Postpartum Back Pain: A Q&A with Dr. Lillie Rosenthal

Expert Contributor: 

Dr. Lillie Rosenthal, Doctor of Osteopathy


“Postpartum back pain is really common,” says Lillie Rosenthal, D.O., an expert in pain management and integrative health. “And like most pain syndromes, there are multifactorial contributions. It's not just one thing.” It could be from a tough labor and delivery or from changes in the body during pregnancy. The anterior weight gain puts a lot of stress on the back during pregnancy, and sometimes it gets better after delivery, but sometimes it gets worse.

While it might be nice to know you’re not the only exhausted mom with back pain, being in good company doesn’t make it hurt any less. 

There are a number of common physical and hormonal changes that occur during pregnancy and delivery that can cause it, but according to Dr. Rosenthal, “back pain is not created equally.” We asked her to explain what causes postpartum back pain, when to see a doctor, and how to ease the strain of everyday new-mom activities. 

Q: What are the top issues postpartum women come to you with?

New moms typically see me for back pain in the lumbar region, but I also see upper-back pain in the thoracic spine, as well as neck pain. Another issue common among new moms is pain caused by carpal tunnel syndrome, often associated with how they hold the baby during breastfeeding and other new-baby-related tasks. 

Q: What are the primary causes of postpartum back pain? 

There are the obvious architectural changes in the body, from pregnancy and hormonal changes. The root cause of postpartum back pain depends on the pregnancy, on the changes in the body from pregnancy, on the type of birth, and the cardiovascular health at pregnancy and after.

So much of what causes postpartum back pain is musculoskeletal. Issues in the muscles, joints, and ligaments often come up postpartum, especially if the mom had a difficult labor and delivery. The pain can be related to the muscles, a disk, asymmetry of the pelvis, or it could be related to restricted fascia, which is connective tissue. There is so much going on in a woman’s body when she’s pregnant and postpartum that back pain could be caused by many different reasons. 

Then there are the mechanical challenges of life as a new mom. Your everyday posture changes, you now have a baby that you're lifting and picking up and breastfeeding, which create their own postural challenges that can cause pain. Your posture is affected by everything you do—sitting, holding a baby, picking up the baby from a crib, leaning over the baby to change a diaper. That is all putting new stress on your back. 

Hormonal changes can cause ligament laxity and make it easy to overstretch your lumbar spine while feeding or lifting the baby. Relaxin, the hormone that loosens up muscles and ligaments during pregnancy and delivery, can stay in the body for months after delivery even if you aren’t nursing. Sleep deprivation decreases the body’s pain threshold and increases stress, both of which can exacerbate back pain. 

Moms who had a regular exercise program prior to and during pregnancy might be getting adjusted to being more sedentary, which can put pressure on the back. Being at home, not moving around, being off a regular exercise routine, and sitting more can also certainly be a cause of back pain. 

Q: What can be done to relieve postpartum back pain? 

1. Pain is a signal, so pay attention to it. Find a practitioner who will be a skilled partner in your health. You want someone who will take a detailed history and complete a thorough physical examination, not just prescribe a drug to quell the pain.

2. Heat helps. Take a hot shower or, when your doctor has given you the OK, a hot bath.

3. Sleep is the body’s time to restore itself, so practice good sleep hygiene (as much as is possible with a newborn at home) and sleep in a back-friendly position. This usually means sleeping on a firm mattress and on your side with a pillow between your knees. I tell my patients to avoid sleeping on their stomachs because it puts extra pressure on the lumbar spine. 

4. Exercise is a crucial component in treating back pain. Ease into a regular exercise program for conditioning so you can meet the physical demands of being a new mom and reduce the risk for injury, as well as optimize your health in general. Focus on the core—not just your abdominal muscles, but the entire core from a 360-degree perspective. There are many muscles that support the spine. Back pain is not all created equal. The exercises I prescribe depend on what the root cause is, because certain exercises are good for certain types of back pain, and you're going to get the best results when you know exactly where the pain is coming from—a personalized approach is always best.

5. Pay attention to posture and ergonomics as much as possible, especially when you’re with your baby. Are you hunching over? Are you slouching? Are you standing symmetrically, with equal weight on both feet? Are you bending from the knees or the back?   

6. Osteopathic manipulation is an excellent treatment option for postpartum back pain. There are different types of techniques, including myofascial release, trigger point therapy, as well as spinal manipulation. These techniques are performed by an osteopathic physician to help reset the body and remove any structural impediments to the body healing itself. It’s an excellent and safe treatment option for back pain.

Q: How do I know if I have sciatica?

True sciatica is a nerve compression issue. Usually, it shows as pain going down one leg—or both, but more typically one leg. Sciatica is a specific diagnosis, and this kind of pain would come from a disk that's pressing on a nerve that's running down the leg. But oftentimes what someone thinks is sciatica is actually piriformis syndrome, which 98 to 99% of the time can be fixed nonsurgically with exercises and posture. With piriformis syndrome, which gives a sciatic-type presentation, the pain is usually coming from the piriformis, which is a muscle deep in the butt. 

Q: Are there anti-inflammatories that help back pain?

Even as a pain-management doctor, I rarely prescribe medication. I believe an anti-inflammatory diet—high in fruits, vegetables, nuts, whole grains, olive oil—is more effective in the long run. Topically, I like arnica cream, which has anti-inflammatory benefits. I also recommend treating the area with heat, which can help with circulation and oxygenation, and ice, which is actually an anti-inflammatory. Both are therapeutic. If medication is needed for pain, the risks and benefits need to be considered. Ibuprofen and acetaminophen are relatively safe options because little of it passes through breast milk. But of course, always consult your health-care provider to see what’s best for you.

Q: What lifestyle habits do you recommend to your patients to ease back pain? 

Doing exercises to strengthen your back before the baby is born is super-important, almost like preseason training. Ideally, you would be able to prevent the pain before it starts.

I also believe in food as medicine, and for people with back pain, an anti-inflammatory diet helps keep things quiet and healthy in the body. Fruits, vegetables, beans, and nuts should be the mainstays. Stay hydrated, get as much exercise as is safe postpartum. When you have a baby, you’re often confined to the house, but walking and mobility is fantastic for keeping your back healthy. And I don't want to be totally unpopular, but avoid alcohol—it can have adverse effects not just on your back but on your health in general.

Q: Are there ways you can sleep to mitigate back pain?

Sleep is king. There's no terribly wrong way to sleep, but there are some good ways that can prevent pain and relax the back, and they focus on two areas: the neck and the lower back.

Find relief for the lower back by putting a pillow between your knees while sleeping in the fetal position. If you're sleeping on your back, putting a pillow under your knees is comfortable, supportive, and relaxing for the low back. Also, put a pillow underneath the neck, not just the head. Bunch the pillow in between the shoulders and the head to support the concave area between the neck and the mattress.

Q: Are there ways you should or shouldn’t hold your baby?

A lot of moms hold the baby on one hip, but that asymmetry is something to be aware of. Posture is important to pay attention to, and it’s not just about the low back—there’s the upper back, too, the thoracic spine between the shoulder blades. In general, with a baby we’re hunched over a lot, and this tends to strain muscles in the upper back. 

If you’ve been using a front-facing carrier and begin to feel upper-back pain as the baby gets bigger, pay attention to it. As the baby grows, there’s a lot of weight on the thoracic spine and the neck. Pain is a clue that adjustments may need to be made—and consider strengthening exercises for your upper back.

Q: Are there tricks to holding the baby while you’re breastfeeding?

Breastfeeding is asymmetrical by definition, unless you have twins, but you still want to keep your body as symmetrical as possible. You want to be supported, and you want the baby to be supported, and that means having support in both the lower and upper back. 

Get yourself in a comfortable position—I'm an advocate of using pillows for support—and watch the position of your neck as well. The goal is to sit more straight up and keep the baby close to your body. Sometimes breastfeeding is tricky, but try to go in with a relaxed attitude so you don't put stress in your body.

Q: Do you have tips for checking posture during the day?

You're going to be on a baby's schedule, so every hour or so, check in with your body and observe what it's doing. Linking a check-in with your body to something else you're doing is a good way to keep track. Every time you sit down to eat, stop and think about what's going on with the body. When you get into the stroller phase, you want to make sure that your stroller is the right height and has the right ergonomics to protect your back. 

Q: When do you need to see a doctor? How do you know if it's serious?

The body doesn't lie. When we have pain, it's signaling that there's something out of balance. It doesn't necessarily mean it's a significant medical problem, but it does deserve attention and an accurate diagnosis to determine the root cause of the pain and to direct appropriate treatment options.

Pain that doesn't go away, radiating back pain that travels down the leg, numbness, or tingling—these are all signs you should see a doctor. Incontinence of urine or bowel when you also have back pain is very rare, but that's a true emergency and means that there's a spinal cord injury. Foot drop or weakness of an extremity signals that there's a neurological issue that you should not ignore. 

Remember that postpartum back pain is a common issue for new moms, and it's important to get a root-cause and accurate diagnosis for your pain issues so you can receive a thoughtful and effective treatment plan.