May 4, 2020

Back pain is a very common complaint in the weeks and months after childbirth. In fact, almost half of new mothers report backache at 6 months postpartum. Back pain is often treatable, but the first step is to narrow down the cause of the pain. Potential causes of postpartum back pain include epidural complications, diastasis recti, suboptimal breastfeeding positioning, and less common medical conditions such as gallstones and pregnancy and lactation-associated osteoporosis (PLO). Addressing the root cause should be the highest priority, but in the meantime, we’ll suggest ways you can help relieve the pain.

The cause: Epidural complications

Studies show a higher risk of low back pain following a delivery with an epidural. However, it usually lasts less than a week after delivery, and it is not shown to be correlated with longer term back pain.

The remedy
Epidural pain will go away on its own, usually within a week after delivery. In the meantime, you can use short-term pain management strategies, including applying heat and/or ice and taking analgesics like acetaminophen and ibuprofen.

The cause: Diastasis recti

Diastasis recti is a common condition after pregnancy when your abdominal muscles separate. Symptoms may include low back pain, poor posture, core instability, pelvic pain, and a bulge in your abdomen.

The remedy
The separation often resolves naturally within 8 weeks after delivery, but if it doesn’t, talk to your healthcare provider. A pelvic floor physical therapist can help develop a specialized exercise plan to help strengthen the abdominal muscles. You should also avoid certain movements like sit-ups or crunches, so you don’t make the separation worse.

Related: Postpartum Conditions - Diastasis Recti

The cause: Breastfeeding

Breastfeeding has been found to lead to a higher risk of lower back and pelvic pain for at least 6 months postpartum. There is not much research on why, but it may be related to how you hold the baby.

The remedy
IBCLCs and other lactation consultants are breastfeeding experts and can take a look at how you hold the baby and suggest changes to your positioning. You can also add pillows under your arms to help support the baby’s weight. Relaxing your shoulders and neck can help reduce muscle strain as well.

The cause: Gallstones

Gallstones, which are hardened deposits in your gallbladder, are fairly common during pregnancy and postpartum, affecting up to 12% of pregnant and postpartum women. However, in most cases they have no symptoms and do not require treatment. In the rare cases they do cause symptoms, symptoms include nausea and vomiting, pain in the upper right part of your abdomen, pain in the center of your abdomen, pain between your shoulder blades, and pain in your right shoulder. If you experience these symptoms, talk to your healthcare provider.

The remedy
In most cases, gallstones do not require treatment and they often disappear after childbirth. However, if they do cause symptoms, the recommended treatment is usually cholecystectomy, which is the surgical removal of the gallbladder.

Related: Postpartum Conditions - Gallstones

The cause: Pregnancy and lactation-associated osteoporosis (PLO)

PLO is a rare form of osteoporosis, where the bones become weak and brittle. It typically occurs during the third trimester or postpartum, but only occurs in 0.4 in every 100,000 pregnancies. Symptoms may include severe lower back pain, hip pain, a decrease in height and vertebrae fractures.

The remedy
If you have symptoms of PLO, talk to your healthcare provider. Treatment includes calcium and vitamin D supplements, and analgesics and physical therapy for pain management.

Related: Postpartum Conditions - Pregnancy and lactation-associated osteoporosis (PLO)

How to relieve postpartum back pain

The causes we discussed above are not exhaustive, so it’s important to discuss your back pain with your healthcare provider to identify the cause of the pain. Depending on the cause, you’ll want to work with your provider to address that cause specifically. For example, if you have diastasis recti, you will want to work with a physical therapist to close the abdominal separation that is causing the pain.

However, in the meantime, you may also want to manage the pain. Typical pain management recommendations include applying heat and/or ice and analgesics like acetaminophen and ibuprofen. If the pain is muscular-skeletal, physical therapy can also include stretches, braces, manual therapy, and other techniques to reduce pain.

In addition to traditional pain treatment, many people use complementary and alternative methods to help reduce pain. According to the The National Center for Complementary and Integrative Health (NCCIH), there is evidence, though low-quality, that massage therapy, acupuncture, and spinal manipulation may be helpful for acute, or short-term, low-back pain. In fact, the American College of Physicians issued a clinical practice guideline that recommends healthcare providers and patients use non-drug approaches including massage therapy, acupuncture, and spinal manipulation as first-line therapy for acute low back pain.

Massage for back pain relief

Massage therapy involves the manipulating the soft tissues of the body for relaxation and pain relief. Numerous studies have found that massage has been associated with short-term improvements in low back pain, but the quality of evidence was low. Most states require therapists to obtain a license or certification before practicing massage, and there are additional prenatal, labor, and postpartum massage certifications that might be preferred by pregnant or postpartum women.

Acupuncture for back pain relief

Acupuncture is a traditional Chinese medicine therapy, which involves the stimulation of specific points in the body by inserting needles and twisting or lifting the needles to achieve the therapeutic effect. It’s widely used for pain relief, especially low back pain, and there are numerous studies that support its effectiveness, including studies specifically on low back pain during pregnancy and postpartum.

Chiropractic spinal manipulation for back pain relief

Spinal manipulation, or spinal manipulative therapy, is a technique in which practitioners, usually chiropractors, use their hands or a device to apply pressure to a joint of the spine. There is some moderate-quality evidence that spinal manipulation is associated with modest improvements in acute low back pain and function. There are some mild, temporary side effects, such as local discomfort and increased pain, but it is considered relatively safe when performed by a trained and licensed practitioner.

Sources:

Cunningham, F. G., & Williams, J. W. (2014). Williams Obstetrics, 24th edition. Stamford, Conn: Appleton & Lange.

Loughnan, B. A., Carli, F., Romney, M., Doré, C. J., & Gordon, H. (2002, September). Epidural analgesia and backache: a randomized controlled comparison with intramuscular meperidine for analgesia during labour. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12402727.

Macarthur A, Macarthur C, Weeks S. Epidural anaesthesia and low back pain after delivery: a prospective cohort study. BMJ. 1995;311(7016):1336–1339. doi:10.1136/bmj.311.7016.1336
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Mogren, I. M. Breast Feeding Pattern may be Associated with Persistent Low Back Pain and Pelvic Pain Half a Year Postpartum. The Open Epidemiology Journal, 2009, 2: 26-33. DOI: 10.2174/1874297100902010026 Retrieved from
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Rabia Terzi, Hasan Terzi, Tülay Özer and Ahmet Kale, A Rare Cause of Postpartum Low Back Pain: Pregnancy- and Lactation-Associated Osteoporosis, BioMed Research International, 10.1155/2014/287832, 2014, (1-3), (2014).
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The National Center for Complementary and Integrative Health (NCCIH). Low-Back Pain and Complementary Health Approaches: What You Need To Know
https://www.nccih.nih.gov/health/low-back-pain-and-complementary-health-approaches-what-you-need-to-know

Qaseem A, Wilt TJ, McLean RM, et al. for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514-530. Retrieved from https://annals.org/aim/fullarticle/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice?_ga=2.168898023.776848225.1588358899-1117219325.1588358899

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