Common Questions About Postpartum Low Back Pain

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey everyone, this is your guest host, Dawne Costantino, with the Restoring Human Movement podcast. Thank you for joining the Movement Movement. If this is your first time joining us, welcome. We do have so many episodes that we've recorded now that nearly go over every part of the body. So please check those out if you're interested or if you have other things going on that you just want to know a little bit more information about.

Today, I'm actually going to be talking about postpartum moms who are dealing with low back pain. I've recently been focusing my efforts on postpartum moms because I was attending certain seminars to see how I can better support them, talking to different people, and it was this realization of at about the six-week mark postpartum, your midwives, possibly doulas, OBGYNs, as long as there's no complications, we'll kind of just clear you to return to normal, let's just say. And so at this point is where I want to help fill the gap. There's still so many questions about what's going on with your body during this time and some aches and pains that you might be dealing with that you're unsure of what to do, how to find time.

Is it normal? Is it not normal? How do I get back to my normal? So that's kind of why I'm making this episode today. Very dear friend of mine. Her name is Becca. She just had her second child a few months ago and we were talking about me wanting to record this podcast to better help and support postpartum moms. And she got very excited and was super helpful and just created the most incredible list I've ever seen of all the questions that she has about just the state that she's in right now. And so today I'm going to answer some of these questions. We're going to focus specifically on low back pain.

I am going to do other parts of the body as well, but today is just, or this episode specifically is just about low back pain. So if you want to know about mid back pain, neck pain, hips, how to get back to working out, I will cover those topics as well. So let's hop right into it. So the first question is, is there a right way to lift a baby from a low crib to avoid or to not provoke low back pain? And the answer is no, to be honest with you, because I can't generalize this question for every single person, as in there's no one right answer for everyone. I like to say that there's a right answer for each person and each person's right way might be different.

So I'm going to use two different examples to get you to conceptualize this a bit. First example is my friend, Becca. She, during her pregnancy, was experiencing low back pain and sciatica. If you're not familiar with sciatica, it's basically just the nerve that comes out of the lower part of the spine and goes down the back of the leg and supplies the muscles back there. She wasn't just experiencing low back pain. She also had the radiating symptoms as well. And so this was caused from the position that you find yourself in when you are pregnant. The heavier you get, the further you get in your pregnancy, you find yourself in this pelvic position.

It's called an anterior pelvic tilt. If you don't know what that is, what you can imagine is, is basically when you're standing for a long period of time, a lot of times you end up finding yourself with your belly button forward, your butt sticking out behind you, your hips shift forward. There's a lot of pressure and compression in the low back. Best way I can get you to kind of visualize this is like that Instagram model position. And honestly, if you're a mom listening to this, you probably know exactly what I'm talking about. So that position, what it does is it puts a lot of pressure on the joints and the lower part of the spine right above your pelvis.

And it also increases pressure of the nerve roots. So out of your spine through a hole called the foramen, exit your nerve roots. And so when we have that compression in that area, it can increase pressure over time. And pressure will cause pressure of the nerve, which eventually, if not fixed or not offloaded, will radiate pain down the back of the leg. And so for Becca in particular, she responded really well to the opposite, meaning we needed to put her in a posterior tilt. We needed to round her spine a little bit. This will offload those joints, kind of open up a space a little bit. This will decrease the pressure around the nerve root and over time will reduce those symptoms.

So the answer for her is during pregnancy, I'm sorry, afterwards during postpartum when lifting baby out of the crib, I would basically ask her every once in a while, just allow a little rounding when you're going to pick up your child. Let your spine slouch a little bit. I know that that's kind of controversial to hear, but I think that for her, it would be super helpful, you know, and there's things that she can do outside of lifting baby out of the crib that can be helpful too. And we'll get into that later. But for her in particular, the answer was every once in a while, when you lift your baby, allow a little sloppy spine, allow a little posterior tilt, and over time, that should be helpful for you.

On the other hand, a different patient that I currently have, she actually was dealing with low back and sciatica before her pregnancy. And these were all caused from different things throughout her day, like sitting for long periods of time, sitting with a slouchy spine, lifting weights with a slouchy spine. And this was all kind of over time causing symptoms in the low back and down the leg. And a different part of the spine was involved in this, which was with the intervertebral disc, which I'm not going to get into today, but she's a different presentation. So meaning during her pregnancy, that anterior pelvic tilt position, that extension and that extra pressure at the lower part of her spine was actually therapeutic for her.

I remember seeing her when she was postpartum after she had her child, she said, all those symptoms went away during my pregnancy. So for her, for example, coaching her to lift baby out of a crib with a rounded spine might put her right back where she was before her pregnancy. So the answer for her might be proper lifting technique. Make sure that you have good pressure in the core before you go and lift up baby. Make sure that you're sitting through the hips to lean forward over the crib. Use the glutes when lifting, kind of that like normal dead lifting technique that people are being taught.

This is what I would ask her to pay attention to more often than not when lifting baby to prevent these symptoms from coming back. So using those examples does show that each of these moms would have responded to a completely different type of approach to protect the spine. So tuning into your body and finding patterns. Oof, my body didn't like that. My spine didn't like when I was sitting for too long. My spine actually likes when I sit for longer periods of time. Finding patterns and tuning into like, what position am I in when my body likes this and when my body doesn't like this can be helpful.

But finding patterns sometimes on your own can be really, really tricky. And so this is where going and asking for a movement professional's help would be a really good idea if you can't find the pattern on your own. Have someone assess you, have someone educate you on what's going on, have someone let you know, here are some ways and some techniques that you can use when lifting baby out of the crib, okay? I use patterns all the time when I'm working with postpartum moms or even anybody with low back pain. It's, let's figure out what the trigger is. Why are we doing that so often that it's starting to cause symptoms?

Let's educate you on how to do the opposite and how to build more of that into your day. It's not that you can't do these things that are causing pain. It's just about limiting it for a little bit of time and then building back tolerance to it. So I like to use a bank account analogy sometimes to get people to understand what I mean by this. So depositing into your health bank account is doing the things that makes your symptoms feel better, okay? So let's use Becca for example again. If throughout the day she continues to allow that extension and that anterior pelvic tilt, she ends up in a net negative in her bank account and that's when pain and symptoms present.

If we sit her into a low squat, ask her to sit down and lean forward or sit a little bit slouchy here and there. When she's picking up baby, allow just a little bit of slouching in the spine when you are doing that. I know that's controversial, but just allowing that here and there is depositing into her bank account. As a mom, you can't always tune into these things. You find yourself in weird positions when you are just trying to keep baby happy. And so it's really, really just tuning into when are the times that I can deposit. I'm lifting baby from the crib and last time I allowed a slouchy spine.

This time I'm going to tune into bracing my core, sitting through the hips to lift baby. I do think that everybody should just be exposed to all different types over time. So last time I bent over really low. I allowed some slouching. This time I'm going to focus on form, embrace my core. Next time I'm going to see if I can, you know, lower the side of the crib so that I don't have to bend down as far. The time after that, I'm going to let baby sleep in a higher spot that I don't have to bend down. I don't have time to think about all this stuff. Set aside time for yourself at some point during the day, maybe when baby is sleeping, to dedicate a couple minutes to doing what your body needs.

Okay. So to conclude the answer to this question, you will likely hear me say this often. There is no right answer. There is only what is right for you. And exposing your body to different things each time instead of doing the same thing over and over can be helpful. And if you are just like, I'm not sure what's right for me. I can't figure out how to get rid of my discomfort. Please reach out to somebody who can help you. Let them guide you. Let them educate you. Let them help you find a pattern. All right. So I hope that was helpful. We're going to hop into the next question. Is there a right way to carry a baby for a long period of time and not have low back pain?

It's going to be a similar answer to the one before, honestly. I highly suggest changing positions often. One thing I noticed is that moms favor carrying their baby on one side. It's almost unconscious. I recognize that I myself, when I'm carrying a baby, I favor cradling the baby in my left arm. Or for an older child, I favor sitting that child on my right hip. And over time, I feel one area of the body become more sore because it's being held in the same position for a long period of time. So after a while, soreness and fatigue start to turn into pain if you don't change things. You're not allowing recovery of those muscles and those joints if you continue to do it over and over and over again.

That's where injury and pain sets in. Pain is at first your body's way of communicating that something needs to change. Try your best to carry baby in different positions often. Switch arms. Switch hips. Use baby carriers. I like baby carriers because you can change where the baby is placed on the chest, higher, lower, which allows you to secure baby in place so you can change your low back position, change your pelvic position. Try getting some squats in. Try hip hinging. Bend over slightly, offload the back. All of these things without the fear that baby isn't secure in your arms, you know, and might slip.

So if you got baby carrier, you can free up the arms. You can really reduce the pressure in your low back. You can sit down. All of these things. There is no right one. It's which one feels right for you in that moment. And if pain is talking to you, you need to change positions. Okay? So the answer is, is try different positions every time. Expose your body to something different every time. The one that feels weak and insecure, that's the one that needs to get stronger. Maybe you do that one for less time, but more often. I hope that was helpful as well. Hey everyone, it's Sebastian. I'm going to hijack the show just for a second here to tell you about an opportunity that we have called the Discovery Session.

A lot of people over the years have reached out to us from our YouTube channel because we have 150,000 YouTube subscribers at this point in time, probably more by the time you listen to this. And we have a lot of people listen to this show and read our articles online. They're frustrated. People are frustrated about not being able to get back to full activity. They're frustrated they can't really trust their body. They're frustrated that they have not found any long-term answers or things to make them happy. And so we're here to help. We may not be the ones to actually help you and we're okay with that, but we're hoping that if you are able to speak with us, that we can maybe give you some insight of things that you potentially haven't tried yet.

And if we know people, we'll suggest those people too. So if you want to take advantage of the Discovery Session, all you need to do is go to p2sportscare.com and find the book now button. It's all in there. We have virtual or in-person options. You can go to the show notes for this show and find a link that'll directly connect you to us, or you can call us 714-502-4243. We'd love to help you the best that we can, and we're always here to serve. Now back to the show. Next question is, are there stretches to do in bed or to do before the activities mentioned, like picking up baby from a crib or holding baby for a long period of time?

Are there stretches we can do before these activities to help with low back pain? This is honestly my favorite question because a lot of times I could easily try to tell you to try new things, try different positions, try lifting differently, and realistically, it's not very easy to remember each time. Or it might feel weak or insecure to hold them with your non-dominant arm. So if me giving you all these suggestions isn't feasible for you or hard to remember and track, then set aside some time to dedicate stretching, offloading, strengthening the areas that need it. I'll give you my top three things that I like to teach moms.

The number one is what we call IAP. It stands for intra-abdominal pressure. So imagine just laying on your back, okay? Feet supported up on the couch, and your hips and your knees are at about 90 degrees. Kind of like you're sitting in a chair, but flipped over on the floor. And so what we're going to do is allow the entire spine to kind of relax into the ground. And we start to coach pressure and breathing into the abdomen. So we reduce the movement of the chest a little bit. We stack the ribs down into our front pockets. We start to breathe into the belly button. Just seeing if you can allow your belly button to rise and fall with the breath.

And then seeing if you can get a little bit deeper into that, meaning kind of down below the belly button, okay? Can we get that lower abdominal area to move with our breath? Once you feel like you can get that, then kind of the stretching, the breath into the sides of the body. So if you put your hands on your hips, kind of where your obliques are, the empty space in the side of your body, if we can breathe into that area. And then we're looking to see if we can breathe with pressure. So instead of allowing relaxation with your breath out, there's still some pressure and activation of the pelvic floor and the abdominal muscles as we cycle through the entire breath.

This has been shown to be really decompressive of the spine. It starts to rehab the pelvic floor after pregnancy, and it can reduce symptoms for a lot of people. So I love teaching this one as like an introduction back into activity and how to protect yourself if we're going to get back into working out and pretty much just protect yourself for just being a mom, okay? Moving forward. Number two, it does seem like a lot of moms love child's pose. I don't know if all of you are familiar with this, but it's a simple yoga pose where you're on your hands and knees, you sit your hips back to your heels as far as your hips will allow you, kind of spread the knees as wide or as close as you need them.

Let your chest fall over your knees and just allow some decompression and some rounding of your low back, and it puts you into that posterior pelvic tilt position, the opposite of what you've been in for nine months, basically. And then still kind of coaching that same breathing that I talked about before. Again, this is all just another way to offload the joints, decrease pressure around the nerve roots, put you into a position you don't find yourself in very often when you are pregnant and especially afterwards when you're holding your child for a long period of time. My third favorite one is what we call thoracic extension.

So the thoracic area of your spine is your mid-back. Between your shoulder blades, it starts at the base of your neck, and it ends where your ribs end, basically. And this area, a lot of times, is stuck in this just kind of slouchy position when you're pregnant, when you're holding baby, when you're sitting down to rest, that you're just constantly in a slouch position, especially when breastfeeding, too. So a lot of this is just kind of educating you on how to find positions that are opposite of what you are constantly in. So extension would be the opposite of that. It's like a tall posture. It's like over-exaggerating, stretching your chest muscles or sticking your chest out, leaning backwards over a chair, pretty much what you naturally do when you wake up and stretch in the morning.

So thoracic extensions throughout the day is one of my favorite things to give moms because it's really easy to incorporate into your day. It can be done when you're sitting down. It could be done in the kitchen on your countertop. So if you're interested in this one, just Google thoracic extension. There's so many ways to perform it. A little bonus one. I like to build in when moms are ready some side bridges. So think about like side planks, but it's a more regressed version. It starts to build in some support for the abdominal wall. You know, if you feel ready to kind of build those into your routine, if you haven't already, start with some side bridges with your intra-abdominal breathing while performing.

So these are all ways to give your body some love while the little one is sleeping, ways to stretch the areas that are being overused, ways to begin building back core strength, and ways to prime your body for the strenuous task of being a mom, basically. Next question is standing with baby or toddler, our hips tend to push forward, adding pressure to our back. Does that do anything to moms long-term, like lower back pain in the future? It can, honestly. This isn't exclusive to moms. It can happen to anyone who finds themselves in that position often over time. The beautiful thing is that the body knows how to adapt to increased stress that you put on it.

So the bad thing is, is that sometimes these adaptations can actually cause changes in the future that will lead to different issues. So some of these changes that could occur are increased bone growth around the spinal column and joints, increased pressure on the intervertebral discs, increased pressure on the nerves, which can begin to affect anything supplied by that nerve down the leg. Weakness, numbness, tingling are common symptoms that this will begin to present, if not taken care of, early on. And this is not me trying to scare anyone. It will take a long time for these adaptations to occur.

So building in little things now can significantly help you in the long run. Next question is, is should we, as moms, put our babies down, readjust ourselves when we start to slouch and push our hips forward? Because that usually is what happens when we've been holding our baby for an extended period of time. The short answer, honestly, is yes. Think about going to the gym and doing something as simple as like a bicep curl. How do you think it would feel if you continue to do a set of bicep curls for a long period of time without stopping? First, you're going to feel fatigue. Eventually, you're going to feel pain.

And then the inability to continue the movement once you've reached complete fatigue. So typically when doing an exercise, you'll do it for a certain amount of time. time or reps and then allow yourself to take a break. Same thing goes when you're finding yourself in the hips forward position described. So you need to take breaks for necessary recovery so that you can continue to do this for your child without injury moving forward. Are there any stretches or helpful tips to ease pain or workouts to strengthen the muscles to hold our baby for longer? I will add another three stretches I like to give that weren't mentioned before.

Anything related to the lower abdominal exercises like practicing posterior tilts on your back, glute bridges, and thoracic rotation. On a podcast, it's really, really hard to describe these things without showing them. But if you type exactly what I said into Google, I'm sure you will find many, many videos and examples of each. Please be careful following suggestions online. It is always best to just ask your doctor, chiropractor, or physical therapist to help you. Having someone watch you give exercises specific to what your body needs is always best. And if you're having trouble finding someone you trust, I do offer discovery sessions virtually or in person.

We can open up a conversation. We can do an assessment. We can talk about whether or not I have ways to help you or if I know anyone near you. So, really quick answer. And again, just kind of circling back. Lower abdominal exercises like practicing posterior tilts, glute bridges, and thoracic rotation are all stretches or workouts that you can build in so that you can tolerate holding your baby for a long period of time. Have you heard of Tush Baby? After seeing it, do you believe that this can help ease pain on the lower back? I did have to Google this one and honestly, it looks wonderful to me.

I typically ask people not to always rely on things like this, though. It is a perfect tool to build in here and there to help. Whether you're holding baby on your hip or on your own or using Tush Baby, doing one thing too often will cause issues. That's obviously a trend on the podcast today. So, it's always about moving often, changing things often, and having a professional help you. So, basically, I want to conclude by saying that I recognize that asking you to think about these things with a brand new baby in the house does feel impossible sometimes. All you can think about is how to keep them safe and give them what they need.

It can make it hard to find moments to think about yourself when life is happening around you. But sometimes, even hearing me talk about this will give you moments of thinking about it more and just trying it here and there can honestly just go a long way. If these suggestions are not all feasible for you, but you do have those small windows of time to dedicate to yourself, this is the time to deposit into your account. Build in stretches and positions that will offload the painful tissues of the low back. Find a provider and a support system near you who can help you identify these triggers and educate you on what is right for your body.

It will allow you not to waste time trying to figure out what is right for you and become a more efficient way to take care of yourself. You truly deserve to be able to have time to dedicate to taking care of yourself. Ask yourself, how can I learn more about my body, my body's needs, ways to stay happy and healthy so I can continue to provide and love my child the way that I want to? Common sentence, you cannot fill other people's glass with an empty glass. So again, if you all want to know some things you can try at home, please visit our YouTube channel, Performance Play Sports Care. To see more, you can type in whatever you're dealing with, low back pain, hip pain, core exercises.

We have all kinds of stuff on there for you to check out. And then please check out the rest of the postpartum podcasts. I am going to cover more areas of the body that moms have questions about.