Lower Back Pain During Pregnancy: First Trimester

Authored by Bodyful Physical Therapy and Wellness

Lower Back Pain in Early Pregnancy: How Prenatal Pelvic Floor Physical Therapy Can Help

Lower back pain during pregnancy can be common, but that does not mean it is normal.

Addressing back pain early—especially in the first trimester—can support a smoother birth experience and a more supported postpartum recovery.

In this blog, you will learn what contributes to different types of back pain during pregnancy and how prenatal pelvic floor physical therapy can help address it effectively.

Understanding Lower Back Pain in Early Pregnancy

One of the biggest misconceptions about back pain during pregnancy is that the pain is always coming from the spine. Sometimes that is true. Other times, the pain originates from a pelvic joint called the sacroiliac joint (SI joint).

The SI joint is part of the pelvic girdle, which means pain here is considered pelvic pain—not just back pain. This distinction is important because if pelvic floor function, hip mechanics, and core coordination are not assessed, progress may be limited.

During the first trimester, your nervous system becomes especially attentive to the pelvis. As your body adapts to pregnancy, research suggests the nervous system increases sensory input around this region to closely monitor change. This can heighten sensitivity—even in the absence of tissue injury.

People with a history of low back pain, chronic gut inflammation, hypermobility, or trauma may already have a more sensitive nervous system, which can amplify pain signals during early pregnancy.

This is why narratives centered only on “instability,” weakness, or things being “out of place” can be unhelpful. These explanations often increase fear and tension rather than supporting regulation and resilience.

A somatic, nervous-system-informed approach to prenatal pelvic floor physical therapy addresses both the cognitive and sensory components contributing to pain. This includes bottom-up resourcing practices, coordinated movement training, and individualized exercise rather than generalized strengthening alone.

Common Contributors to First-Trimester Low Back Pain

In addition to increased sensitivity around the pelvis and SI joints, other contributors often include:

• Postural adaptations that develop early as your center of gravity begins to shift forward

• Compensation patterns at the head, shoulders, ribs, low back, hips, and pelvic floor

• Excessive tension or stretching of muscles like the upper trapezius, pectorals, piriformis, hip flexors, and obliques

• Breath holding or inefficient breathing strategies that increase spinal compression

When these patterns persist, muscles such as the hip flexors and back extensors may become very stiff, contributing to ongoing discomfort and inefficient movement patterns and dysfunction.

How to Manage Lower Back Pain in the First Trimester

1. Supportive Body Mechanics

Reduce strain and breath holding during lifting, squatting, pushing, and pulling. Aim for a neutral, stacked posture where the ribcage rests over the pelvis. Avoid open scissoring or excessive arching, rib flare, or tailbone tucking, all of which increase compression.

An individualized prenatal PT assessment can help identify what neutral support looks like for your body.

2. Increase Movement Variety

Avoid staying in one position for more than an hour. Frequent positional changes support lymphatic circulation, reduce tissue stiffness, and improve blood flow to nerves.

A simple option: cat-cow spinal movement, done on hands and knees or modified at the wall. Try 10 slow repetitions, 2–3 times per day.

3. Pelvic Floor Awareness

Your pelvic floor is a key component of your core and plays a role in shock absorption and abdominal pressure management and postural support. During pregnancy, these muscles often become tense from compensations.

A tight muscle is not a strong muscle. Constant contraction without relaxation can contribute to back and pelvic pain. Awareness of both contraction and release throughout the day is essential.

4. Diaphragmatic Breathing

Diaphragmatic breathing supports pelvic floor strength. When the respiratory diaphragm descends during inhalation, the pelvic floor naturally meets that pressure and generates tone. This is the basis of functional strength and posture support.

Focus on breathing into your ribcage, not your belly or chest. Allow the rib basket to widen gently on inhale and recoil passively on exhale. This can reduce unnecessary tension through the back and pelvis.

5. Daily Postural Support

Even effective exercises will have limited carryover if sitting, standing, and sleeping positions remain unsupported.

• Use lumbar support when sitting

• Place pillows between your legs and under your side waist when side-lying

• Avoid prolonged tailbone tucking or forward head posture when standing

When to Seek Prenatal Pelvic Floor Physical Therapy

If symptoms persist despite consistent self-care, or if pain worsens, limits walking, or affects daily function, professional support is recommended.

Prenatal pelvic floor physical therapists are uniquely trained to assess the whole body and the pelvic floor. Treatment may include manual therapy, somatic movement integration, breathing practices for functional movements, and education tailored to pregnancy.

Mild back pain in early pregnancy is common—and it is also highly responsive to specific care.

Prenatal PT in Oakland, CA

If you are pregnant and want to be proactive about pelvic floor health, prenatal pelvic floor physical therapy can provide clarity, support, and confidence early on.

Bodyful Physical Therapy and Wellness is located in Oakland, CA and offers in-person prenatal PT for the Bay Area. Telehealth prenatal PT is available throughout California, and virtual somatic wellness sessions are available both in and out of state.

You can book a free 15-minute discovery call to explore whether working together feels supportive for you.