More than two-thirds of pregnant women report low back pain and up to one-fifth report pelvic pain during pregnancy. Reports of pain tend to increase later in pregnancy and interfere with daily activities, sleep, and work. About 20% of women who experience low back or pelvic pain during pregnancy report persistent pain for up to 3 years following pregnancy.
Chronic pain is complicated and much research in recent years has revolved around the term “pain catastrophizing”. Catastrophizing is a process of becoming fixated on pain, magnifying the effects of it, feeling helpless, and expecting negative outcomes associated with pain.
Research shows that those who catastrophize are more likely to develop persistent chronic pain and disability. Women who demonstrated pain catastrophizing during their pregnancy were found to be less likely to have been active throughout their pregnancy and more likely to develop persistent pain after.
The recommendation of daily physical activity during a low-risk, healthy pregnancy is 30 minutes per day. However, only 1 in 6 pregnant women meet this criteria. Physical activity during pregnancy is associated with better sleep, less pain, and improved perception of health. Many women tend to avoid physical activity due to pain, fear of movement, or lack of understanding of the benefits for their pregnancy.
It is not only possible to have a pain-free pregnancy, but it should be the norm. Pregnant women should be able to comfortably walk 3 to 5 miles per day throughout their pregnancy. Through trial and error, I compiled these simple daily movement tips to encourage a more comfortable pregnancy. Not only have my clients found success with incorporating more movement throughout their pregnancies in small ways, I found success with these during my own pregnancies. These tips are also important in the recovery phase immediately following pregnancy.
These movement tips are intended for a healthy, low risk pregnancy but are also very low intensity. As always, discuss any concerns with your doctor particularly if you are high risk or have movement restrictions.
Basic principles to keep in mind:
Now onto the movement tips...
Not only should heels be avoided during pregnancy for safety reasons due to balance concerns, but for better alignment as well. Wearing heels results in shortened calves and hamstrings, forcing the pelvis to tuck under to keep your balance and support your torso while carrying the extra weight of a growing baby. A posteriorly tucked pelvis is not your friend during pregnancy and is a position that should be avoided at rest as it results in increased pressure on the sacrum and low back.
The size and shape of your feet also change throughout pregnancy due to increased weight and fluid volume, particularly toward the end of pregnancy. Wear shoes that are flexible and accommodate for changes in the feet. Flat shoes keep the calves and hamstrings in a lengthened position, allowing you to maintain a neutral pelvis in standing.
Walking keeps your hips, pelvis, and low back moving to help maintain strength and flexibility throughout pregnancy. You should be able to walk 3–5 miles per day throughout all of pregnancy comfortably. The key is to keep moving in small bursts every day. Don’t just jump right up and walk 5 miles in one go. Spacing your walking out throughout the day is more beneficial for a variety of reasons. Try 5–10 minute walking breaks every 2 hours. You may need to start small with this and slowly build up.
Sitting in chairs, especially ones that are soft make it near impossible to maintain a neutral pelvis. Anyone in their 9th month of pregnancy wants nothing more than to flop on the couch with a pint of ice cream, but consider enjoying the pint of ice cream while sitting on the floor instead! Soft seats, such as a couch, force the pelvis into a posterior tilt, which again is to be avoided as it puts increased pressure on the spine and sacrum. Sitting on the floor rather than in chairs gives you an opportunity to stretch the muscles of your hips, knees, and low back while engaging the muscles of the trunk (bringing major benefits to you during labor and delivery!). Without back support, your body has to do the work to keep you sitting upright.
Try to sit on the floor most of the time and change positions often. The act of getting on and off the floor throughout pregnancy will also keep you strong. Floor sitting encourages the pelvis and hips to open up. Bonus points if you can still get yourself off the floor without using your hands at 9 months pregnant. This is also one of the best ways to start to recover after baby.
There are times where you cannot avoid sitting in a chair or have to spend a few hours in a car. Some chairs (particularly seats in the car) are bucketed, forcing you into a posterior pelvic tilt. Use a half foam roll, balance disc, or rolled up towel under your bottom to prop yourself up, making it much easier to maintain a neutral pelvis. This is a very important step if you have a history of SI joint or low back pain before or during pregnancy. Sitting on a balance disc helps keep you out of posterior pelvic tilt and allows you to more actively engage the muscles of your trunk.
Stretching the legs, hips, and shoulders during pregnancy all have benefit however focus on the calves, hamstrings, and muscles of the hips for maximum benefit. Tight calves and hamstrings force the pelvis into a posteriorly tucked position. Stretching these muscles along with avoiding shoes with heels allows you to avoid fighting muscle tension to maintain a neutral pelvis. Stretching the hips throughout pregnancy will also help with the birthing process. The more relaxed your hips are the, less your body has to fight muscle tension to push the baby out.
Back your hips up over your heels, use the muscles of the backs of your legs to hold yourself up instead of pushing the pelvis forward. Pushing the pelvis forward changes your center of mass and compresses the low back. You can do this by using a plumb line to check your alignment. When you drop a plumb line from the bony part on the side of your hip, it should fall in line with your ankle. Not in front of it. It takes some practice and awareness to maintain this during the day.
All of the above movement tips can be implemented throughout the day without a big investment of time or equipment. Even just one of the above tips will drastically improve your movement and comfort throughout pregnancy. And again, it's never too early or late to start moving better! If you try the above tips and find that you are still experiencing pain, reach out to a physical therapist. Some physical therapists specialize in women’s health and can help you make a personalized plan for better movement both during and after pregnancy.