There is no dancing around the fact that motherhood can be painful. It is a beautiful and rewarding journey, but a woman’s body goes through some significant changes and traumas during the pregnancy and birthing process.
Having back pain during pregnancy is almost an expectation for most women. The thing is, that lower back pain from pregnancy often sticks around for months, and sometimes years, after your baby is born.
But it doesn’t have to.
The hip flexor muscles are major players in the anatomical changes a woman’s body goes through during and after pregnancy. Because of their deep connection to the hip and pelvis, it is not uncommon for tight muscles to become even tighter with the strain of carrying a baby.
The best way to avoid lower back or sacroiliac joint pain during pregnancy is to get ahead of it, especially since it is widely known as an issue for pregnant women.
Understanding how your body changes as your baby grows, during birth, and beyond will set the stage for three ways you can prevent or manage lower back pain from pregnancy.
Tailbone and lower back pain during pregnancy and beyond
The lower back pain that you experience during pregnancy can start before you even are pregnant, and can continue long after you’ve given birth.
The way your hips are aligned before you even get pregnant will influence if you have lower back pain during pregnancy - and how severe it is if you do.
The hip flexor muscles, or iliopsoas, take on the brunt of supporting the pelvis as it changes during pregnancy. So whether you have flexible hip flexors or tight hip flexors, even before you get pregnant, will impact how your body adapts and reacts during pregnancy.
Having relaxed hip flexors before pregnancy often means that your pelvis and hips are properly aligned, and will be fully prepared to handle the variety of physical changes that occur during pregnancy and birth.
Hypermobility also impacts many women and can mean your hip flexors are too relaxed to fully stabilize and support hip movement. A balance of strength and flexibility is necessary to prevent lower back pain in pregnancy.
If there are underlying issues with your hip flexors before you get pregnant, that’s when you run into issues with sacroiliac and lower back pain during pregnancy. This is not just because your hip flexors were too tight to begin with; it’s also because your body is changing to prepare for giving birth.
One of the most prevalent changes that occurs during pregnancy is that your body releases a chemical hormone called relaxin. This hormone relaxes (hence the name) the ligaments in the pelvis and softens connective tissues surrounding the cervix.
The reason the body does this is to ensure your baby can easily leave the birth canal. Essentially, relaxin is your body’s natural way of creating elasticity and space for the baby during childbirth.
Obviously, loosening everything up for childbirth is extremely important, and you want that to happen. But ligaments are the fibrous tissue that connects bone to bone and stabilizes, in this case, the pelvis. The loosening of these ligaments that hold the hip and pelvis together is part of the reason why so many women experience back, tailbone, or hip pain during and after pregnancy.
The instability of the iliopsoas muscles and the continued release of relaxin hormones contributes to muscle tightness. It seems counterintuitive for your body to tighten muscles when relaxin is being released. But as the ligaments and other tissues loosen, your iliopsoas tightens to try to stabilize the pelvic region.
Women that have a genetic predisposition to extra elastin, or are naturally hypermobile, will experience even looser joints during pregnancy and, in turn, even tighter hip flexor muscles. This can lead to lower back pain in pregnancy.
As natural a giving birth may be, your body still experiences it as trauma. Your baby’s position, and the birthing position itself, puts your iliopsoas muscles into an extremely strained position.
During childbirth, the body will be hypermobile in the pelvic region regardless of your pre-pregnancy hip flexors. So for any woman, the iliopsoas is working hard to keep the pelvis stable during the birthing process.
Since the iliopsoas is strained and shortening during birth, it is normal for women to have hip and lower back pain post-pregnancy. Many women expect this pain to subside as their pelvis heals and returns to normal, but the issue is that once the iliopsoas has tightened, it doesn’t easily relax again on its own.
This continued muscle tightness is why many moms, even years after giving birth, continue to have the same sacroiliac and lower back pain after pregnancy as they did during it.
How your muscles can cause back pain
It can be hard to imagine that muscle tightness causes your sacroiliac pain or lower back pain during pregnancy. The fact is: From walking to sitting to running, the iliopsoas muscles (the primary hip flexors) are involved. They are engaged during almost every bodily movement that you make.
When the iliopsoas muscles are too tight, your joints and bones are pulled out of alignment. This in turn leads to more issues and pain over time.
The iliopsoas muscle is made up of two muscles: the psoas and the iliacus. The psoas originates at the vertebrae of your lower spine, and the iliacus originates on the inside of your pelvic bowl. The muscles both cross the hip joint and attach to the top of your femur (the thigh bone). Both the spine and the pelvis are responsible for lower back and sacroiliac joint alignment.
This relationship of the iliopsoas to these integral bone structures and joints means that when there is trauma or stress around the pelvis, the iliopsoas muscles step in to protect it. Their primary job is to stabilize, so if there is an irritant threatening to cause your hip region instability, they tighten to reinforce balance.
However, this also happens in reverse. When your hip flexor muscles start too tight, they can cause trauma or stress in that area. It is a domino effect: If one aspect is out of whack, it creates issues elsewhere. That’s why you experience lower back pain during pregnancy in addition to other bodily traumas.
So what can you do about your lower back pain during pregnancy? There are three helpful steps to releasing your tight hip flexor muscles, but you must be proactive if you want to enjoy the benefits of all three of them.
Three steps to healthy hip flexors
Working through all three steps to release your hip flexor muscle tightness and relieve back pain will only be possible before or after pregnancy. There are some ways to release the front of the hip during pregnancy, but they will not be as consistent or easily accessible.
1. Releasing the front of the hip
Releasing the front of the hip is by far the most difficult - and one of the most vital - aspects of improving your iliopsoas muscle health.
To do this, you need to reach the iliacus and the psoas muscles, which is tricky because the best release point is tucked slightly behind the hip bone. To reach this area, you need a physical therapist to help you or a tool like the Hip Hook.
Unlike other massage tools, the Hip Hook is specifically designed to access both the psoas and the iliacus muscle. The unique shape allows it to reach around the hip bone and press directly onto the iliacus muscle, providing a much-needed release.
Releasing both the psoas and iliacus are essential to healthy hip flexors. If you have really tight hip flexors, you can also use a tool like the Hip Flexor Release Ball. The size, shape, and density of the ball are perfect for releasing the front psoas muscle.
These tools cannot be used during pregnancy. Getting this muscle released isn’t impossible though. You may be able to work directly with a physical therapist to relieve your lower back pain during pregnancy, as they will know how to release the muscles in a way that will not be harmful.
If you are trying to get pregnant, it can help to start this three-step process before conception. This will prepare your body for all of the hormonal changes that influence lower back pain during pregnancy.
Once you’ve given birth and have had ample time to heal, you should begin with this front hip release once again.
As mentioned before, after the trauma of giving birth, your hip flexor muscles will have tightened even more. So, your lower back pain after pregnancy may be even worse than during pregnancy. Regular hip flexor release will help establish alignment and relax the muscles.
2. Releasing the back of the hip
Since the muscles in our bodies work in tandem, you need to balance things out and release the back of your hip as well. The Hip Flexor Release Ball mentioned in the last section is the perfect tool to do this.
Although you will not be releasing your iliopsoas muscle when lying on your back, you will want to release your piriformis muscle. This muscle is often related to sacroiliac joint pain and sciatica; learning to access and release this muscle during pregnancy can be a complete game-changer during pregnancy.
When your iliopsoas muscle is tight, it will pull on various parts of your body, including the piriformis muscle. If the piriformis muscle is tight, it will pull on the iliopsoas muscle. This tug of war will continue unless they are both released.
To do this, lay on your back and place the Hip Flexor Release Ball under your glute, near the center of one buttcheek. When you find a tight spot, relax into that; you want to put prolonged pressure on these spots for 30-90 seconds to help them release. Do this on both sides of your hip.
During most of your pregnancy, you should be able to release the back of the hip, which will relieve some of your lower back pain during pregnancy.
3. Realignment exercises
The last step in this process is to perform realignment exercises. These exercises can be done (and are effective) before, during, and after pregnancy. Once your hip flexor muscles are being released with the tools described above, begin integrating realignment exercise into the routine.
When your iliopsoas muscles are tight, they often will pull the hips, back, and tailbone out of alignment. So, helping your body realign during this three-step process will only have benefits for your body.
To enable you to do this even during pregnancy, you can do the exercise either on your back, standing, or seated.
Before you start, note that this exercise is only meant to be performed on one hip, unlike the muscle releases. So, you will need to decide which side of your body has the tightest iliacus muscle. The reason behind this is because the tightest side of your body is going to be pulling your hip forward slightly, causing misalignment.
You can watch this hip realignment exercise, but to give you an idea of what to expect, I will explain how the realignment exercise works when lying on your back:
- Lie down on your back
- Bring both knees up towards your chest so your feet are off of the ground
- Place a hand behind the knee on the designated side of your that is tighter and being pulled forward
- Squeeze your hand behind the calf by bending your knee
- Simultaneously push against your hand without moving, as if you are trying to push your foot towards the ground
- Naturally, your hand will resist this pressure. You don’t need to press too hard, so only apply a mild/moderate amount of force.
- The opposing leg will simply stay up off the ground during this time so it doesn’t accidentally push into the ground.
- You will hold this pushing motion with your hand for two seconds, or one deep breath
- Then, relax for a few moments
- Repeat 10 times
If you’d like to learn more about how to realign your hips properly and complete the three-step process, my book Tight Hip, Twisted Core breaks it down in detail, along with providing other necessary information about how tight iliopsoas muscles can impact your life - and how releasing them can free you from your lower back pain during pregnancy.
FAQs on lower back pain during pregnancy
Why does lower pain back occur during pregnancy?
Part of the problem includes tension in the hip flexors, which tighten to provide stability in the pelvis.
Is it normal to have lower back pain in pregnancy?
A pregnant body is changing daily, and the muscles and ligaments of the body are constantly compensating for the needs of the growing baby as well as preparing the body for childbirth. This creates stress and tension in different parts of the pelvis, and can often be relieved by releasing the tight muscles.
How can I relieve lower back pain in pregnancy?
Follow a three-step system: release the front of the hip, release the back of the hip, and realign the pelvis to release muscle tension. Releasing the front of the hip will require the help of a skilled practitioner if you’re pregnant, but you can still get relief by following the last two steps.