A Prenatal Practice for Lower-Back Relief

I had never been more intimately connected to my quadratus lumborum (QL) muscles than during my recent pregnancy. As a yoga teacher and athlete, I was aware of the QL and knew its basic functions, but I never grasped just how important those muscles were until they were restricted! Six-pack abdominals seem to get all the press when it comes to the “core,” but the QL plays an even more crucial role in supporting the upper and lower portions of our body. Unfortunately, during pregnancy (when the body may need it the most!), the QL has a high chance of tightening up and even spasming.

Week 14 of pregnancy is an exciting milestone. It is the start of the second trimester, when the baby’s viability greatly improves and first-trimester symptoms such as morning sickness and fatigue often lessen. Many people feel ready to get back to physical movement, and then just when it seems possible, back troubles appear.

For me, it was as though my body’s alarm clock was set for the minute the calendar hit week 14, because I woke up every morning thereafter with lower back pain. Back issues are incredibly common during pregnancy, affecting 50 percent of pregnant folks, according to one 2017 study, and beginning for most in the second trimester.

While it was (somewhat) reassuring to know that back discomfort is part of pregnancy, in order to find the right solution, I had to identify exactly which part of my spine was bothering me. The spine is composed of four curving sections—the sacrococcygeal, lumbar, thoracic, and cervical—and my back pain was isolated between my ribs and my pelvis, aka the lumbar spine, aka the lower back.  It also seemed to be concentrated on my left side. When my back was in spasm, I found it most painful to lean over to one side to pick something up but also to breathe. These clues led me to think the QL might be the culprit.

Meet the QL

We actually have two quadratus lumborum muscles, one on either side of the spine. They originate at the top of the pelvis and insert at the lowest rib and along lumbar vertebrae one to four (L1 to L4). Their two main functions are spinal extension (backbending) when both sides contract together, and lateral flexion (side bending) when they contract unilaterally. Besides articulating the trunk, the QL is used in most movement, from standing to sitting to walking. Additionally, one of the main ligaments of the diaphragm sits directly atop the QL, which means that if the QL goes into spasm, it is not only uncomfortable, but the breath is often affected. 

What is cool about the QL is that it can move the ribs or the pelvis—unlike a muscle like the bicep, which moves one joint. This is particularly important when we are walking. Ideally, the QL stabilizes the pelvis as we transfer weight from one leg to the next, but still allows the ribs to move freely. Imagine walking around and the pelvis and ribs were like a block of wood. Having the upper and lower parts of the body move independently allows for more efficient movement. The QL is also a key player in good posture, activating whenever we bring our spine to neutral from rounded.

Back Pain and Pregnancy

Back pain can occur anywhere in the spine during pregnancy, but the lower back is particularly vulnerable for a few reasons. The hormone relaxin loosens the connective tissue throughout the body to accommodate the expanding uterus and to prepare for birth. This loosening can destabilize the spine, causing the surrounding muscles to overcompensate by tightening up or going into spasm. The lumbar section is one of the more mobile parts of the spine, particularly when it comes to spinal extension. Add in extra mobility, and the spinal extensors end up working overtime to keep the body stable. 

Despite the fact that many pregnant people do not show until well into their third trimester, the growing belly and uterus also place undue stress on the low back. Major internal changes, collectively what I like to call “the great organ migration,” tax the surrounding musculoskeletal system starting as early as the first trimester. The Museum of Science and Industry in Chicago actually created a GIF depicting these dramatic changes: It shows the organs being pushed upward and into the diaphragm as the uterus balloons in size. Among the muscles and ligaments affected by this internal rearrangement is the QL, which is directly beneath the diaphragm.

Lower back pain can be a nuisance and sometimes even debilitating during pregnancy. Given the causes, you may think it is inevitable, but while the body must adapt to accommodate baby, there are many ways to mitigate the accompanying discomfort. Spending time giving love to the QL, both strengthening and stretching it, may help ease your discomfort, freeing you up to enjoy, instead of resent, the miracle taking place inside you!

Use this sequence to spend some QT (quality time) with your QL.

1. Sukhasana With Lateral Flexion

One good way to stretch the QL is to keep the pelvis stable as you move the ribs. Sukhasana (easy pose) is an especially good base for this release during pregnancy, because it also opens the outer hips—another culprit in back pain can be tight external rotators. 

Sit in a cross-legged position on a folded blanket with your right shin in front of your left. Flex your ankles and align your knees over them. Put a block about a foot away from your left hip and place your left hand on it. On an inhale, reach your right arm to the sky, and as you exhale begin to side bend to the left. Anchor your right sitting bone as you create an even arch along the right side of your torso. Bend your left elbow while keeping length in the underside of your waist. Keep your head in line with the rest of your spine, gaze forward, or, if it’s comfortable, look up toward your right arm.

Take 15 breaths here. Then ground into your sitting bones on your next exhale, and bring your torso back upright on an inhale. Switch sides. 

2. Low Lunge With Side Stretch 

This pose is not only a QL release, but it also releases the psoas on the back-leg side. Certain muscles work so closely together that if one is tight, the other may be too. The psoas major and the QL are not only next-door neighbors, but they share a common insertion site along the vertebrae of the lumbar spine. This shape stretches both. 

From hands and knees, step your right foot between your hands and come into low lunge. Have a blanket under your back knee for padding if it is sensitive. Reach both arms overhead and grab your left forearm, just below the wrist, with your right hand. Make sure the right palm is facing up to encourage external rotation in the right arm. Inhale up through both sides of your torso equally, and on an exhale lean toward the right. Ground into your front (right) heel and draw your back (left) hip forward. Keep your chest square to the front of the room by drawing your right ribs back and left waist forward. Look up toward your left arm or, if it bothers your neck, keep your gaze straight ahead.

Stay for 10 breaths. On an inhale lift your torso back up to center, and on an exhale place your hands on the floor. Come through table top to switch sides.

3. Leaning Vrksasana

Another muscle that has a direct effect on the QL is the gluteus medius. The glute medius firms the hips into the midline and, like the QL, keeps the pelvis stable when you walk or balance on one leg. If the glute medius is weak, the QL overcompensates by tightening up. Enjoy the side stretch in tree, but come out slowly to build strength in both the QL and glute medius.

Standing next to a wall so your left side is parallel to it, bend your right knee, open it to the right, and place your right foot either above or below your left knee, coming into vrksasana (tree pose). On an inhale reach both arms overhead alongside your ears, and on an exhale begin to lean to the right.

If your right foot is above your knee, bend your right arm and lightly rest your elbow on your right thigh. If your right foot is closer to your ankle or the floor, keep both arms alongside your ears, but hold your left forearm with your right hand, as you did in the previous pose. Either way, allow your pelvis to tilt as you bend, letting your left hip jut out slightly. This is different than traditional tree where the hips are relatively level. On an inhale lengthen your spine, and on an exhale lean a little more to the right. Gaze either straight ahead or up toward your left arm.

Remain in the pose for five breaths, then very slowly, over the course of multiple breaths, bring your torso upright, firming your left hip into the midline and contracting your left-side waist to do so. Bring your right arm up parallel to your left and keep both arms reaching alongside your ears in the transition. Once you are fully upright, bring your hands to your hips on an exhale and place your right foot back on the floor. Switch sides, remembering to come out of the pose slowly.

4. Trikonasana With Arching Side Body

Traditionally, the aim is to keep both the right and left sides of the body long in trikonasana (triangle pose), but allowing the spine to flex laterally is actually an amazing QL release. Going with gravity naturally tractions the spine and ribs. Just don’t tell the yoga police! 

Stand on your mat facing the long side. Step your feet three and a half to four feet apart. Have a block next to your right foot (inside of it or outside of it, depending on your preference). Turn your right leg out from deep within the hip and turn your back foot and hip in slightly. On an inhale, bring your arms up into a T at shoulder height, and on an exhale begin to tip your torso over your front leg from your hip crease. Place your right hand on the block and inhale your left arm alongside your left ear. Rather than keeping your spine evenly long, allow the left side of your upper torso to arch, as if trying to touch your right ankle with your left hand. Allow your head to fall to the right as well, keeping your gaze straight ahead. This will release your neck.

Remain for 20 breaths. To come out, first inhale and lift your left arm to the sky. Exhale, ground into both feet, and inhale to lift your torso upright. Parallel your feet and switch sides.

5. Parivrtta Janu Sirsasana 

This pose has it all! It’s a twist, a side bend, a hamstring opener, a hip opener, and even a shoulder opener! And it is one of the best poses to target the QL. Remember that it is not just stretching the QL that is beneficial, but also the slow exit from the pose, which strengthens the side body.

Start seated in dandasana (staff pose) facing the long edge of your mat. Bend your right knee, pulling your right heel up toward your groin, and let your thigh fall open to the side, and then pull your heel up toward your groin. Move your left leg out a bit to create about a 90-degree angle in your groin. Place a block on the low or medium setting on the inside of your left leg.

On an inhale, reach your arms overhead, and on an exhale lean toward the left, placing your left elbow on the block with the palm facing up. On an inhale, bend your right arm and place your right hand behind your head, encouraging your neck to lengthen. Keep your right sitting bone and outer thigh rooting down, and on an exhale lean farther to the left.

If this feels like a good stretch, remain here. Otherwise, lower or remove the block. Reach your right arm overhead and begin to turn your head to look up at it.

Some people like to grab their left foot with both hands, but keep in mind that in pregnancy we want to favor stability over flexibility, so it’s best to avoid those deeper variations.

Remain for 25 breaths. Come out very slowly on an inhale, slowly lifting both arms up. Stretch your right leg out in front of you and bring your left leg to meet your right, coming back through dandasana. Switch sides.

Conclude with a few of your favorite feel-good stretches if you like, or head right into a restful savasana from here.

The Takeaway

Parenthood is a long and selfless road. In order to best take care of others, we need to take care of ourselves, especially our bodies. Spending quality time with our bodies in pregnancy will lay the foundation to continue to do so after our babies arrive! 

Photography: Andrea Killam