may indicate some serious complications [3]. Back pain is believed to be more common in twin pregnancies [18].

Types of Back Pain during Pregnancy

A mild to moderate lower and middle back pain when you stand up or sit down^[3]
Severe pain in the back of the pelvis and the buttocks
Considerable lower back pain experienced when lying down in bed

Is lower back pain an early sign of pregnancy?

Although back pain can occur anytime during the first, second or third trimester, mild chronic lower and middle back pain is considered one of the less common early symptoms of pregnancy^[4], often resulting from the hormonal changes occurring in your body^[5]. It is often accompanied by other symptoms like nausea, vomiting, gas, heartburn, constipation, fatigue and headache in the first trimester.

Back Pain in Pregnancy Risk Factors

Being overweight ^[6]
Being over 30 years of age^[7]
Second pregnancy

What causes back pain in pregnancy

The hormonal changes associated with pregnancy is often responsible for back pain in late pregnancy as well, as it loosens the pelvic joints and softens the ligaments in the area to prepare the body for labor and childbirth^[8]
Your center of gravity, moving forward with the growth of your baby can lead to back pain by altering your posture ^[9]
The additional weight gained during pregnancy^[3]
Poor posture and standing or bending over a lot
Lifting something heavy or performing something strenuous
Excessive stress associated with pregnancy
Past injury to the pelvic region can lead to back pain while pregnant
Pelvic girdle pain or a slipped disk

It is quite normal to experience back pain after pregnancy due to the hard work associated with delivery as well as the body changes after childbirth [27].

How to prevent back pain in pregnancy?

Avoiding slouching or bending down
Avoiding sitting or standing still for a long time
Wearing comfortable low-heeled shoes (not flat) that provide proper arch support ^[10]
When getting out of bed, rolling on to the side of the bed before sitting up and finally getting into a standing position
Maintaining good posture (keeping your back straight when sitting or standing) and using proper lumbar support when sitting in a chair
Avoiding lifting heavy objects unless necessary (bending down your legs and lifting with your hands and legs instead of the back, keeping the object close to your body can prevent the pain) ^[11]
Avoiding twisting your body; instead, move your feet while turning around ^[12]
Sleeping on one side in a pregnancy pillow to support your body (supporting your back and legs with a normal pillow can help as well) ^[10]
Sleeping in a firm mattress that can properly support your back (placing a hard board between the box spring and mattress can make a soft mattress firm) ^[3]
Wearing a maternity support belt (especially to prevent upper back pain)
Doing exercises like pelvic tilts to strengthen your back ^[13]
Getting plenty of rest
Drinking lots of fluid to eliminate certain toxins, which may cause various complications, leading to upper back pain ^[14]
Sleeping on your left side

Pregnancy Back Pain Relief

Home Remedies for Relieving Back Pain in Pregnancy

Applying a hot water bag or a heating pad (make sure the temperature is not too high; wrapping the hot water bag with a towel helps to avoid excessive temperature) ^[3]
Applying a cold compress to the painful area to relax the sore muscles ^[13] (make sure the ice pack is not too cold; avoid applying it for an extended period of time)
Taking a warm bath ^[19]
Bed rest
Asking a friend to rub the painful area gently

Exercises

Light exercises like pelvic tilts ^[15], walking and stretching can help. But, avoid forcing yourself to exercise too hard as it may strain the ligaments further or harm the baby. Here is a simple exercise technique to help ease the pain ^[12]:

Begin by resting in a box position, with your knees under the hips, your hands under the shoulder and your fingers facing forward
Make sure your abdomen is lifted high enough to keep the back straight
Next, pull in the stomach muscles before lifting your back up in the direction of the ceiling while curling the trunk and letting your head relax gently forward (do not lock the elbows)
Hold in this position for a few seconds before slowly returning to the previous (box) position (keep your back straight)
Repeat the whole procedure slowly 10 times

This exercise helps to strengthen your muscles; but be careful not to put too much pressure on your back or you may hurt it further.

Water exercises and swimming are good for your back as well (make sure to avoid the styles that are likely to strain your neck and back)^[16].

Natural Remedies

There is a lack of scientific research regarding the safety of using natural back pain cures, like devil’s claw, in pregnancy ^[16]. So, it is safe to avoid these herbal remedies.

Medication

Pain relieve medicines are usually not recommended to pregnant women as they may increase the risks of various complications^[3]. It is recommended to talk to your doctor before considering using any pain medication for fighting back pain.

Other Treatments to Relive Back Pain

Massage therapy by a trained professional therapist ^[6]
Chiropractic therapy by a licensed practitioner ^[20]
Practicing relaxation techniques (e.g. slow breathing, tai chi etc)
Doing pre-natal yoga ^[17]
Taking homeopathic medicines like rhus tox 12C and arnica 30C ^[21] or applying arnica ointment to the affected area ^[16] (make sure to consult a qualified professional homeopath)
Taking an aromatic warm bath with a few drops of lavender oil (not recommended during first trimester as lavender may induce premature contractions) ^[16] or using special aromatherapy massage oils meant for pregnant women
Studies show acupuncture to be an effective treatment option ^[22]

Lower Back Pain Vs Sciatica during Pregnancy

Sciatica is a relatively uncommon pregnancy complication related to the sciatic nerve, occurring due to a herniated disk in lower spine. Severe lower back pain radiating into the thighs and buttocks is often mistaken for sciatica. But, sciatica is characterized by leg pain that is usually more severe than the lower back pain along with a tingly numbness in the knees, foot and toes^[1].

When to call the doctor?

Lower back pain severe enough to wake you up at night
Severe back pain accompanied by vaginal bleeding and abdominal pain (might indicate a miscarriage)^[23]
Severe upper, lower or middle back pain that continues for more than 2 weeks^[20]
Burning pain that gradually runs down your legs to the knees and ankles (might indicate a rupture disk)^[24]
Lower back pain accompanied by low blood pressure, dizziness and vaginal spotting (might indicate an ectopic pregnancy)^[25]
A dull pulsing pain in the lower back area that may be accompanied by pelvic pressure, menstrual-like cramping, over four contractions in an hour and diarrhea (might indicate pre-term labor) ^[26]
Pain on either the right or left lower back along with pain during urination and blood in the urine (might indicate a kidney stone) ^[24]

References +

Overall Pregnancy

Information and Articles About Pregnancy Period

Back Pain During Pregnancy