Postpartum Back Pain: The Unexpected Answers

The myriad of reasons mothers might have back pain

Estimates show that approximately 75% of women experience postpartum back pain. Of course, the reasons for this could be infinite. In addition to the general demands of baby care, there is also the bending, twisting, lifting, and carrying involved in household chores, tending to older children, and the dreaded infant carrier.

Naturally, attempts to resolve this pain should address the root cause, which might be as simple as learning better body mechanics. But it also might involve factors we don’t typically associate with back pain.

I want to share a very interesting Australian study with you, but before I do, let’s take a look at some of the common answers to low back pain.

Abdominal strengthening as an answer for postpartum back pain

Abdominal exercises are one of the most common treatments for low back pain and for really good reason. They work. In fact, there have been entire books (probably hundreds of them) written on this exact topic. And research articles too. In short, strong abs provide stability to the spine and can absorb loads that would otherwise be transmitted to the little joints of the spine.

But in a postpartum population, the abdominal muscles have endured a phenomenal stretch while growing a baby, and the idea that they need to be restrengthened is a no brainer. However, after enduring that kind of stretch, it’s crucial that the strengthening process involves a gradual progression of learning to recruit the right muscles at the right times.

If you’d like more specifics on the abs of a postpartum woman, this blog post might help you understand some of the nuance that’s important after growing babies.

We need big glutes and I cannot lie

Okay, super cheesy, I know, but so hard to resist. Before I get to the research article that I think you’ll find really interesting, I want to share one more. This one wasn’t a large study, but they looked at the cross-sectional area of the gluteus maximus as measured on CT scan. Then, they compared the size of glute max in women with and without chronic low back pain.

In summary, they found that the women with chronic low back pain had significantly smaller glutes than the women without back pain.

Previously, we’ve talked all about why pregnant women lose their bums. (If you missed it, you can read it here.) But essentially, your abs should provide an upward force from the front of your pelvis, while your bum provides a downward force from the back of your pelvis. Because pregnancy causes women to lose ab strength, it consequently causes them to lose glute strength. In other words, it’s a bit like playing tug-of-war by yourself. There’s nothing to pull against.

But strengthening the abs and the bum are not that uncommon when trying to resolve back pain. So, here are the answers you may not have expected.

That very interesting Australian study

This just might upset what you think you know about back pain. (If you’re interested in reading the whole thing, you can find it here. There’s a link at the top that will allow you to download the PDF).

But before you read it (or before you read my summary of it), I want to ask you a question. In this study, they considered over 38,000 women aged 18-75, and they looked at the correlation between back pain and four other factors. Specifically, these factors included physical activity, obesity, incontinence, and breathing disorders. Which ones do you think had the strongest association with back pain?

If you’re like me, you’ve heard a million times that increased exercise or activity will help back pain. Along the same lines, you’ve probably also encountered the idea that if so-and-so lost weight, then her back wouldn’t hurt so much. Am I right? You’ve heard this before, haven’t you?

The study found that back pain was most closely associated with incontinence and breathing disorders.

What?!? Are you blown away?

How does incontinence have anything to do with postpartum back pain?

While you stop yourself from reeling after this stunning revelation, let’s review pelvic floor anatomy.

To be brief, there are two layers. The superficial layer is responsible for holding back pee and poop. While the deeper layer provides an upward lift that keeps your organs on the inside as well as provides a stabilizing force to your spine.

However, when there’s a baby on the inside, the baby provides a lot of stability to the mother’s trunk. Consequently, the demands on her pelvic floor change, and it generally becomes weaker during pregnancy.

Now, obviously, there are women who have no pelvic floor problems after pregnancy, but for those that do, it may shows itself as incontinence. Since the pelvic floor has a role in both continence and trunk stabilization, it certainly stands to reason that these women might experience both back pain and issues with leaking.

If you’d like more information on why unintended pee occurs in the first place, please take a look at last week’s blog. And lastly…

How does breathing affect back pain?

For a pregnant woman with a great big belly and a baby under her ribs, it can be really hard to get a good, deep breath. Of course, taking a deep breath involves the diaphragm moving down so the rib cage can expand. Instead, there’s a baby preventing the diaphragm from moving as far, and consequently, breathing becomes more shallow.

Like I’ve said before, there are plenty of women who will resume a normal breathing pattern after delivery. But some will not.

If you imagine the trunk like a muscular cylinder, the diaphragm closes the top of the cylinder, the abs wrap around the sides, and the pelvic floor closes the bottom. Consequently, dysfunction of the diaphragm can alter the function of both the abs and the pelvic floor. They all have to work together to create spinal stability. So, decreased function in any of them can easily lead to problems in the others, and all of it has the potential to result in low back pain.

How to resolve postpartum back pain

Clearly, there is no way anyone can resolve low back pain through this blog post. Even in a population who has never experienced pregnancy or delivery, back pain can be a complicated beast. My only intent is to show how interconnected all of a woman’s body is and maybe to provide a little food for thought on the layers that should be dissected in a mother with back pain. Even if her babies are grown. The human body is an amazing combination of genetics, consciousness, and experience, and for a mother, one of these experiences was growing her babies.

As a physical therapist, it’s my opinion that physical therapy is one of the best places to start. If you need answers specific to your postpartum experience, you will want to consult with a pelvic floor physical therapist. If you’d like to begin rebuilding your body after babies, take a look at my postpartum program. It’s designed to help you do exactly this from the privacy of your own home.