There is a lot of focus on pre-natal lower back pain, but clinically I treat many women in this population that experience upper back (thoracic spine) pain as well. Upper back pain during pregnancy can occur at any point, but is most common in the third trimester. This occurs for several reasons. First, as pregnancy progresses, the growing size of the baby and the uterus shifts the center of gravity forward placing increased pressure on the muscles in the back. Secondly, a woman can gain 25-30% of their body weight in a relatively short period of time, which also places increased stress on the muscles in the back. The changing hormones in the later stages of pregnancy can also have an effect. As the body prepares for delivery, hormones are released that loosen the ligaments and muscles in the body. When this occurs there is less inherent stability in the pelvis and back, which causes the muscle to work harder, and sometimes this increased demand on the muscles can cause muscle spasm. Lastly, the enlargement of breast tissue during pregnancy can alter posture and increase strain on the neck, shoulders, and thoracic spine.
While upper back pain during pregnancy is common there are some steps that you can take to prevent this from occurring and relieve symptoms when they do occur.
- Maintaining a neutral standing posture. Stand up straight and tall with your chest high and shoulders back and relaxed. Don’t lock your knees. Use a wide stance for a good base of support and try to keep weight equally distributed between sides. If you are statically standing for prolonged periods of time, rest one foot on a small step stool and change feet regularly to change the weight distribution.
- Maintain a neutral sitting posture. Use a chair that has good lumbar support or purchase a lumbar support pillow. Do not cross your legs and keep your feet flat on the floor approximately shoulder width apart. If your feet do not sit comfortably on the floor consider using a foot stool. Make sure that your chair is of a proper height with the hips positioned at approximately 90 degrees. Your knees should never be higher than your hips in sitting. By keeping the lower back supported, the muscles in the upper back can relax more in sitting.
- Maintain a neutral spine while sleeping. It is recommended that pregnant women, especially in the second and third trimesters of pregnancy, sleep on their side. Placing a pillow between the knees and under the abdomen can help to maintain a neutral spine with sleeping. Also, using the appropriate number of pillows to ensure a neutral neck or cervical spine position is important.
- Avoid lifting and carrying heavy objects and, when necessary, use proper body mechanics with lifting. Some helpful reminders for lifting are: Face the object that you are going to lift. Keep the object close to your body at all times to decrease the lever arm and in turn the force that is placed on your back. Bend from your knees not your back when lifting the object. If you need to bend forward to lift the object hinge from the hips do not bend at the back. Do not twist while lifting. Wait until you have lifted the object and have it close to your body before pivoting or turning.
- Wear a good supportive bra and comfortable clothing during pregnancy. Also wearing supportive shoe wear without a heel can help relieve some of the back discomfort by keeping the spine more neutral and providing a good base of support.
- Perform daily physical activity or exercise such as walking or swimming. This will keep your back muscles strong and can help to relieve discomfort. Always consult with your healthcare provider before beginning any new exercise program during pregnancy.
- Performing a few simple stretching exercises daily can also help prevent or alleviate upper back pain. The two exercises that follow can help to reduce some of the postural stresses and therefore decrease upper back pain.
- Doorway pectoralis stretching: Stand in a door frame and place your arms on the door frame at shoulder height with the elbows bent to 90 degrees. Place one foot forward and gently lunge forward until you feel a moderate stretch at the front of the chest into the front of the shoulders. Hold for 30 seconds and repeat 3-5 times several times a day.
- Scapular retraction: After you have stretched the pectoral musculature as noted above, keep the arms relaxed at your side and gently pinch the shoulder blades together as if you are trying to hold a pencil between them. Hold for 5 seconds and then relax. Repeat 20-30 times several times a day.
If you do experience upper back pain during pregnancy you can use ice, heat, or massage to relieve symptoms. Do not leave either on for extended periods of time (greater than 15 minutes at a time). Make sure there is proper padding between your skin and the hot pack to prevent burns and place a barrier between your skin and the ice pack to prevent skin irritation. Ask your partner to massage the area or schedule a professional prenatal massage. Also, talk to your healthcare provider about physical therapy. A physical therapist can evaluate you to determine the specific factors that are contributing to your upper back pain and design an individualized program to address these factors and facilitate your return to pain-free functioning.
If upper back pain is not relieved by the above, contact your physician. While upper back pain during pregnancy is common, it isn’t something to ignore. In some cases back pain may be a sign of pre-term labor or other obstetrical conditions, so always mention the back pain to your doctor so that they can evaluate the cause and suggest the proper treatment. Upper back pain during pregnancy can be successfully treated, which can improve the quality of your pregnancy and make your 4th trimester recovery and transition easier. Have a healthy and happy pregnancy!
The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.
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