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Postpartum Back Pain: The straw that broke the mama’s back

Written by Deanna Camilo PT, DPT, OCS, FAAOMPT

When I was pregnant, I wanted to do everything possible to prepare for the arrival of my little one.  I read the popular pregnancy and baby books, combined that information with my background in physical therapy, and thought that I was ready for anything that parenthood could throw at me.  The seasoned parents are likely laughing out loud right now.   No amount of reading can prepare you for the joys, surprises, and stresses of becoming a parent!  That being said, as a physical therapist, I believe the literature could have done a MUCH better job of warning me about the aches and pains related to caring for an infant.  In this first blog of my postpartum pain series, we’ll discuss back pain.

In the early days as a new mom, your focus is purely on survival.  You’re just doing whatever it takes to get through the days and nights, and you are definitely not focusing on your body mechanics while you are holding/feeding/changing your sweet little bundle of joy.  At first, you may be able to get by without too much difficulty.  Over time, however, the little things you’re doing to stress your body start to catch-up with you.  Let’s break things down.  As moms, our bodies are already stressed from carrying a tiny human for 9 months.  At the very least, there is abdominal and pelvic floor muscle weakness due to the stretching of the muscles to accommodate the size of your baby, but there may also be a diastasis recti- a separation of the abdominal muscles (more to come on this later in the blog series).  Then, we stress our bodies even more during delivery.  If you have a vaginal delivery, there is stretching, and maybe even tearing of the pelvic floor musculature.  If you undergo a C-section, your doctor cuts through your abdominal muscles in order to get to the baby.  Now combine all of that underlying weakness from pregnancy and trauma from child birth with repeated poor postures and bad ergonomics, and we have the perfect combination of factors leading to back pain!

Your pain may develop in your SI joint, low back (lumbar spine), or your middle back (thoracic spine) and it may start out as just an annoying ache or stiffness.  Left unchecked, however, the dull aching pain can worsen and begin to significantly impact your ability to perform your daily activities including caring for your baby.  For me, it started with thoracic spine pain beginning within two weeks of having my little girl.  Reflecting on that early period, I spent 90% of my time hunched over in a rounded (kyphotic) spine position.  I was recovering from a C-section, so sitting upright was already uncomfortable and everything else I did further contributed to that kyphotic spine position.  I had to lean over the changing table and bassinet and feeding my baby often resulted in awkward postures.  Even as someone who should theoretically “know better”, I found myself in times of sleep deprivation, reverting to survival mode and doing whatever it took to accomplish tasks.  Rather than consciously adopting “good postures, I would put myself in any position that felt comfortable at the time, ignoring the long-term implications of sitting crisscross in a gliding recliner while breastfeeding my baby (insert grimace here).  What could I have done differently in order to decrease the likelihood of back pain? SO MANY THINGS!

During my pregnancy, I was diligent about performing stabilization and mobility exercises with the goal of entering the postpartum phase as strong as possible.  While this was a great start, I shouldn’t have stopped there.  I realize now that expecting myself to stop and think about my posture and ergonomics during middle of the night feeds is the most ridiculous concept on the planet.  What I should have done is set myself up for success from the beginning.  I should have taken advantage of my drive to nest.  Instead of pouring all of my effort into making sure the nursery was the most adorable room in the house, I should have considered the equipment and furniture that I would be using most frequently and adapted it to fit my body type.  I should have asked my doctor more specific questions about exercises I could do during my recovery to mitigate scar tissue development and maintain my mobility.  The advice I received from my doctor?  Go for walks and start off slowly.  I mean, come on.  I shouldn’t have tried to be my own physical therapist (duh).  I should have scheduled a consultation with a physical therapist prior to my delivery.  Below are a few simple suggestions for you, strong mama, in hopes that you can decrease the likelihood of developing postpartum back pain:

  • Find a physical therapist, bonus points if this person is also trained in pelvic floor assessment and treatment. Your physical therapist can help you to create a program that fits your specific needs during pregnancy and postpartum.  I cannot stress this one enough!
  • Test out furniture before you buy it. In this digital age, it’s so easy just to pick out things online and have them arrive at your door in a few days.  That sounds great in theory, but you have no idea how that rocker/glider/recliner will fit your body until you actually sit in it.
  • Adjust your equipment. I have this great bassinette that is height adjustable, but didn’t think to actually change the height to fit my needs until my back was already hurting.
  • Utilize ALL the pillows. Lots of women really like nursing-specific pillows.  This didn’t work well for me (although my husband loved it- go figure), but I eventually found that using two to three standard pillows for propping my baby while nursing was very helpful in bringing her to me rather than me leaning over to reach her.
  • Give yourself grace! Take the time you need to heal and gradually return to gentle movement/exercise after you receive the all-clear from your doctor and your physical therapist.

If you are interested in establishing a pregnancy or postpartum exercise plan, or are experiencing pregnancy/postpartum pain, please reach out to me: [email protected].

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