What are the recommended treatments for back ache in pregnancy?

Recommended Treatments for Back Pain in Pregnancy

For pregnancy-related back pain, initiate a structured exercise program—either lumbar stabilization exercises or stretching exercises—as first-line treatment, combined with acetaminophen as needed for pain control. 1, 2, 3

Initial Treatment Approach

Exercise Therapy (First-Line Treatment)

Both lumbar stabilization exercises and stretching exercises are equally effective and should be started as soon as back pain is identified. 3

• Lumbar stabilization exercises reduce pain intensity by approximately 1.68 points on the Visual Analog Scale and improve postural stability after 6 weeks of treatment (twice weekly, 50-minute sessions) 3
• Stretching exercises provide equivalent pain reduction and functional improvement compared to stabilization exercises 3
• Water-based exercise (aquatic gymnastics) starting at 20 weeks gestation reduces pain severity and allows more women to continue working (odds ratio 0.38 for work absence after 32 weeks) 4
• Exercise programs significantly reduce both pain intensity and the need for analgesic medication (median reduction of 500 mg paracetamol usage) 5

Pharmacologic Management

Acetaminophen is the recommended analgesic for pregnancy-related back pain when non-pharmacologic measures are insufficient. 6

• Acetaminophen temporarily relieves minor aches and pains including backache and muscular aches 6
• Use the lowest effective dose for the shortest duration necessary 5

Additional Effective Interventions

Acupuncture

Acupuncture provides superior pain relief compared to group physiotherapy sessions. 4

• Women rate acupuncture as providing "good" or "excellent" help more frequently than physiotherapy (odds ratio 6.58) 4
• Individual treatment sessions appear more beneficial than group sessions 4

Supportive Devices

Specially shaped pillows designed to fit under the abdomen (such as the Ozzlo pillow) reduce back pain in late pregnancy and improve sleep quality. 4

• Fewer women rate specially shaped pillows as providing "little help" compared to standard pillows (odds ratio 0.32) 4

Treatment Schedule and Duration

• Begin exercise therapy as soon as back pain is identified, ideally before symptoms become severe 1, 2
• Schedule sessions twice weekly for 50 minutes over a 6-week period 3
• Continue exercises throughout pregnancy with modifications as the abdomen grows 7
• Maintain upright sitting position during exercises to optimize comfort and bladder control 7

Expected Outcomes

Most women experience pain resolution spontaneously after delivery, but treatment during pregnancy improves function and reduces disability. 2

• Pain reduction occurs within 6 weeks of starting exercise therapy 3
• Postural stability improves significantly (mean effect size d=0.77) 3
• Trunk muscle activation increases, particularly in the external abdominal oblique muscle 3

Risk Factors Requiring Activity Modification

Women performing heavy lifting (10-20 kg or 22-44 lb) more than 20 times per week should reduce this activity to prevent worsening symptoms. 2

• Obesity increases risk due to chronic overloading of connective tissue structures 2
• Adjust physical activities and work demands to prevent symptom progression 2

Red Flags Requiring Urgent Evaluation

Immediately evaluate for serious pathology if any of the following are present: 1

• Progressive neurological deficits (motor weakness at multiple levels, fecal incontinence, urinary dysfunction) 1
• Fever, unexplained weight loss, or history of cancer 1
• Severe pain unresponsive to conservative measures 1

Common Pitfalls to Avoid

• Underreporting by patients: Actively question pregnant women about back pain, as many do not volunteer this information 1, 2
• Delaying treatment initiation: Start exercise therapy early rather than waiting for symptoms to become severe 1
• Ignoring persistent postpartum pain: Women with both low back pain and pelvic girdle pain during pregnancy, early symptom onset, or pre-pregnancy back pain are at highest risk for persistent postpartum pain and require closer follow-up 2
• Prescribing bed rest: This is not supported by evidence and exercise therapy is preferred 3, 4