Exercises for Back Pain During Pregnancy

The single most important principle for exercising with back pain in pregnancy is this: stay moving, but do every movement gently, without pain and without bouncing. Staying active during pregnancy reduces back pain and improves your ability to go about your daily activities — provided you have no complications and you have first talked with your doctor or midwife to confirm the exercises are safe for you ^[2]. Back pain is extremely common in pregnancy: more than 60% of pregnant women experience low back pain, which occurs because weight gain and a shift in the centre of gravity increase the forces across the joints and spine ^[2]. This article walks you through why back pain happens in pregnancy, whether exercise is safe, the gentle pelvic tilts, cat-cow and pelvic floor exercises you can do at home, and the symptoms that mean you should contact your doctor, midwife or the emergency services without delay — all grounded in evidence-based sources.

The information below is general education and does not replace an individual treatment plan. Deciding whether it is right for your pregnancy, and choosing and progressing exercises for your situation, belongs to a doctor, midwife or a physiotherapist experienced in pregnancy care. Always talk with your care team before starting a new exercise ^[2].

Why does back pain happen in pregnancy?

Back pain in pregnancy has several interlinked causes, most of them tied to the natural changes your body goes through to grow a baby. First, pregnancy hormones relax the connective tissue that holds bones in place — especially in the pelvic area — while the growing uterus stretches out the muscles of the abdomen ^[3]. Second, as your baby grows, your centre of gravity shifts forward; to keep from tipping over you lean back without realising it, and this strains the muscles of your lower back and contributes to pain ^[3]. ACOG summarises the mechanism this way: weight gain and a shift in the point of gravity result in progressive lordosis (an increased inward curve of the lower back), which increases the forces across the joints and spine during weight-bearing ^[2].

Back pain is not limited to the midline of the spine. In pregnancy, pain can extend from the lower back into the pelvic girdle — that is, the area between the posterior iliac crest, the gluteal fold and the general lumbar spine ^[5]. For this reason, clinicians distinguish two patterns: pregnancy-related low back pain (PLBP) and pregnancy-related pelvic girdle pain (PPGP). The distinction matters because the management and prognosis of the two may differ; the site of pain, its character and severity, provoking factors and the resulting disability all help tell them apart ^[5].

How common is back pain in pregnancy? According to Physiopedia, around 60% to 70% of pregnant women experience low back pain at some point during their pregnancy ^[5]. ACOG reports that more than 60% of all pregnant women experience low back pain ^[2]. A Cochrane review found that more than two-thirds of pregnant women experience low back pain and almost one-fifth experience pelvic pain, with pain increasing as pregnancy advances and interfering with work, daily activities and sleep ^[4]. In other words, this is very common and usually a natural part of pregnancy.

When does the pain start and peak? Physiopedia notes that the onset of pain may occur around the 18th week of pregnancy and may reach peak intensity between the 24th and 36th weeks ^[5]. A history of low back pain or pelvic girdle pain, and a family history of pregnancy-related pelvic girdle pain, are associated with developing pregnancy-related pelvic girdle pain ^[5].

Is exercise for back pain in pregnancy safe?

For most healthy pregnancies the answer is yes — regular, moderate movement is recommended and helps reduce back pain ^[2]. ACOG states that, provided you have no complications, staying active during pregnancy reduces back pain and increases your ability to carry out daily activities; as a general target, pregnant women should ideally get at least 150 minutes of moderate-intensity aerobic activity each week ^[2]. Mayo Clinic likewise notes that regular physical activity can keep your back strong and might relieve back pain during pregnancy, and that many people find walking, water exercise, and prenatal stretching and strength classes such as yoga helpful ^[3].

Water exercise can be especially valuable for back pain, because the water supports your weight to avoid injury and muscle strain; many women swim right up to the end of their pregnancies ^[2]. On the evidence side, a Cochrane review reported that for women with low back pain, taking part in strengthening exercises, sitting pelvic tilt exercises and water gymnastics reduced pain intensity and back pain-related sick leave better than usual prenatal care alone ^[4]. The same review found low-quality evidence that exercise improves pain and disability for women with low back pain, and moderate-quality evidence that exercise leads to less sick leave and fewer women reporting pain in those with both low back and pelvic pain together ^[4]. So exercise is not a magic fix, but done regularly it offers a modest yet real benefit.

The golden rule of safe exercise: it should not cause pain. ACOG is explicit — exercising should not cause pain, and if you have pain you should stop doing the exercise ^[2]. The NHS similarly advises that exercises in pregnancy should be comfortable and that you should only move as far as you remain pain-free ^[1]. Avoid jerky, bouncy or high-impact motions, which can increase your risk of being hurt ^[2].

How does physiotherapy help with back pain? Physiopedia notes that there are many physiotherapy treatments for pregnant women with low back pain, and that research supports a combination of instruction, manual therapy, active exercises, aerobic exercises and stretching ^[5]. It adds that a biopsychosocial approach aimed at improving a person's self-knowledge and self-efficacy is recommended in managing pelvic girdle pain, because it helps minimise disability ^[5].

What should I check before starting home exercise?

A few simple precautions improve both your safety and the benefit you get from exercise:

• ·Talk with your care team first. Before doing any exercises, talk with your doctor or other obstetric care provider to make sure they are safe for you ^[2].
• ·Use pain as your compass. Exercising should not cause pain; if a movement brings on or worsens pain, stop doing it ^[2]. Only move as far as you remain pain-free ^[1].
• ·Avoid high-impact and jerky motions. Bouncing, jumping and sudden twisting movements increase your risk of injury ^[2].
• ·Mind your posture. The principles of good posture include standing up straight and tall, holding your chest high, and keeping your shoulders back and relaxed ^[3]. Good posture reduces the load on your lower back.
• ·Use heat or cold as a support. A heating pad, hot pack, warm water bottle or ice pack placed on your back can give sore muscles relief; if you use a heating pad, set it to the lowest temperature and wrap it in a towel to lower the chance of burns ^[3].
• ·Progress slowly and gradually. Begin with a few repetitions and increase your reps and time slowly as you feel better.

One practical note: from the second trimester onward, many sources advise against lying flat on your back for long periods, because the growing uterus can press on major blood vessels. If a back-lying move such as a pelvic tilt does not feel right, choose the seated or hands-and-knees alternatives instead, and raise it with your doctor or midwife.

The exercises below are for healthy, uncomplicated pregnancies and for people whose clinician has confirmed they are not at risk. If you have any of the "red flag" symptoms described later in this article, you should get a health assessment first rather than starting to exercise.

Safe exercises for back pain in pregnancy: step by step

The exercises below are general, low-load movements based on the principles emphasised in the sources. Do each one slowly, do not hold your breath, and stop any movement that increases your pain or does not feel right. Ideally, have a physiotherapist or midwife experienced in pregnancy tailor this programme to you ^[5].

1. ·

   Brisk walking (a starter activity). Begin with short walks at a comfortable pace on level ground. Walking is a safe, recommended activity that helps keep your back strong and may relieve back pain in pregnancy ^[3]. You might start with 10-15 minute walks a few times a day and build the total time gradually over the weeks. Keep the general target of 150 minutes of moderate activity per week in mind ^[2].

2. ·

   Seated pelvic tilt. Sit upright on a chair. Tilt your pelvis forwards, arching your back, hold for 5 seconds and return to the starting position; then tilt your pelvis backwards, rounding your back, and return ^[1]. The Cochrane review reported that sitting pelvic tilt exercises reduced back pain intensity ^[4]. Move only within a comfortable, pain-free range and without bouncing.

3. ·

   Standing pelvic tilt. Stand with your knees soft and your hands on your hips. Gently tuck your tailbone under, bringing your pubic bone forwards; imagine your pelvis is a bucket full of water and you are trying to tip a little out of the back of the bucket ^[1]. Hold for a few seconds, return to the start and repeat several times. The NHS notes that pelvic tilt exercises help reduce lower back pain and increase the strength of your abdominal muscles, that there are no side effects, and that following this advice will not harm you or your baby ^[1].

4. ·

   Cat-cow (hands-and-knees pelvic tilt). Move onto your hands and knees, with your head in line with your back. Gently lift and arch your back, tucking your tailbone under, hold for a few seconds (the "cat"); then lower the middle of your back and stick your bottom out gently (the "cow") ^[1]. Mayo Clinic describes a low back stretch in the same position: rest on your hands and knees with your head in line with your back, pull in your stomach to round your back slightly, hold for several seconds, then relax ^[3]. This gives the lower back and abdomen a gentle stretch and movement.

5. ·

   Pelvic floor exercises (Kegels). First find the right muscles: imagine you are trying to stop yourself from passing urine and wind; the feeling of "lift and squeeze" — closing and drawing up the front and back passages at the same time — exercises the pelvic floor muscles ^[6]. Sit with your feet flat on the floor, or lie down to start with; as you get stronger you can progress to standing ^[6]. Close and draw up the muscles around your back passage (as if stopping wind, without tightening your buttocks) and around your vagina and urethra (as if stopping the flow of urine); hold to a count of 5 (if that is hard, hold for 2 then 3 and build up to 5), breathing normally throughout ^[6]. Do not hold your breath or clench your buttocks ^[6]. The NHS recommends that all pregnant women do pelvic floor exercises, performing them daily for at least three months and then a few times a week for maintenance, aiming for three sets of eight squeezes a day ^[6].

6. ·

   Low back stretch (gentle hands-and-knees hold). As a slower, held variation of cat-cow, on your hands and knees pull in your stomach to round your back slightly, hold for several seconds, then relax ^[3]. This gives tight lower-back muscles a gentle stretch.

7. ·

   Water exercise / swimming (if available). Water exercise can be especially helpful for back pain because the water supports your weight, reducing the load on your spine and joints and helping you avoid injury and muscle strain ^[2]. Many women can swim safely until late in pregnancy ^[2]. Mayo Clinic also lists water exercise among the activities that may relieve back pain in pregnancy ^[3].

8. ·

   General movement and posture habits. Alongside the exercises, keeping good posture through the day, not staying in one position for long, and moving gently and often will ease your back ^[3]. Aim for the 150 minutes of weekly moderate activity gradually, combining walking, water exercise and these gentle movements ^[2].

Movements to avoid in pregnancy

Knowing which movements to avoid is as important as knowing which to do:

• ·Any movement that causes or worsens pain. This is the most basic rule: exercise should not cause pain, and if you feel pain you should stop that movement ^[2]. Only move within a pain-free range ^[1].
• ·Jerky, bouncy and high-impact motions. Avoid sudden twisting, jumping and high-impact moves, which raise the risk of injury ^[2].
• ·Lying flat on your back for long periods. In later pregnancy, lying flat on your back for long stretches can feel uncomfortable; if back-lying moves such as pelvic tilts do not feel right, do them seated or on hands and knees, and discuss it with your care team.
• ·Overexertion and fatigue. Listen to your body rather than pushing hard; avoid exercising so intensely that you are breathless and cannot talk, and stay well hydrated.

Remember that an exercise programme should be individual. Physiopedia notes that back pain in pregnancy varies from person to person and can change over the course of a pregnancy ^[5]. So apply the list mindfully, watching your own responses and, where possible, working with a professional.

When should I see a doctor or midwife?

Back pain in pregnancy is usually natural and temporary, but some symptoms can signal a more serious problem and need prompt assessment. If you have severe back pain, or if the pain lasts more than two weeks, call your doctor or other obstetric care provider — because back pain can be a sign of some pregnancy complications, such as preterm labor, and it can also be a symptom of a urinary tract infection (UTI) ^[2].

Urgent — contact your doctor or midwife without delay, or go to the nearest emergency care if, alongside or instead of back pain, you have any of the following ^[2]:

• ·Vaginal bleeding — heavy vaginal bleeding in particular needs prompt assessment ^[2],
• ·Regular contractions — back pain can be a symptom of preterm labor ^[2],
• ·Leaking fluid / your waters breaking — if you feel fluid that trickles or gushes from your vagina, the amniotic sac may have broken; call your obstetric care provider's office and follow their instructions ^[2].

These signs, together or alone, can herald an emergency and should be addressed by your care team immediately, not with exercise. ACOG's general advice is clear: if you feel like something just isn't right, or you aren't sure if it's serious, it's always best to tell your care provider and get the help you need ^[2].

See a doctor or midwife if you have any of the following:

• ·Severe back pain, or pain lasting more than two weeks ^[2],
• ·Signs of a urinary tract infection, such as burning when you urinate or needing to urinate more often ^[2],
• ·Pain that does not improve, or that worsens, despite rest and gentle exercise,
• ·Pain that radiates into a leg with progressive weakness or loss of sensation.

In short: bleeding, regular contractions and leaking fluid need urgent assessment, and severe back pain or pain lasting more than two weeks should always be raised with a health professional ^[2]. If you have none of these and your pain can be managed with gentle exercise and posture changes, you can consider supports such as home physiotherapy with a doctor, midwife or physiotherapist.

Short Summary

• ·Back pain is very common in pregnancy; more than 60% of pregnant women experience it, driven by weight gain and a forward shift in the centre of gravity ^[2], ^[5].
• ·If you have no complications, staying active in pregnancy is safe and reduces back pain; the general target is 150 minutes of moderate activity per week ^[2].
• ·Seated pelvic tilts, standing pelvic tilts, cat-cow and pelvic floor exercises (Kegels) are safe, gentle starting options ^[1], ^[6].
• ·There is evidence that sitting pelvic tilt and water gymnastics reduce back pain intensity; the benefit is modest and needs consistency ^[4].
• ·Exercise should not cause pain; avoid jerky, bouncy and high-impact motions ^[2].
• ·Talk with your doctor or midwife before starting a new exercise ^[2].
• ·Bleeding, regular contractions and leaking fluid need URGENT assessment; severe back pain or pain lasting more than two weeks should also be reported to a clinician ^[2].

For more on a related condition, see our herniated disc (lumbar disc herniation) page.

Frequently Asked Questions

Is it safe to exercise for back pain during pregnancy?

For most healthy pregnancies, yes. ACOG states that, provided you have no complications, staying active during pregnancy reduces back pain and increases your ability to go about your daily activities ^[2]. However, before doing any exercises you should talk with your doctor or other obstetric care provider to make sure they are safe for you ^[2]. The core rule is that exercise should not cause pain ^[2].

Why does back pain happen in pregnancy?

It happens through a combination of factors. Pregnancy hormones relax the connective tissue in the pelvic area, the growing uterus stretches the abdominal muscles, and as your centre of gravity shifts forward you lean back to keep your balance, which strains the lower-back muscles ^[3]. ACOG adds that weight gain and the shift in the point of gravity increase the inward curve of the lower back (lordosis), raising the forces across the spine and joints ^[2].

Can pelvic tilt exercises harm the baby?

No. The NHS states clearly that there are no side effects from doing pelvic tilt exercises and that following this advice will not harm you or your baby ^[1]. These exercises help reduce lower back pain and strengthen the abdominal muscles ^[1]. You are advised to do the movement only within a pain-free range and without bouncing ^[1].

How often should I do pelvic floor (Kegel) exercises in pregnancy?

The NHS recommends that all pregnant women do pelvic floor exercises ^[6]. It advises doing them daily for at least three months and then a few times a week for maintenance, aiming for three sets of eight squeezes a day — you could do a set at each meal to help you remember ^[6]. Hold each squeeze to a count of 5, breathing normally and without clenching your buttocks ^[6].

What should I do if I feel pain during exercise?

ACOG's rule is clear: exercising should not cause pain, and if you have pain you should stop doing the exercise ^[2]. A gentle feeling of stretch can be normal, but if a movement brings on clear pain or worsens existing pain, do not do that exercise, and raise it with your doctor or midwife if needed ^[2]. Only move as far as you remain pain-free ^[1].

When is back pain in pregnancy a sign of something serious?

You should call your doctor for severe back pain, or pain lasting more than two weeks, because back pain can be a sign of preterm labor or a urinary tract infection ^[2]. In addition, vaginal bleeding, regular contractions and leaking fluid (your waters breaking) are symptoms that need urgent assessment; in those cases, contact your doctor or midwife right away ^[2].

Does water exercise or swimming help back pain in pregnancy?

Yes — water exercise can be especially helpful for back pain. ACOG notes that the water supports your weight, which helps you avoid injury and muscle strain, and that many women can swim right up to the end of their pregnancies ^[2]. Mayo Clinic also lists water exercise among the activities that may relieve back pain in pregnancy ^[3].

How much benefit will I get from exercise?

The benefit is modest but real, and it needs consistency. The Cochrane review found that strengthening exercises, sitting pelvic tilt exercises and water gymnastics reduced back pain intensity and back pain-related sick leave, and that in women with both low back and pelvic pain there was less sick leave and fewer reports of pain ^[4]. So exercise is not a magic fix, but done regularly it helps you manage back pain ^[4].