Pregnancy Back Pain and Sciatica Physiotherapy in Indirapuram

Why your back hurts more as the weeks go on

Hormones get most of the blame, and they do play a part. Relaxin and progesterone make ligaments more pliable so the pelvis can open for birth. But the bigger driver is plain mechanics. As the bump grows, your centre of mass moves forward, the curve in your lower back deepens, and the abdominal muscles lengthen until they lose most of their leverage. The muscles along your spine end up doing work they were never asked to do on their own.

Add the weight most women gain by the third trimester, somewhere around ten to fifteen kilos, and it makes sense that the ache builds through the day and peaks in the evening.

Not all pregnancy back pain is the same problem, though, and the first job in an assessment is to work out which one you have. Pain above the belt line that gets worse with long standing or sitting and eases when you move is usually lumbar. Pain below the belt line, over the dimples at the back of the pelvis or the pubic bone at the front, that flares with walking, stairs and turning in bed is pelvic girdle pain, which is managed differently. Plenty of women have a bit of both.

Sciatica in pregnancy is often not a disc problem

Leg pain in pregnancy frightens people, because sciatica sounds like a slipped disc. True nerve root compression from a disc does happen, but it's the less common cause. Far more often the pain is referred from an irritated sacroiliac joint or from tight, overworked deep buttock muscles. That kind of pain sits in the buttock and the back of the thigh and rarely travels below the knee.

Pain below the knee with pins and needles, numbness or a weak foot points to the nerve itself. We test for this properly at the first visit, because it changes what we do. The general approach to nerve pain is covered on our sciatica physiotherapy page; in pregnancy we adapt every position and technique around the bump.

Neck, shoulder, upper back and knee pain

The lower back gets the attention, but it isn't the only area that complains. Breast tissue gets heavier, which pulls the shoulders forward and loads the upper back. Sleeping on one side for months compresses the shoulder underneath. Fluid retention can squeeze the nerve at the wrist and cause carpal tunnel symptoms, usually worse at night. Knees take extra load too, and a wider, flatter walking pattern can leave them aching after stairs. Rib pain under the bra line in the last trimester is the uterus pushing up, and it responds well to side-bending stretches and changes in sitting posture.

How we treat it

Assessment

We sort lumbar pain from pelvic girdle pain and referred leg pain from nerve pain, check posture, hip and thoracic movement, and review any obstetric instructions you have been given.

Hands-on treatment

Soft tissue work to the back, buttock and upper back, gentle joint mobilisation and kinesio taping, all done side-lying, seated or propped up.

Exercise

A short routine for hip, glute and deep core strength, plus mobility for the spine. Five to ten minutes a day is usually enough.

Daily habits

Specific changes to sleep, sitting, lifting and getting out of bed, because that's where most of the aggravation happens.

What we change for pregnancy

Posture advice that actually helps

"Stand up straight" doesn't work, because no single posture is right for eight hours. What helps is changing position before the ache sets in and setting up the positions you spend the longest in.

• Sleep on your side with a pillow between the knees and a small one under the bump. Many women find a full-length pregnancy pillow worth the space it takes.
• Get out of bed by rolling onto your side first, dropping your legs over the edge and pushing up with your arms.
• At a desk, get up every thirty to forty minutes. Hips slightly higher than knees takes load off the lower back.
• Floor sitting is fine if it's comfortable. Sitting on a folded blanket so the hips are higher makes cross-legged sitting easier on the back.
• Lift a toddler or a bucket by squatting close to it, not by bending from the waist with straight legs.

When to call your obstetrician instead

Back pain is usually mechanical, but a few symptoms need medical review the same day rather than physiotherapy:

• Back pain that comes in regular waves or tightenings, especially before 37 weeks
• Vaginal bleeding or a leak of fluid
• Fever, burning when passing urine, or pain in the side under the ribs
• Numbness around the saddle area, or new difficulty controlling the bladder or bowel
• Calf pain or swelling in one leg
• Severe headache, blurred vision or sudden swelling of the face and hands

How quickly it settles

Most women notice a clear change within two to four sessions. The honest answer is that the pain may not disappear completely until after delivery, because the load that causes it keeps increasing. The realistic aim is pain you can manage, sleep that isn't broken by it, and a body that's in good shape going into labour. Our clinical team has also written about how physiotherapy helps pregnancy back pain in more detail.

Frequently asked questions