The Benefits Of Yoga in Pregnancy

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Written by Jessie Balandiuk PT, DPT Physical Therapist at Summit Physical Therapy

Low back pain (LBP) is extremely common. At some point or another, most people have experienced acute (<3 months) or chronic (>6 months) LBP. Women are 70% of those who report LBP. LBP can be experienced as both lumbar or pelvic pain. Pelvic pain is very common in women, especially during pregnancy and post-partum. This is because the physical changes that occur during pregnancy put women at risk of experiencing LBP. There are many approaches to dealing with back pain including medication and physical therapy. Yoga has been shown to reduce non-specific LBP in the general population, while evidence on the benefits of yoga on LBP in pregnant women continues to grow. It can improve posture and strengthen the back, abdominal wall, and pelvic floor musculature, all of which may contribute to back pain whether you are male or female. Yoga has been shown to have benefits prenatally, during childbirth, and post-partum, with more evidence emerging over the last decade to support yoga as a safe and cost-effective way to treat LBP. It has even been shown to be as effective as traditional interventions, such as physical therapy in the treatment of back pain.

Like I mentioned before, the female body goes through a variety of changes during pregnancy which increases her risk for back pain. The most obvious change is weight gain, particularly in the breasts and abdominal region. It is normal for a woman to gain anywhere from 20-40 lbs. during pregnancy. This increasing size of the abdomen causes the abdominal muscles to stretch, which results in an inability of these muscles to help maintain proper posture. As a result, the low back ends up supporting an increased load. Even outside of pregnancy, weakening of postural muscles such as the abdominals increase the risk of low back pain. Due to the hormonal changes during pregnancy, there is a global increase in laxity of the joints. This is amplified in the Sacroiliac (SI) joints and public symphysis as the body prepares for child birth. There is also increased laxity of the ligaments of the spine which leads to increased mobility and decreased stability in the lumbar region. Strengthening the muscles of the abdominal and pelvic region (hello hips) helps stabilize the pelvis and improve posture to allow for increased weight bearing capability, whether that added weight is from the growing baby inside of you or the very common weight gain due to COVID- related reduction in physical activity.

The women most at risk for developing LBP during pregnancy are those with previous lumbar or chronic back pain. Although most women report discomfort during the 5th to 7th month of their pregnancy, a large number begin to experience pain during their first trimester. These women are more likely to experience pain due to other hormonal changes as opposed to mechanical changes. Increased fluid retention during pregnancy may also contribute to LBP because it creates a low oxygen environment in the pelvic and lumbar regions (from impaired blood flow) and ultimately leads to altered muscle metabolism. LBP can also be a symptom of pelvic organ prolapse resulting from pelvic floor dysfunction. Women who give birth are at risk for pelvic organ prolapse due to weakening of the pelvic floor musculature, however there are various reasons why a person (male or female) may experience pelvic organ prolapse. The greatest risk factor for post-partum pelvic floor dysfunction is pre-pregnancy pelvic floor dysfunction. Yoga can be a way to reduce or prevent prolapse by strengthening pelvic floor musculature in addition to strengthening hip or postural muscles. Most cases of LBP resolve within 6 months post-partum. Women at risk for prolonged symptoms are those with a history of back pain, young age (< 20), increased joint mobility, early onset of pain, and a BMI >25.

By strengthening the back, abdomen, and pelvic floor, yoga is able to increase pelvic and core stability, which can alleviate LBP. Yoga is an effective tool to use because it involves sustained contraction of multiple groups of muscles. A combination of low activity from multiple muscles rather than high activity from one muscle has a greater contribution to stability of the lumbar spine. Many yoga poses require similar levels of activation as commonly prescribed back exercises and have been shown in some cases to be more effective than walking or prenatal exercises. Yoga is a lower-intensity exercise compared to more traditional methods of strengthening, but this does not mean that it is easy! Moderate physical activity is thought to improve muscular endurance, which is essential for postural muscles such as the erector spinae muscle group in the lumbar region and the abdominal muscles. Many studies have concluded that yoga is an effective method of reducing LBP in pregnant women. It is also important to look at the long-term effects of yoga and pregnancy on LBP because approximately 43% of women experience pelvic girdle pain three years post-partum and 1/10 suffer up to eleven years later! Long term yoga seems to be protective against Degenerative Disc Disease because the decreased weight-bearing nature of yoga practice reduces stress on the spine.

Yoga has been shown to be safe in the treatment of LBP in pregnant women, even those with high-risk pregnancy; however, it is always safest to speak with your physician prior to beginning a new exercise routine. In addition, if you are having acute or severe back pain, it may be helpful to see a healthcare professional such as a physical therapist to first reduce pain, learn about further injury prevention, and begin to improve strength and mobility. In pregnant women, an integrated approach to yoga during pregnancy can improve birthweight, decrease preterm labor, and reduce pregnancy induced hypertension. There are many types of yoga classes available with levels from beginner to advanced, 30 min to 75 min, and restorative to energizing. Although you may be using yoga at first to help manage back pain, you may find yourself adding it to your regular routine to maintain your physical and mental health long after your pain is gone!

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