Low Back Pain During Pregnancy: A Physical Therapist's Complete Guide (Salt Lake City)

Dr. Emily Warren, DPT treats pregnancy-related low back and pelvic pain at Mindful Movement Physical Therapies in Holladay and Salt Lake City. No referral required in Utah. Pregnant patients welcome at any trimester.

📞 Call: (385) 332-4939
📅 Book Your Evaluation →

Quick Answer

Low back pain during pregnancy affects 50–70% of pregnant women and is the leading cause of work disability and activity limitation during pregnancy. Despite how common it is, it’s not something you simply have to endure. Physical therapy — specifically targeted manual therapy, stabilization exercises, and education — can significantly reduce pain intensity, improve function, and make the remainder of your pregnancy far more manageable. The key is distinguishing between lumbar pain and pelvic girdle pain (PGP), which require different treatment approaches.

Why Pregnancy Causes Low Back Pain

Pregnancy-related low back pain isn’t a single condition — it’s the intersection of several physiological changes that simultaneously stress the lumbar spine and pelvis:

1. Postural Shift and Center of Gravity

As the uterus grows, the center of gravity shifts forward and upward. To compensate, most women develop increased lumbar lordosis (the “pregnancy sway back”). This shift transfers compressive load to the posterior elements of the lumbar spine — the facet joints, disc posteriors, and lumbar multifidus muscles — all of which were not designed to sustain prolonged compressive loading in an exaggerated lordotic position.

2. Relaxin and Joint Laxity

Relaxin — a hormone produced primarily in the first trimester and again near delivery — loosens ligamentous tissue throughout the body to allow pelvic expansion for birth. This is essential for delivery, but it also reduces the passive stability of the sacroiliac joints, pubic symphysis, and lumbar facets. With reduced passive stability, the muscles must work harder to control movement — and when they’re fatigued or under-recruited, pain follows.

3. Abdominal Wall Separation (Diastasis Recti)

By the third trimester, approximately 100% of pregnant women have some degree of diastasis recti — separation of the rectus abdominis along the linea alba. When this separation is clinically significant (typically >2 cm gap with poor tension generation at the linea), the anterior abdominal wall loses its ability to effectively transfer load across the midline. The posterior chain — erector spinae, multifidus, gluteals — compensates by working overtime, leading to fatigue and pain.

4. Weight Distribution and Gait Changes

The average pregnancy involves a 25–35 lb weight gain, much of it anterior. This shifts loading through the hips and knees in ways the neuromuscular system wasn’t calibrated for. Gait changes — wider base of support, increased trunk sway, reduced step length — alter load transmission through the lumbar spine with every step.

5. Compression on Neural Structures

The expanding uterus can compress the sciatic nerve, the femoral nerve, and the obturator nerve — any of which can create radiating pain that mimics “low back pain” but actually originates at a different level. Additionally, the lateral femoral cutaneous nerve is frequently compressed at the inguinal ligament, producing meralgia paresthetica (outer thigh numbness/burning) that many women assume is back-related.

Lumbar Pain vs. Pelvic Girdle Pain: Why the Distinction Matters

The most important clinical distinction in pregnancy-related back pain is between lumbar pain (arising from the lumbar spine) and pelvic girdle pain (PGP) (arising from the sacroiliac joints or pubic symphysis). These conditions have different causes, different tests, and critically — different optimal treatments. Applying the wrong treatment to the wrong condition can make things worse.

Lumbar Pain

• Located in the lower back, typically between the 12th rib and gluteal crease
• Worsened by sustained postures (sitting, standing for long periods)
• Improved with movement, position change
• May refer into the buttock or posterior thigh (but rarely below the knee in pregnancy)
• Responds well to McKenzie-style directional preference exercises and lumbar stabilization

Pelvic Girdle Pain (PGP)

• Located in the posterior pelvis, often at or just below the PSIS (the dimples of the low back)
• May include pubic symphysis pain (symphysis pubis dysfunction / SPD) — pain at the pubic bone
• Worsened by weight-bearing on one leg: stairs, rolling over in bed, getting dressed
• The ASLR (Active Straight Leg Raise) test is positive — lifting one leg flat causes pain or felt heaviness in the pelvis
• Responds well to sacroiliac joint stabilization, compression belts, and pelvic floor coordination training
• Does not respond as well to lumbar extension exercises — which may actually aggravate it

A proper physical therapy evaluation will differentiate between these presentations within the first session — which is why “just do stretches you found online” often fails. The wrong stretch for the wrong diagnosis is at best useless and at worst painful.

What the Research Shows About PT for Pregnancy Back Pain

Physical therapy for pregnancy-related back pain has a robust evidence base:

• Cochrane Review (Pennick & Liddle, 2013): Found that exercise (including physiotherapist-supervised stabilization programs), pelvic belts, and acupuncture were each more effective than usual care for reducing pelvic girdle pain and lumbar pain in pregnancy. Specifically, stabilization exercises significantly reduced sick leave and disability.
• Stuge et al. (2004, Spine): A landmark RCT showed that specific stabilization exercises targeting the local stabilizer system (transversus abdominis, pelvic floor, multifidus) reduced PGP intensity, disability, and sick leave significantly more than general exercises at both 20-week and 1-year follow-up. The stabilization group had 4x less sick leave.
• NICE Guidelines: The UK’s National Institute for Health and Care Excellence recommends physiotherapy assessment and treatment — including stabilization exercises and manual therapy where appropriate — as first-line care for pregnancy-related PGP and lumbar pain.
• Safety: Manual therapy and targeted exercise during pregnancy are safe when performed by a trained PT. A systematic review in Manual Therapy found no adverse effects on pregnancy outcomes from spinal manipulation or mobilization in uncomplicated pregnancies.

Safe Exercises for Pregnancy Low Back Pain

The following exercise categories are well-supported in the literature and safe for most uncomplicated pregnancies. Your PT will individualize these to your specific presentation and trimester:

Deep Stabilization (Local System)

• Transversus abdominis (TrA) activation: The “drawing-in” maneuver — a gentle activation of the deep abdominal wall without bearing down or bracing hard. This is the pregnancy-safe alternative to aggressive bracing and forms the foundation of pelvic stability.
• Pelvic floor coordination: Not just Kegels, but learning to coordinate pelvic floor contraction with breath and TrA activation. Many pregnant women with PGP have an overactive or poorly coordinated pelvic floor — which is a fixable problem with PT.
• Multifidus activation: Quadruped arm/leg raises (“bird-dog”) in neutral spine train the deep lumbar stabilizers in a weight-distributed position that’s comfortable in all trimesters.

Hip Strengthening

• Sidelying hip abduction (clamshell): Targets gluteus medius, a primary contributor to pelvic stability in single-leg stance. Weak glutes = excessive pelvic drop and SI joint stress with every step.
• Supine bridge (hip thrust): Safe into the second trimester for most women. Activates gluteus maximus and trains posterior chain co-contraction.
• Side-lying hip extension: Targets glute max without the supine positioning concern.

Aquatic Exercise

Water reduces compressive load on the spine and pelvis by approximately 60% at waist depth. Aquatic stabilization exercises are particularly beneficial for women with severe PGP who find land-based exercise painful — the unweighted environment allows progressive loading without symptom flare.

What to Avoid

• Asymmetrical loading exercises (single-leg deadlifts, lunges) in PGP — provoke SI joint shear
• High-impact activity in moderate-severe PGP
• Sit-ups, crunches, or traditional core exercises — worsen diastasis recti
• Prone lying after the first trimester

Red Flags: When to See a Doctor Immediately

Most pregnancy back pain is musculoskeletal and appropriate for PT. However, the following symptoms require immediate obstetric evaluation:

• Severe, sudden-onset back pain unlike anything prior
• Back pain accompanied by vaginal bleeding, fluid leakage, or contractions
• Fever + back pain (possible kidney infection / pyelonephritis — common in pregnancy)
• Pain radiating down the leg below the knee, especially with bowel or bladder changes
• Rapid worsening of pain that doesn’t respond at all to position change

What Treatment Looks Like at Mindful Movement PT

Dr. Emily Warren has extensive experience treating both lumbar pain and pelvic girdle pain during pregnancy. MMPT’s approach combines:

Comprehensive Evaluation (60–90 minutes)

Dr. Warren will assess your movement patterns, screen for lumbar vs. pelvic girdle pain, evaluate pelvic floor function (via external assessment — no internal exam required without consent), assess diastasis recti, and identify which muscles are under- or over-recruited. You’ll leave the first session with a clear diagnosis and a plan.

Manual Therapy

Soft tissue mobilization, joint mobilization (gentle — not high-velocity thrust techniques), and myofascial release applied to the thoracic spine, hips, gluteals, and piriformis — all safe and effective during pregnancy. Research supports manual therapy reducing pain intensity by 30–50% in pregnancy-related PGP when combined with exercise.

Stabilization Program

A trimester-appropriate progressive stabilization program targeting TrA, pelvic floor, multifidus, and gluteal recruitment — building from isolated activation to functional movement patterns.

Postural and Activity Guidance

How to sit, sleep, get out of bed, lift, and move in ways that minimize pelvic and lumbar stress. These are immediate, practical changes that reduce pain the same day you implement them.

Pelvic Belt Fitting

For moderate-severe PGP, a properly fitted sacroiliac belt can provide immediate pain relief by adding external compression to the SI joints. Dr. Warren can recommend appropriate options and ensure you’re using one correctly — worn too low or too loosely, they don’t work.

Common Questions

Is it safe to see a PT while pregnant?

Yes — and it’s recommended. Physical therapy for pregnancy-related musculoskeletal pain has a strong safety record. Dr. Warren is experienced in pregnancy-appropriate assessment and treatment techniques. No manipulation (high-velocity thrust) is used in the third trimester. Always let us know your trimester and any complications (placenta previa, preterm labor history, cerclage) at intake so we can adjust accordingly.

I’m in my first trimester — is it too early to come in?

No — early intervention is better. The postural and muscular changes that drive back pain begin in the first trimester, often before the bump is visible. Starting stabilization exercises early gives you a foundation that reduces cumulative strain through the second and third trimesters.

I’ve heard “back pain is just part of pregnancy.” Should I just push through?

This is unfortunately common advice — and it’s wrong. Back pain in pregnancy is common, not normal or inevitable. It’s a sign of a mechanical imbalance that responds well to treatment. Women who don’t address pelvic girdle pain during pregnancy are also at higher risk for persistent pain postpartum. Treating it during pregnancy protects your recovery after delivery.

Will this pain go away after delivery?

For lumbar pain, usually yes. For pelvic girdle pain, it’s more variable — about 25% of women still have PGP symptoms at 3 months postpartum, and for some it persists longer. Physical therapy after delivery (including internal pelvic floor assessment if appropriate) speeds recovery and reduces the risk of persistent symptoms.

Does insurance cover PT during pregnancy?

Most insurance plans cover PT for musculoskeletal diagnoses including pregnancy-related back and pelvic pain. Dr. Warren’s office will verify your benefits before your first appointment. If you have a high deductible or prefer cash-pay, we can discuss options.

The Postpartum Connection

Pregnancy-related back and pelvic pain doesn’t always resolve automatically after delivery. Several issues often persist or emerge postpartum:

• Diastasis recti: If the abdominal separation doesn’t heal with proper rehabilitation, it can cause persistent core weakness and back pain for months or years. A postpartum PT evaluation at 6 weeks checks for this and guides return to exercise safely.
• Pelvic floor weakness or hypertonicity: Whether from vaginal delivery or cesarean, the pelvic floor needs re-education after birth. Weakness causes stress incontinence; hypertonicity causes pain and urgency. Both respond well to PT.
• SI joint instability: Relaxin levels remain elevated in breastfeeding mothers, meaning the ligamentous laxity that drove PGP during pregnancy doesn’t fully resolve until breastfeeding ends. Many postpartum women have ongoing SI pain that began during pregnancy.

MMPT treats the full pregnancy-to-postpartum continuum. You don’t have to restart the process after delivery — Dr. Warren can follow your care from mid-pregnancy through postpartum recovery.

Low Back and Pelvic Pain Treatment in Salt Lake City — During and After Pregnancy

You don’t have to white-knuckle through nine months of back pain. Pregnancy-related low back and pelvic girdle pain is treatable — and treating it now means a smoother pregnancy, better delivery preparation, and faster postpartum recovery.

Dr. Emily Warren sees pregnant patients at Mindful Movement Physical Therapies in Holladay and Salt Lake City. No referral needed in Utah. Appointments typically available within 1–2 business days.

📞 Call: (385) 332-4939
📅 Book Your Evaluation →

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Dr. Emily Warren, DPT is a women’s health physical therapist with over 14 years of clinical experience in Salt Lake City. She specializes in pregnancy-related musculoskeletal pain, pelvic girdle dysfunction, and postpartum rehabilitation at Mindful Movement Physical Therapies in Holladay, Utah.

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