Prenatal Yoga for Pregnancy-Related Back Pain

Awardee Recipient

  • Gloria Yeh, MD, MPH

    Gloria Yeh, MD, MPH

    Director of Mind-Body Research, Division of General Medicine and Primary Care

    Beth Israel Deaconess Medical Center

    Dr. Yeh is Associate Professor of Medicine at Harvard Medical School. Her research program is based in the Division of General Medicine and Primary Care at the Beth Israel Deaconess Medical Center, where she serves as the Division’s Director of...


  • 2014 - Pilot Grant

Background, Significance and Aims

Pregnancy-related back pain is a significant health problem affecting over two thirds of women in the
U.S.1 It is poorly and infrequently treated due to a misconception that it is self-limited, resolves with the birth of the baby, and does not have lasting effects. On the contrary, gestational low back pain is associated with considerable morbidity, not only during pregnancy, but extending through childbirth and into motherhood.

Pregnant women with lower back pain have higher rates of insomnia, impaired daily activity, loss of work, pain medication use, increased rates of Caesarean section, post-partum depression, and chronic recurrent back pain.2,3 Up to forty percent of those afflicted will continue to have pain after birth.4
Obstetrical providers in the United States typically ‘normalize’ gestational back pain and do not provide women with skills to manage pain on their own. One U.S. study found that 85% of pregnant underserved women with back pain report that they do not receive any treatment for it.5

Most of the available, evidence supported treatments such as acupuncture, supportive belts, and osteopathic manipulation, place the expecting mother in a passive role. Exercise 6 is one of the few effective self-care treatments for gestational back pain that an expecting mother can actively participate in, which can boost her self-confidence and overall self-efficacy.

While the exact etiology of pregnancy-related low back pain is unclear, possible causes are increases in maternal weight, spinal lordosis, and higher levels of the hormone relaxin in combination with biomechanical factors. Increased joint laxity within the pubic symphysis and sacroiliac joints diminishes the efficiency of load transmission in the pelvis. These changes, in combination with decreased abdominal muscle strength and anterior shift in the body’s center of mass, increase shear forces across the joints of the lower back and pelvis.7,8,9

Compounding the morbidity of pregnancy-related back pain is the increased risk of falling as pregnancy progresses. The 27% rate of falls in pregnancy is similar to the rate in women >70 years old.10

Having a fall during pregnancy can also be a source of back pain for expectant mothers. In pregnant women, falls are the second leading cause of emergency room visits11 and up to thirty percent of all hospital admissions during pregnancy are due to accidental falls.10,12 Still, there are no evidence-based recommendations for fall prevention. Biomechanical factors have been found to influence a pregnant woman’s chance of falling. These include alterations in mobility and gait that arise primarily from increased joint laxity due to relaxin, increased body mass and changes in the body’s center of mass.13 Some of these are the same factors that are suspected to increase the incidence of pregnancy-related back pain.

Finally, psychosocial factors independently impact an expecting mother’s pregnancy, developing fetus,
childbirth, mothering skills and infant wellbeing. Pregnancy-related depression and stress are associated with prematurity,14,15 low birth rate,16,17 and post-partum depression. Pregnancy-specific scales are becoming more readily available, which measure elements of maternal wellbeing such as depression, anxiety, and childbirth self-efficacy. These tools offer an opportunity to more subtly track how these elements influence an expecting mother. Efforts to improve individual psychosocial factors have included exercise,18 mind-body interventions,19 and group visits.20

Literature supports physical activity, as well as cognitive behavioral strategies to help with back pain and wellbeing in the adult population.21,22,23 Yoga is a novel multi-modal intervention that incorporates these components into one gentle, accessible activity that includes elements of stretching, core strengthening, balance training, cultivation of mindfulness, acceptance, and self-compassion. Studies have shown yoga to be an effective intervention for back pain and overall well-being in the non-pregnant patient population.24,25,26,27,28

Practicing yoga also improves gait, postural stability and flexibility for non-pregnant practitioners.29 Yoga could have the potential to reduce pregnancy-related back pain, holistically empower an expectant mother, and improve her overall wellbeing. Small, limited studies done in India, Brazil and the U.S. have suggested promise in this area.30,19,31,32 However, despite the fact that pre-natal yoga is offered widely in metropolitan areas in the U.S., its safety and efficacy during pregnancy has not been thoroughly studied and there have been very few randomized trials for this population within the US.32,33,34 Utilizing a time-matched, randomized controlled design, our overarching goals are to evaluate the potential efficacy of pre-natal yoga in prevention and treatment of pregnancy-related back pain and enhancing overall maternal wellbeing.

Specific Aims:
1) To explore the potential benefit of prenatal yoga for reducing disability due to back pain during
pregnancy. We hypothesize that 12 or more weeks of prenatal yoga classes will prevent or attenuate
the degree of disability that pregnant women with back pain experience at the end of their pregnancy.

2) To explore the potential benefit of prenatal yoga on stress, quality of life, self-efficacy, and

3) To explore the potential benefit of prenatal yoga on both objective and subjective measures of gait,
balance, and falls.


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2 Gutke A, O€stgaard H.C. & Oberg B. “Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning”. Spine 2006;31(5), E149–155.
3 Bergström, C, Persson, M. & Mogren, I.  “Pregnancy-­‐related low back pain and pelvic girdle pain approximately 14 months after pregnancy – pain status, self-rated health and family situation”. BMC Pregnancy and Childbirth, 2014;14:48
4 Mogren IM. “BMI, pain and hyper-­‐mobility are determinants of long-­‐term outcome for women with low back pain and pelvic pain during pregnancy”. Eur Spine J 2006;15(7):1093–102.
5 Skaggs CD, Prather H, Gross G, George JW, Thompson PA, Nelson DM. “Back and pelvic pain in an underserved United States pregnant population: a preliminary descriptive survey”. J Manipulative Physiol Ther. 2007 Feb;30(2):130‐4.
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11 Weiss, H., Sauber-­‐Schatz, E., & Cook, L. “The epidemiology of pregnancy-­‐associated emergency department injury visits and their impact on birth outcomes”. Accident Analysis and Prevention. 2007; 40, 1088–1095.
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19 Beddoe AE, Lee KA. “Mind-­‐body interventions during pregnancy.” J Obstet Gynecol Neonatal Nurs. 2008 Mar-Apr;37(2):165-75
20 Ickovics JR, Kershaw TS, Westdahl C, et al. “Group prenatal care and perinatal outcomes: A randomized controlled trial.” Obstet Gynecol 2007;110:330–338
21 Kerns, R. D, Sellinger, J. J, & Goodin, B. “Psychological treatment of chronic pain”. Annual Review of Clinical Psychology, 2011;7, 411–434
22 Henchoz Y, Kai-Lik So A. “Exercise and nonspecific low back pain: a literature review”. Jt Bone Spine. 2008;75:533–539
23 Conn, V. S. “Depressive symptom outcomes of physical activity interventions: Meta-­‐analysis findings”. Annals of Behavioral Medicine. 2010;39, 128–138.
24 Saper RB, Boah AR, Keosaian J, Cerrada C, Weinberg J, Sherman KJ. “Comparing Once-­‐versus Twice-­‐Weekly Yoga Classes for Chronic Low Back Pain in Predominantly Low Income Minorities: A Randomized Dosing Trial”. Evid Based Complement Alternat Med. 2013
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27 Posadzki P, Ernst E. “Yoga for low back pain: a systematic review of randomized clinical trials”. Clin Rheumatol. 2011;30:1257–1262
28 Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. “Comparing yoga, exercise, and a self-­‐care book for chronic low back pain: a randomized, controlled trial”. Ann Intern Med. 2005;143:849–856
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30 Martins RF, Pinto e Silva JL. “Treatment of pregnancy-­‐related lumbar and pelvic girdle pain by the yoga method: a randomized controlled study”. J Altern Complement Med. 2014 Jan;20(1):24-31
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Complementary and Alternative Medicine Use Among Women During Pregnancy and Childbearing Years. Birth. 2015 Sep;42(3):261-9. doi: 10.1111/birt.12177.

Poster Abstract – design and preliminary findings – International Congress for Integrative Medicine & Health, Las Vegas, May 2016 Poster No. P05.29