In the process of recovering from birth - regardless of the type of birth - low back pain can be a persistent (and super annoying) symptom.

During pregnancy you most likely experienced some sort of low back pain/tension simply due to the changes that bodies go through to grow a human. These include an increase in joint laxity due to circulating hormones (thank you relaxin), shifts in your centre of gravity due to an ever expanding bump and the muscular weaknesses or imbalances that develop as your abdominals stretch, movement patterns change and overall bodily fatigue sets in.

These shifts that occur in the musculoskeletal system during pregnancy transfer into the postpartum period and can continue to cause low back pain for weeks and even months postpartum. So let's go over some of the changes that happen in the body that lead to low back pain and then I'll give you some examples of how you can adapt your posture, correct some imbalances and minimize your symptoms.

Hormonal Changes

The major hormones that will shift postpartum are estrogen, progesterone and relaxin. After delivery, the levels of these hormones decline significantly, causing the joints to return to the pre-pregnant state. It takes an average of 6 to 8 weeks for the joints and surrounding tissues to stabilize and bear weight effectively.

Symphysis pubis dysfunction is a collection of signs and symptoms of discomfort and pain in the pelvic area, including pelvic pain radiating to the upper thighs and perineum. This can occur due to the physiological pelvic ligament relaxation and increased joint mobility in pregnancy due to hormone relaxin. Personally I experienced this to a minor degree both during pregnancy and postpartum.

The severity of symptoms varies from mild discomfort to severely debilitating pain. The symphysis pubis gap is normally 4-5 mm wide and it widens 2-3 mm during the last trimester of pregnancy (and up to 10mm in severe cases). This separation and pain can continue into the postpartum period as it takes time for hormones to shift back to a non-pregnant state.

However, if you are lactating, then relaxin will still be present and can account for the symphysis pubis gap remaining wider for a longer period of time. For me, in the instance of postpartum I breastfed (and supplemented with formula) for 12 months with my first son and 6.5 months with my second son - AND I had symptoms of symphysis pubis pain during certain exercises and movements during the duration that I was lactating. So if you experience this pain, know that there's a link between lactation and how long you may experience symphysis pubis pain symptoms.

Skeletal Changes

During pregnancy there is a natural tendency for the pelvis to shift into an anterior pelvic tilt. This is when the front of the pelvis shifts downwards towards the floor and the back of the pelvis conversely shifts upwards creating an exaggerated arch in the lumbar spine (aka low back). This happens due to the weight of the uterus and baby shifting the body's centre of gravity forwards along with the stretching and thinning of the linea alba causing weakness in the abdominal wall. Other factors in this shift towards an anterior pelvic tilt also include tight and shortened hip flexors and weak or inactive glutes.

These weaknesses and imbalances follow our bodies into postpartum (I know right, we can't catch a break!) and so does that anterior pelvic tilt. The hormonal changes discussed above mean that it takes time for the tissues to become more tensile and supportive again.

Coccydynia, the medical term for tailbone pain, is a condition that may affect women who have a difficult vaginal delivery due to a large newborn, excessive weight gained during pregnancy, or an instrumental delivery. I experienced this during my first postpartum period after delivering an 8lb 10 oz baby via forceps. The traditional seated/leaned back birthing position puts the pelvis into an posterior pelvic tilt and tends to cause the coccyx (aka tailbone) to impede some of the space of the birth canal. In my experience, this position was not supportive for my delivery but because I had an epidural, I wasn't able to be in a squat position (which shifts your pelvis into a posterior tilt and opens up the birth canal). During the first few weeks postpartum, I found that when I tried to sit cross-legged on the floor I would get sharp pain in my tailbone and have to shift to a different position. I brought this up with my pelvic health physiotherapist and she was able to use some mobilization techniques to help my coccyx return to it's natural position which quickly resolved my pain.

Approximately 35% of women still have an abdominal

separation after 6 months postpartum.

Muscular Changes

Diastasis recti is defined the widening of the space between the sides of the rectus abdominus muscles. It is NOT a tear but rather a thinning and stretching of the tissue of the linea alba (the midline of the "6 pack" muscles). It can occur anywhere along the length of the linea alba and is very common in the final 8 weeks of pregnancy as the uterus continues to expand and postpartum.

For many, any diastasis present postpartum heals within 8 weeks. But approximately 35% of women still have a separation after 6 months postpartum. This separation affects the muscle's ability to engage and support the trunk and can lead to symptoms of low back pain.

So how do we manage this postpartum?

Here are 3 key things to incorporate into your postpartum recovery to manage and minimize low back pain:

Pelvic Tilts

Anybody who's participated in my classes or has worked with me as a 1-on-1 personal training client knows this is one of the things I will focus on until it becomes a natural part of your exercise movement pattern. I can just hear one of my postpartum clients in the back of my head saying "I just can't escape these damn pelvic tilts can I?" The answer is nope.

Stretching and Mobility

I know, I know it seems boring but it's so vital to managing the imbalances that are probably causing some of your low back pain symptoms. Tight muscles usually equate to weak muscles and therefore are not supporting your body the way they're supposed to. And tight joints prevent the body from moving the way that it's intended to move.

Wake Up Those Lazy Glutes

We spend A LOT of time sitting - especially in the early days postpartum when you feel like your constantly feeding a baby around the clock. When we sit, our glutes are disengaged and they begin to get laaazzzzyyy. Teaching them to re-activate and support your pelvis and core can definitely alleviate some of the symptoms of low back pain.

I encourage you to give these a try and see how your low back feels after incorporating them into your day. These 3 key things will only take 5-10 minutes to go through while laying on the floor and can significantly improve how your body feels and moves postpartum.

And if you need more support and guidance to manage your postpartum low back pain - or any postpartum symptoms affecting your ability to move your body freely - I invite you to book a FREE discovery session with me to discuss your individual fitness needs.