Under the effect of hormones and the belly which grows bigger day by day, it is the whole balance of the body of the mother-to-be that is compromised. And the first to suffer is often the back. With half of pregnant women affected, back pain is one of the most common ailments in pregnancy.

Back pain that affects pregnant women generally takes the form of low back pain, that is to say pain in the lower back, sometimes accompanied by pain in the sacroiliac joints. The future mother sometimes complains of having “backache”.

These pains are often more acute when changing position, for example when changing from lying down to standing. They can appear early in pregnancy and usually get worse over the months.

During the third trimester of pregnancy can appear very specific pains to the pregnant woman: the “pelvic pain syndrome” or “Lacomme syndrome”. This syndrome associates lower abdominal pain with a feeling of heaviness in the lower abdomen, pain in the groin, lumbosacral pain (in the lower spine, between the 4th and 5th vertebrae and the sacrum. ) and on the buttocks.

Very disabling, these pains can disrupt the daily activities, work and sleep of the mother-to-be.

Back pain is the direct consequence of physiological changes in pregnancy.

With the uterus growing over the weeks, the body’s center of gravity shifts forward. To keep her balance, the mother-to-be tends to arch herself which leads to hyperlordosis, that is to say a very pronounced arch of the lower back.

This tilting of the pelvis and this arch are increased by the hormonal impregnation of the pregnancy. Estrogens and relaxin, produced in large quantities during pregnancy, cause the ligament structures to relax, making the joints more mobile (2).

The lumbar zone is therefore highly stressed, especially since the abdominal muscles, which are also less toned under the effect of hormones in order to allow the uterus to develop, no longer play their role of “corset” correctly. This muscle tension causes low back pain and pain in the sacroiliac joints.

Different factors can promote this pain:

• the pre-existence of scoliosis;
• multiparity;
• significant weight gain;
• lack of physical activity before pregnancy and during pregnancy;
• intense and stressful professional activity;
• magnesium deficiency (3).

The expectant mother must adapt her posture and adopt the right gestures on a daily basis in order to support the changes in her body during pregnancy and thus limit back pain (4).

• When standing: in order to correct the arch, it is important to “grow yourself”, as if a thread were pulling the head and the whole body upwards;
• In the assist position: we will also seek this self-enlargement upwards, avoiding leaning against the backrest, or with a cushion. A few books or a small step placed under the feet help to adopt the correct sitting posture.
• To get up from a chair, we start by placing the center of gravity of the body forward by moving the feet forward. Then, keeping the neck and back straight, stand up by taking firm support on the feet.
• To get out of bed, it is recommended to roll onto your side, with your knees bent, then sit on the edge of the bed using your arms. This technique relieves pressure on the spine and pelvic girdle.
• To bend down, make sure to bend the knees to avoid leaning the body forward.

On a daily basis, various actions and precautions help to limit back pain:

• daily practice of tilting the pelvis and stretching on all fours or squatting against a wall in order to lengthen the lower back as much as possible and thus correct the arch;
• wear comfortable shoes, without a high heel, so as not to accentuate the imbalance of the body;
• to sleep, favor the position on the left side preferably (to avoid compression of the vena cava), “gun dog” (the top knee bent). For more comfort, place a nursing pillow under the knee;
• wearing a kidney belt can help correct arch and relieve the back by effectively supporting the weight of the belly in the front. The pregnancy belt is particularly suitable for pregnant women working long hours on their feet, for those who already suffered from back pain before their pregnancy or for pregnant women who gained a lot of weight during their pregnancy. Seek advice from your gynecologist or midwife;
• maintain regular physical activity suitable for pregnancy. Walking and swimming are particularly beneficial. Prenatal yoga can also help mothers-to-be to adapt to their new body;
• eat a balanced diet to avoid gaining too much weight;
• ensure its magnesium intake, which is found in interesting quantities in certain mineral waters, dark chocolate, oilseeds, whole and semi-complete cereals;
• take care of yourself and rest;
• do relaxation exercises: sophrology, meditation, prenatal yoga, abdominal breathing.

Taking paracetamol is possible to calm the color. If the pain persists, the gynecologist or midwife can prescribe other analgesics, but in any case, never self-medicate during pregnancy. Taking NSAIDs in particular is to be avoided. The more so as often, the drugs prove to be ineffective. They can occasionally limit pain, but do not focus on treating the cause of low back pain.

The gynecologist or midwife can prescribe physiotherapy sessions. In addition to massages, these sessions will include postural work during which the physiotherapist will help the mother-to-be to become aware of the changes in her body and to adapt her statics and her movements accordingly. He will also teach her how to practice a key exercise in pregnancy: the pelvic tilt.

Alternative medicine and manual therapy can also help reduce back pain during pregnancy. Seek advice from your gynecologist or midwife to find a specialist used to treating pregnant women.

• with gentle manipulations and mobilizations practiced only with his hands, the osteopath can unblock certain areas and help the body to find its new balance;
• the chiropractor focuses on the spine. With gentle adjustment techniques at the level of the vertebrae or manipulations on the soft tissues, he will focus on eliminating vertebral dysfunctions in order to restore the alignment of the pelvis and joint mobility;
• with fine needles placed on specific points along the meridians, the acupuncturist will restore the good circulation of vital energy. This can relieve low back pain and sciatica because an excess or slowing down of the energy flow can lead to muscle and ligament pain.

According to a Cochrane systematic review (5), evidence from single studies suggests that acupuncture or craniosacral therapy improves pelvic pain associated with pregnancy and that osteomanipulative therapy or an intervention combining manual therapy, exercise and education may also be beneficial.