Reduce Pregnancy Pain With These Simple Posture Tips

Reduce Pregnancy Pain With These Simple Posture Tips

Our posture and alignment go through significant changes during pregnancy to accommodate our growing uterus, breasts and baby. These normal postural changes aren’t directly correlated with pain1, however some women do experience new or exacerbated aches and pains in postures and positions that other women may find comfortable. Having good body awareness during pregnancy helps to decrease discomfort, pain (especially in the low back, hips and sciatic nerve pain) and promotes a healthy position of the ribs, core and pelvic floor to promote better breathing and prevent excessive separation of abdominal muscles (diastasis recti). In addition, good body awareness allows the hips to function well and stay mobile, making more space for baby to get in their just-right position for labor and birth. The earlier you start practicing healthy posture and alignment habits the better, even before getting pregnant, though it’s never too late! Through neuroplasticity, the nervous system adapts to our most frequently used positions. If our most common positions are poor (such as with slouching/rounded shoulders, forward head/neck, excessive anterior/posterior pelvic tilt), we will have a tendency to use these as our ‘default’ postures which can increase stress, pain and tension over time. There is no such thing as ‘perfect’ posture to strive for as each individual body has a range where the muscles seem to work more optimally, however there are general posture habits that set the right environment for your body to function well

Standing

As the belly continues to grow in pregnancy, we may notice our ribs flare up and out, an increased inward curve in the lower back, rounded shoulders and a wider foot stance with our feet turned slightly outward, all impacting both our standing and walking patterns. Support your standing posture with the following shifts:

• Feet hip distance apart (or slightly wider)

• A neutral low back, allowing ribs to stack over the pelvis as best you can

• Neutral shoulder blades that are relaxed and dropped

• Neutral and dropped lower ribs, without thrusting the ribcage forward

Seated

You will likely be sitting often during pregnancy, whether it’s sitting in a car, a chair at work, on the couch, on the floor playing with your toddler or while exercising seated on a birth/exercise ball. Aim to sit on a firm surface the majority of the time. Soft surfaces can promote slouching (think how you might sit on the couch) which can place extra pressure on the sacrum and stress out the sacroiliac (SI) joints, contributing to SI joint pain and sciatic nerve pain. When sitting on a birth/exercise ball, aim to keep your knees slightly lower than your hips which facilitates a more upright posture on the sitz bones (the two bony ischial tuberosities you may feel against the surface you’re sitting on). These bones are strong and can best withstand the weight of our body. We also want to allow neutral thigh position or slight external thigh rotation through both legs when sitting. Think about allowing the thighs to be positioned forward or a bit outward when we sit as compared to internal thigh rotation (thigh turned inward) that happens to the top leg when we cross our legs at the thigh. We also want to keep in mind the core foundations of standing posture when sitting, including a neutral spine, ribs stacked over pelvis and relaxed and dropped shoulders that aren’t rounded forward. To summarize sitting body awareness:

• Sit upright on our sitz bones (the bony protrusions) on a firm surface the majority of the time

• Keep knees level with the hips, or slightly lower than the hips

• Thighs forward or slightly externally rotated (turned outwards) with feet flat on the floor  

All Fours

All fours can be a common position in pregnancy to help take some weight off the back and relieve back aches and pains, reduce feelings of pressure and heaviness on the low belly and pelvis, and as you get closer to the end of pregnancy, all fours uses gravity to help baby rotate into their just-right position while also stretches and releases the round ligaments (ligaments on the side of the low belly that support the uterus). This stretching of the round ligaments helps relieve tension and creates more space in the pelvis for baby to get well positioned. Gently engaging the core in all fours can feel wonderful and relieves pressure while helping avoid a sagging spine. Key body awareness habits in all fours include: 

• A neutral back, of course unless you are performing an exercise like the cat/cow 

• Keeping knees directly under hips or in a slightly widened stance

• Wrists positioned directly under the shoulders

• Activated shoulders, you can do so by gently pressing arms and hands into the floor

Reclined

As pregnancy progresses and the belly grows, side-lying positions are typically more comfortable and help maximize blood flow to baby. It’s common advice to avoid the supine (back lying) position in pregnancy, however research varies on the guidelines for this supine position (laying on your back) during pregnancy. Lying on your back for short periods of time, such as when performing an exercise set, is generally considered safe as long as you aren’t experiencing adverse symptoms (such as light-headedness, nausea, leg tingling, discomfort or difficulty breathing)2. In side-lying positions, place a pillow between the knees to keep knees in line with the hips, or in a slightly widened position if that feels better for you. If knees are consistently unsupported, the internal rotation at the hips (inward turning) along with the extra joint elasticity from relaxin (a hormone that rises in pregnancy with various functions, one being that it helps soften ligaments) can pull on hip ligaments and low back muscles and contribute to discomfort, tension and even pain. To recap reclined positions: 

• Side-lying positions 

• Support your knees and thighs by placing a pillow between them

• During exercise, slightly elevate your back as needed

Pregnancy Posture Habits to Avoid & Try

Avoid: standing with weight shifted to the same hip consistently as this can create imbalance in the hips

Try: standing with weight evenly distributed through both legs or sway side to side

Avoid: consistently leaning back and arching the low back in attempt to ‘counterbalance’ the increased weight of your belly

Try: telling your family and friends to cue you when they notice you are in the leaning back posture. Also, make a habit to check in with your posture every so often and create a manta that will remind you to bring your ribs down and weight slightly forward over the middle of your feet so that ears, ribs and hips are lined up as best you can. Something like “ribs down, lower abs engaged, weight forward”

Avoid: consistently crossing legs at the thigh as this can add extra stress to the hip joint

Try: crossing your feet at the ankles to maintain neutral hip alignment 

Avoid: sitting on top of one leg

Try: if you are needing extra stability, try sitting criss-cross on top of a pillow or yoga block to allow for hips to be slightly higher than your knees

Avoid: sitting slouched forward with a rounded back and shoulders

Try: sitting on a wobble disc, boppy or placing a pillow or firm cushion behind your low back to maintain your spine’s natural curve. Tune into the ergonomics of your sitting space, such as if you notice rounded back/shoulders while using the computer, ensure the computer is positioned a bit higher for you. Orr when using your phone hold it up higher toward your face to prevent constant neck flexed postures looking down

Avoid: consistent reclining on a soft surface

Try: side-lying with a pillow between your knees, or if you are exercising, place a towel roll or small ball between your thighs. If reclining back to complete exercises during a workout is not comfortable for you, elevate your back and shoulders slightly where it feels more comfortable and less pressure

Overall, movement variability is typically more important than posture. This simply means that varying your movements throughout the day by getting into different positions as often as possible (like during workouts, taking standing/movement breaks to decrease sitting durations) helps support your pregnancy body changes and your overall comfortability. 

1. Franklin ME, Conner-Kerr T. An analysis of posture and back pain in the first and third trimesters of pregnancy. J Orthop Sports Phys Ther. 1998 Sep;28(3):133-8. doi: 10.2519/jospt.1998.28.3.133. PMID: 9742469.

2. Jeffreys RM, Stepanchak W, Lopez B, Hardis J, Clapp JF 3rd. Uterine blood flow during supine rest and exercise after 28 weeks of gestation. BJOG. 2006 Nov;113(11):1239-47. doi: 10.1111/j.1471-0528.2006.01056.x. Epub 2006 Sep 15. PMID: 16978230.