Postpartum low back pain is one of the most common physical complaints I encounter during new client intakes.
While there are a LOT of possible causes for low back pain postpartum, by teaching folks to breathe differently and move in new ways- we often see improvement in symptoms.
A lot of low back pain after pregnancy is rooted in core strength and/or biomechanics (how you move and how you stand).
In these cases, exercise training can make a really big impact.
What we’ll cover:
◾️ Why Does My Back Hurt So Much Postpartum?
◾️ How Long Does Postpartum Back Pain Last?
◾️ How To Relieve Postpartum Back Pain
◽️ 1) Examine Your Alignment
◻️ 2) Breathe Better
◻️ 3) Strengthen Your Core
◻️ 4) Build Glute And Hamstring Strength
◻️ 5) Learn To Hip Hinge
◾️ Bonus Tip: Move More
Why Does My Back Hurt So Much Postpartum?
One of the greatest risk factors for postpartum lower back pain is low back pain during pregnancy (1). And a lot of people experience back pain during pregnancy!
Immediately postpartum, a lot of the same hormonal and biomechanical contributors to pregnancy-related back pain are still at play.
The relaxin that prepared your pelvis for labor, still courses through your body. It creates laxity and instability in the joints and tissues of your pelvis and low back.
Left image: Non-pregnant core with “normal” spinal curvature. Middle image: Pregnant core with exaggerated lower lumbar curvature (lordosis). Third image: Me during my third trimester. Check out the extra curvature in my low back! Copyright images are used WITH PERMISSION, courtesy of the Global Pelvic Health Alliance Membership.
How Long Does Postpartum Back Pain Last?
Up to 70% of people report low back pain immediately after giving birth (2). The good news is, postpartum pain usually resolves within a few months. 70% of people who experience low back pain immediately after birth don’t report any pain one month later (3). And 80% report no pain by 6 months (3).
That’s great news!
If you’re experiencing chronic back pain that has lasted beyond your first 6 months postpartum, it’s probably time to seek medical guidance (start with physical therapy!!).
How To Relieve Postpartum Back Pain
Everyone wants a stretch for back pain- but stretching won’t address the root of the problem.
And in some cases, stretching might actually make your problem worse.
The solution then?
Address your posture, breathing, core, glute and hamstring strength and movement mechanics.
While that might sound like a long checklist, I think you’ll see that these 5 elements are deeply intertwined.
➡️ As you improve your posture, you’ll improve your breathing mechanics.
➡️ As you improve your breathing mechanics, you’ll improve your core strength.
➡️ Glute and hamstrings impact alignment and core strength.
➡️ As you become stronger, your movement mechanics will improve AND as you improve your movement mechanics, your core, glutes and hamstrings will get stronger.
You’ll see there is some redundancy as you move through the “checklist”. Master one item and then move on to the next. You don’t have to master everything at once to start feeling some immediate relief.
1) Examine Your Alignment
If your back hurts, look to how your body is aligned.
While there’s no one “proper” posture, there are a few postures that seem to correlate with more back pain. In these cases, making some changes to your posture may relieve some of your pain.
Sway Back And Anterior Pelvic Tilt
A “sway back” posture or a significant anterior pelvic tilt place a lot of strain on your lumbar spine.
Left image: Anterior pelvic tilt.; the rib cage sits in front of the pelvis and tends to flare “up”. Middle image: Stacked alginment; rib cage sits over the pelvis. Third image: Sway back posture; pelvis presses in front of the rib cage. Rib cage typically drops down.
Stand near a mirror and check in with your alignment.
If you have a sway posture or if you have a signigifcant anterior pelvic tilt, you’ll want to bring your rib cage and pelvis into a more “stacked” alignment.
A stacked alignment relieves pressure on the lumbar spine AND will help position your core musculature to better stabilize your spine.
Here’s a great resource to help:
Body Alignment For Postpartum Recovery And Pelvic Health
You don’t need to be hyper-vigilant, just bring awareness to your standing posture a few times daily and adjust as needed.
High Hinge Point
The anterior pelvic tilt or sway posture result from changes in pelvic orientation. But changes to the spine and rib cage can also create postural changes associated with back pain.
For example, to accommodate the additional load of the growing fetus, sometimes the lower lumbar curve decreases and a new higher lumbar curve emerges.
This is often called a “high hinge point.”
The high hinge point, which typically occurs about 2 inches below the bra line, has the appearance of a higher-than-usual lumbar curve. It’s accompanied by a flatter lumbar spine and a flared rib cage.
This hinge point disrupts the desirable 360 breathing pattern, leads to movement compensations and compresses the back muscles and the spine.
With breathing exercises, you can begin to retrain your ribs to expand in 360 degrees, relax the hinge point and restore the “normal” lumbar curve.
Try these two breathing exercises:
1. 360 Breathing
The 360 breathing exercise is really effective for creating back body expansion and improving rib mobility. Bring intention into expanding into the area just below your sports bra band.
2. Rock Back Breathing
Rock back breathing is a really wonderful exercise to “stretch” the back muscles from the inside out. Bring intention to lengthening the muscles around that bra line to help decompress your high hinge point.
2) Breathe Better
The deep core, made up of the diaphragm, pelvic floor, deepest abdominal muscles and back extensors, is the muscular system most impacted by pregnancy
When the deep core system gets disrupted, the back muscles often assume more than their fair share of the work load.
Overworked muscles become achy, cranky muscles.
De-load your low back by reminding the rest of your core what it’s supposed to do.
Practice coordinated breathing exercises (like the Connection Breath) to restore coordination and reflexive function of your deep core. Breathing is one of the easiest and most effective interventions for back pain (4).
Connection Breath
3) Strengthen Your Core
Once you’ve addressed your alignment and you’ve learned some basic breathing mechanics, the next step is building strength in your deep core muscles.
Practice anti-rotation, anti-lateral flexion, and anti-extension core exercises to build the strength necessary to stabilize the torso and offload the low back.
In early postpartum, good exercises include:
As you advance, try out:
4) Build glute and hamstring strength
The glutes and hamstrings are key to maintaining a more neutral pelvis orientation (pulling you OUT of an anterior tilt) and balancing the tone of your pelvic floor.
Spend time strengthening your glutes and hams to support your pelvis positioning and assist your postural muscles.
1. 90/90 bridge with hams
The 90/90 bridge is a great exercise to “find” the hamstrings and gently bring them on board.
2. Long lever bridge
Set up for this bridge with a “longer lever” to recruit more hamstrings. Your knee angle should be closer to 120 degrees than 90 degrees.
3. Kickstand deadlift with rotation
Deadlifts are one of the most accessible and effective glute-strengthening exercises.
5) Learn To Hip Hinge
A big contributor to low back pain is movement mechanics- the WAY we bend to pick stuff up.
Rounding through the spine to pick things up, rather than hinging through the hips, places a lot of strain on the lumbar spine. Over time, this can lead to pain.
The hip hinge is the technical term for the movement pattern behind bending over and picking stuff up off the ground.
And it can be hard to do well after pregnancy.
If you’ve you’re restricted in this movment pattern, you might find bending over to be irritating to your low back.
Along with breathing and alignment exercises, practice:
1. Hip Hinge
2. Hip Shift
The hip shift exercise is like a one-sided hip hinge- but as a unilateral exercise it lets you get deeper and it allows you to address side-t0-side strength differences.
Bonus tip: Move More
A risk factor for pregnancy-related low back pain is lack of physical activity (5). Lack of physical activity is also a risk factor for back pain in the general population (6).
During postpartum, we tend to move less. We spend long periods sitting with baby- feeding, rocking, soothing. Our body position becomes biased towards hunched, rounded shapes that probably contribute to our back feeling crummy.
As much as you can, change positions frequently. Make sure you’re taking walks. Perform mobility exercises when you can and begin a structured strength training program when you have the capacity.
👋🏼 Before you go
Stretching your low back isn’t a long-term solution for back pain.
Tuning into your alignment, moving more, and building strength often is.
That said, back pain is a super complex subject.
If you’re in severe pain, or if you’ve been trying to DIY it for a while- it might be time to check in with a pelvic floor physical therapist and/or a chiropractor.
When you’re ready to add a structured strength training plan to your routine, please reach out! I offer free Meet and Greets and I’d love to connect to find out how I can support you.
References
Grab your copy of:
The No B.S. Guide to a STRONGER, DRIER Pregnancy & Postpartum
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My mission is to make sure that having a baby is not a reason why you can’t do all the things.
Laura Jawad holds a PhD and a personal training certification (NASM). She’s a proud Certified Prenatal & Postnatal Coach and Pregnancy & Postpartum Athleticism Coach. You can check out the rest of her alphabet soup here.
