Upper Back Pain During Pregnancy: Causes & How to Get Relief

Upper back pain is common during pregnancy and can occur in any trimester. As your body adjusts to carrying two people in one space, this discomfort is often normal. However, the severity of this pain, or lack thereof, doesn’t always reflect how serious the issue may be.

It is crucial to recognize when upper back pain may indicate something serious. While it can result from simple muscle straining, it may also indicate pregnancy complications involving the liver, spleen, lungs, or heart. Understanding the difference between normal discomfort and potential dangers is essential.

Is it normal to experience upper back pain while pregnant?

Yes, upper back pain is common and quite normal when it is mild. It’s typically just an inflammatory response in your muscles to the physical strains. Over nine months, your muscles not only adjust to changes in weight but also to the rapid shift in your center of gravity.

Your pelvis normally is your center of gravity. As it changes, so does your walking, also called your gait, and your posture. These changes can inflame muscle fibers, causing pain until your body adjusts to the new stresses.

One of the female hormones, progesterone, has many functions. It helps relax your uterus to prevent premature contractions that lead to premature birth and it is an anti-inflammatory. It also relaxes the ligaments in your joints, especially your pelvis, which is part of preparation for childbirth. However, this joint relaxation extends beyond the pelvis, affecting your spine, shoulders, and ribs. These changes in connective elasticity can alter posture and gait, sometimes causing stress and inflammation in these areas.

A note on pain during pregnancy

Pain is a subjective experience. It’s perceived in the brain, which influences how well it’s tolerated. While everyone experiences pain differently, hormonal changes during pregnancy can alter how it is perceived.

Progesterone, a powerful anti-inflammatory, rises tenfold during pregnancy. Estrogen, produced in higher amounts than during the non-pregnant life, boosts circulation and helps heal muscle fibers. While elevated hormone levels can make pain feel less intense, they may not fully counterbalance the pain caused by changes in weight, gait, and posture. Each pregnancy and individual experience varies.

Common causes of upper back pain while pregnant

Common causes of upper back pain can range from harmless to concerning, making assessment difficult. We'll break down the common causes by trimester to help clarify when symptoms might require medical attention.

In the first trimester

First-trimester upper back pain, weeks 1-12 of the pregnancy, is often due to the posture changes caused by rapid weight gain. Hormonal changes can increase the appetite, leading to weight gain and an additional strain on muscles, which may trigger upper back pain. This pain is often considered normal and not dangerous.

The abnormal causes of upper back pain in the first trimester include:

• Ectopic pregnancy typically causes pelvic pain, but if it ruptures, internal bleeding can irritate the diaphragm and cause pain in the shoulder blades. This is known as referred pain, where discomfort is felt in a different area from the actual injury.
• Kidney infection or stone can cause referred pain on the side of your back, corresponding to the affected kidney.
• Pulmonary embolism, for which there is a higher risk in pregnancy due to pregnancy’s increase in coagulation properties.

If you think any of these abnormal causes may be responsible for your pain, it’s essential to reach out to your doctor or go to the emergency department.

In the second trimester

In the second trimester (weeks 13-26), your blood volume increases significantly, and typically body weight increases. Your baby, along with the amniotic fluid, placenta, and growing uterus, also contributes to this added weight. Additionally, progesterone loosens the cartilage in your joints, which can lead to joint pain. Pain from these causes is generally considered normal.

Abnormal causes of upper back pain can also arise in the second trimester. Although the gallbladder, liver, and spleen are abdominal organs, nerve signals can be misinterpreted by the brain, causing pain to be felt in the upper back.

These abnormal causes include:

• Gallbladder stones or disease with pain felt in the right upper back or shoulder blade.
• Liver swelling, typically seen in third-trimester, with pain felt in the right upper back or shoulder blade.
• Spleen problems, due to infection, blood diseases, clotting disorders seen in pregnancy, or trauma. This pain can be felt in the left upper back or shoulder blade.
• Pulmonary embolism.There is a higher risk in pregnancy due to pregnancy’s increase in coagulation properties.

If you believe any of these abnormal causes may be contributing to your pain, it’s important to see your OBGYN or go to the emergency department..

In the third trimester

In the third trimester, weeks 27 to delivery, normal pain results from the cumulative effects of pregnancy, putting the most pain on your muscles and joints.

These are common causes of normal pain during the third trimester:

• In the last month of pregnancy, your baby gains an extra half pound a week. This rapid weight increase can quickly overwhelm your body’s ability to adapt.
• As your body prepares for breastfeeding, the increase in breast size adds extra weight, creating additional physical stress to adjust to.
• If you develop gestational diabetes, the weight and fluid changes can become more pronounced.
• Swelling, called edema, also adds extra weight. The third trimester is when this typically peaks.
• In the third trimester, you naturally slow down, adopting a more sedentary lifestyle. This reduced activity, combined with limited exercise, can contribute to increased weight and fluid retention. This can also mean more pain.

The following may be causes of abnormal back pain during the third trimester:

• Pneumonia or pleurisy can occur more frequently in the third trimester due to shallow breathing. These lung infections cause sharp pain when inhaling and is typically felt around the affected lung tissue or its lining.
• Preterm labor contractions are typically felt in the lower back and abdomen. Any rhythmic, repetitive discomfort, even in the upper back, should prompt concerns about preterm labor.
• Placental abruption is the premature separation of the placenta, causing abdominal pain and vaginal bleeding. This can also cause pain that is felt in the upper back.
• Complications of preeclampsia, such as liver swelling, can be life-threatening. This can present as right upper back pain or right shoulder blade pain.
• Pulmonary embolism, as above, due to increased coagulation tendencies in pregnancy.
• Any of the 2nd trimester causes

Contact your OBGYN or go to the emergency department if you suspect any of these abnormal causes might be contributing to your pain.

How to get relief from upper back pain while pregnant

Relieving upper back pain during pregnancy sometimes can be challenging, depending on the cause. While the abnormal causes listed above require medical attention, the normal causes can be managed with self-care strategies.

Physical therapy

Since most treatable upper back pain in pregnancy is related to muscles and joints, a physical therapist is an excellent resource. They can identify what might be causing the pain and strategies to avoid it. Therapies, like heat or stretching, may also be used to relax and heal strained muscles and joints.

Exercise

Exercise should be done only in conjunction with physical therapy, since any muscle injuries require healing first.

Diet

This does not mean dieting for weight loss, which can be dangerous to your baby. A healthy, balanced diet supports your pregnancy and aligns with recommended weight gain.

Typically, weight gain should be two to four pounds in the first trimester, and one pound per week in the second and third trimesters.Your doctor can refer you to a dietitian or nutritionist for guidance.

Heat

Applying heat to the affected area can be helpful, especially moist heat, which won’t dehydrate your skin. However, avoid hot tubs and saunas as it is not safe to increase your body temperature.

How to prevent upper back pain during pregnancy

Respect your body and its limitations to the added stresses of pregnancy, via the following:

Remember your gait

Changes in the way you walk can stress the entire body, including your upper back. Wear low-heeled, but not flat, shoes with good arch support to promote a healthy gait.

Exercise

Low impact exercise, especially walking, can help maintain the muscle tone that prevents strain and injury. The “slow and steady” approach is best. Additionally, women who exercise regularly have the lowest complications in labor and delivery.

Diet

Gaining the recommended weight for a normal pregnancy is your best prevention. A dietitian or nutritionist can provide personalized guidance to meet your unique needs.

Avoid unusual strenuous activity

Sudden challenges that stretch, push, or engage muscles beyond their abilities will cause injury. Stay mindful of your activity at all times to avoid strain. Your body will let you know if you’ve gone too far.

When to seek medical attention for upper back pain during pregnancy

If your back pain concerns you, seek medical attention immediately. If you you are unsure whether you should go to the doctor or emergency room, here are common scenarios:

You should see a doctor for any of the following:

• Any chest pain.
• Any upper back pain in either shoulder blade.
• Any pain associated with vaginal bleeding, vomiting, or coughing up blood.
• Any pain that affects your ability to breathe adequately or that causes shortness of breath.
• Any pain that is sharp, pin-point, and continues worsening.
• Any pain that makes walking impossible.
• Any pain when there is fever.
• Shortness of breath.

You should go to the emergency room:

• For any of the above, if not during regular office hours when you can contact your doctor, nurse practitioner, or midwife immediately.

Frequently asked questions: upper back pain during pregnancy

Below are the most common questions that come up about upper back pain during pregnancy.

What if the upper back pain feels sharp?

This indicates a sudden change. It can be harmless if it is very brief and goes away spontaneously. It is considered abnormal if it worsens and you should seek help from a medical provider.

What if you’re experiencing upper back pain along with chest tightness?

Breathing difficulty may be the baby’s size pushing your uterus against your diaphragm. But any chest tightness or chest pain may indicate pneumonia or a heart problem, and you should seek help from a medical provider immediately.

How can you get relief from upper back pain that happens while you’re sleeping?

Try changing positions. When you find that one position that works, remember that your body is changing, so it may not work later in your pregnancy. Experiment to find a new position that feels comfortable for you.

It is not recommended to lay flat on your back after your second trimester. The weight of the uterus can compress your circulation, causing blood pressure drops, nausea, and even poorer oxygenation for your baby.

Takeaways on upper back pain during pregnancy

Carrying two people in one body is a natural but challenging process. Discomforts are to be expected, but it’s important to recognize when something may be abnormal or concerning. Being cautious and seeking help when unsure is always the right choice.

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