Parenthood is an amazing, life-altering experience for both first-time and veteran parents. The job of caring for infants and toddlers is mentally and physically demanding. Mothers and fathers spend countless hours holding their baby, carrying him in his car seat (you know how heavy and awkward that can be), and bending over changing diapers. These tasks require strength and stamina and can result in aches and pains for mom and dad if they’re not careful.

Common injuries, such as neck, back, shoulder, or wrist pain can result from the repetitive lifting, bending, and carrying of young children.
Regular exercise is one of the best ways to help prevent these injuries.
The better your endurance, strength, and flexibility, the less likely you are to develop pain.

If you don’t generally exercise, walking is often a nice way to start.
Hand and ankle weights, an exercise ball, and a jump rope are also excellent investments for the home that allow mom and dad to do basic strength and toning exercises when the kids are sleeping or playing. In addition, running outdoors, working out at a gym, or joining a group exercise class will help improve overall fitness. If alone time is sparse, you could always experiment with family fitness.

With the help of some kid-friendly gear, it can be fun for the whole family to exercise together. Strap baby into a backpack and take a hike, or exercise with kids in tow in a jogging stroller or child bicycle seat around the neighborhood. After all, what could be better motivation than a two year old yelling “Faster, faster!”?

Mommy and baby Yoga and Pilates classes and videos are gaining popularity and are a great way to tone stomach muscles and improve flexibility (and there’s no reason Daddy can’t join in). On a rainy day, parents can join their toddler in dancing along to their favorite music or video. It may feel a little silly, but exercise benefits the body, and children enjoy this quality time. Exercising not only keeps the body fit and pain free, but also helps parents model a healthy lifestyle that children can embrace from an early age.

If despite your best efforts you develop pain, don’t ignore it. Aches and pains should be addressed promptly to prevent a chronic condition from developing. Your primary care doctor can evaluate you and prescribe the appropriate treatment, which could include medication, exercise, physical therapy, chiropractic care, massage therapy, or acupuncture.
Your health is essential to you, your children, and your family’s well-being, so make yourself a priority. You deserve it!

An often overlooked muscle group when it comes to stabilization exercises for the pelvis and low back are the pelvic floor muscles (the levator ani and coccygeus). This is a group of muscles that connect from the front of the pubic bone to the tailbone. They create a hammock between the legs and assist in stabilizing the pelvis as well as supporting the abdominal organs, particularly the bladder and bowels.

Weakness in the pelvic floor muscles can contribute to back pain, sacroiliac joint pain, pubic symphysis pain, as well as incontinence (leakage of urine) when you cough or sneeze. Dysfunction in the pelvic floor muscles can be due to trauma, as a result of childbirth, or due to poor posture with associated muscle imbalances.

To exercise the pelvic floor muscles, try to envision pulling the muscles of the saddle area up and in towards your abdominal cavity. You should not feel your buttocks, thighs, or abdominals tightening as you do this. One of the simplest ways to learn to contract the pelvic floor is to stop the flow of urine while you are on the toilet. You can try this technique to verify which muscles to isolate, but avoid doing this often, as it can cause urinary tract infections.

This type of pelvic floor contraction is also known as Kegel exercises. Though it can be difficult to learn how to isolate these muscles, they are an important component of a lumbosacral rehabilitation program. (They’re also very important to do throughout pregnancy and immediately following birth in order to prevent and manage incontinence.) If you are not certain that you are performing these with the correct technique, discuss it with your health care provider or physical therapist.

Back pain during the childbearing year affects up to 80% of women as a result of the vast changes happening in the body as the baby grows. During pregnancy, the joints throughout the body become more mobile due to the production of several hormones. The spine is therefore more easily sprained or pulled into sub-optimal alignment. This can result in muscle spasm, inflammation, pain, and a decrease in functional and recreational activities. In addition, women gain on average 25-35 pounds over a short period of time, with the majority of that weight distributed at the abdomen and breasts. This change in her shape shifts the woman’s center of gravity forward and upward, resulting in changes in her posture. She tends to stand with an excess arch in her lower back and her upper back rounded forward. These postural changes place stress on the muscles and ligaments surrounding the spine which can also lead to pain and functional limitations. Although back pain during pregnancy is a common problem, it often goes untreated as it is often perceived as an inevitable side effect of pregnancy.

Research findings suggest that the majority of cases of pregnancy-related back pain go unreported, with only a third of women discussing the problem with their maternity providers. Within that group, only 25% of their providers recommended a specific form of treatment.1 Women do not, however, have to suffer through their pregnancies with back pain. There are several safe, effective treatments that can help them manage their pain and optimize their well-being throughout pregnancy and into the postpartum period. A description of each follows, as well as some pros and cons.

Independent Exercise Program

Exercise is beneficial in preventing back pain, as well as helping to manage and reduce existing pain. In fact, research findings suggest that regular exercise during pregnancy can result in a significant reduction in the intensity of back pain. 2,3 Achieving a good balance between the strength and flexibility of the muscles surrounding the spine and pelvis can help provide stability and decrease the risk of injuries. In particular, the abdominal, back, and pelvic floor muscles should be targeted, as they are often most impacted by the physical changes that occur during pregnancy. Prenatal fitness classes offer a nice way for women to improve their cardiovascular fitness, strength, and flexibility, with the added benefit of socializing with other women. Prenatal yoga and Pilates are nice options as they target the spinal stabilizing muscles while focusing on alignment and posture. If such classes are not accessible or affordable, there are numerous book and video resources that can help women design their own programs.

Pros:

• May help prevent pain
• Can do exercise when it’s convenient
• Inexpensive
• Can use as an adjunct to individualized treatments for optimal results

Cons:

• If exercises are done incorrectly, pain and injury could result
• If lacking motivation, women may not be consistent with an exercise program
• Exercise may not be suitable for women with high risk pregnancies

If attempts to exercise independently are unsuccessful or pain initially prohibits exercise, individualized treatment by one of the following professionals could be beneficial.

Physical Therapy

A physical therapist experienced in treating pregnant women can evaluate the woman’s posture, spinal and pelvic alignment, joint mobility, muscle flexibility, strength, and tone. The physical therapist can perform safe, gentle techniques to re-align joints, improve joint motion, and reduce muscle spasm. In addition, a physical therapist can design an exercise program specific to the client’s needs in terms of muscle strength and flexibility, as well as teaching her how to move, position herself during sleep, and optimize her posture during daily activities. The treatment modalities physical therapists commonly use, including ultrasound and electrical stimulation, are for the most part contraindicated during pregnancy, but moist heat or cold packs could be used to help reduce pain and spasm.

Pros:

• Postural re-training will help during pregnancy and throughout motherhood to decrease stress to the spine, thereby decreasing risk of injury
• The pregnant woman can stop seeing the physical therapist and continue independently with her individually designed exercise program once she is ready
• Most health insurance covers the cost of physical therapy minus a co-payment

Cons:

• Depending on the facility, patients may not receive one on one treatment
• Not all therapists are experienced in treating pregnant women, so it is advised to inquire with local facilities to find an experienced provider

Massage Therapy

A massage therapist trained in prenatal massage will evaluate the client’s muscle tone and address any areas of tightness or restriction. The pregnant woman may be treated on her side, and some massage therapists use special pillows with a cutout for the abdomen so the woman can lie on her belly. Using various techniques, the massage therapist can help improve the circulation to the muscles, reduce stress, and promote relaxation, which can in turn improve posture. One study also found that pregnant women receiving massage therapy for 20 minutes twice a week experienced less anxiety, improved mood, better sleep, and a reduction in back pain.4

Pros:

• Improves circulation to muscles in pain or spasm
• Promotes relaxation and improved posture
• Gives the pregnant women an opportunity to rest and unwind, which is often much needed

Cons:

• Can be costly, even if subsidized by insurance
• Without exercise to help address muscle weakness and inflexibility, relief may be temporary
• As with physical therapists, one should find a massage therapist trained in prenatal massage

Chiropractor

A chiropractor experienced in treating pregnant women will assess the client’s posture, alignment, muscle tone, and mobility for regions of restricted movement or mal-alignment which would contribute to swelling, pain, and muscle spasm. S/he will then use various techniques to adjust, manipulate, or realign the joints. This restoration of joint positioning helps to reduce pain and improve movement and function. Some chiropractors will also recommend appropriate stretching and strengthening exercises to help maintain the corrections in alignment. In addition, one study found that women with back pain who were treated with spinal manipulation experienced less back pain during labor. 5

Pros:

• An effective way to correct an alignment problem
• Can sometimes provide immediate relief
• Effective if done in conjunction with the appropriate stretching and stabilization exercises

Cons:

• Can be costly depending on insurance
• Manipulating joints that are already more mobile (as a result of hormonal changes) could result in pain and injury if done incorrectly, so it is important to work with a chiropractor experienced in treating pregnant women
• If done without incorporating exercise, relief may be temporary

Acupuncture

Acupuncture, an ancient form of Chinese medicine, continues to gain popularity as a treatment for back pain in the general population. Recent studies have found that acupuncture helps improve function and reduce the intensity of back pain during pregnancy.6 An acupuncturist will perform a comprehensive exam including an evaluation of the client’s appearance, color, speech, pulses, tongue, and physical condition to determine where the flow of energy is obstructed. The treatment consists of fine needles (generally painless) being inserted into specific points throughout the body to help open the energy channels, thereby restoring balance, reducing pain and muscle spasm, and improving mobility. Acupuncture is safe during pregnancy, with the exception of specific points around the ankle that may stimulate the uterus.

Pros:

• A safe alternative treatment for back pain and restoring good flow of energy
• May also help reduce morning sickness in early pregnancy

Cons:

• Can be costly depending on insurance
• Patients need to be open and receptive to a alternative medicine
• People who fear needles may be intimidated by it

It is important to discuss with your OB/GYN or midwife to determine what type of treatment is best suited for you.

1 Wang, S et al. Low back pain during pregnancy: Prevalence, risk factors, and outcomes. Obstet Gynecol 2004 Jul;104(1):65-70.

2 Garshasbi, A, et al. The effect of exercise on the intensity of low back pain in pregnant women. Int J Gynaecol Obstet. 2005 Mar;88(3):271-5.

3 Kihlstrand, M et al. Water-gymnastics reduced the intensity of back/low back pain in pregnant women. Acta Obstet Gynecol Scand Mar 1999;78(3):180-185.

4 Field, T et al. J Pregnant women benefit from massage therapy. J Psychosom Obstet Gynaecol. 1999 Mar;20(1)31-8.

5 Diakow, PR et al. Back pain during pregnancy and labor. J Manipulative Physio Ther. Feb 1991;14(2)116-8.

6 Guerreiro da Silva, JB et al. Acupuncture for low back pain in pregnancy. Acupuncture in Medicine. 2004 Jun;22(2):60-7.

The Shiva Rae Prenatal Yoga DVD is an excellent choice for pregnant women (with or without back pain). This DVD has a very nice flow and is safe and appropriate for beginner and experienced yoga practitioners. I particularly like that there are 3 students in this video, one in each trimester, and the instructor demonstrates the appropriate modifications for the various poses as your pregnancy progresses and body changes.

Prenatal yoga is beneficial for relaxation, preventing and reducing back pain, taking time to connect with your baby, and for gentle strengthening and stretching. It also helps prepare the body for the experience of childbirth and mindful parenting. I did this video during both of my pregnancies and found it to be so helpful especially on days when I felt like I was really huge and dragging.

If you’re unsure about doing yoga on your own, finding a prenatal yoga class in your area is another great way to get comfortable with yoga and meet other expectant moms.