Yoga and the Management of Back Pain (Part 2)

Swami Bhaktipoornananda Saraswati

Postural patterns

Regular practice of hatha yoga can help to correct poor patterns of posture that have created the tiny injuries which led to back pain. Different postural problems require a different emphasis in exercise. Lordosis is a forward curving of the spine found in the lower back (sway back) or neck. Kyphosis is an exaggerated forward curve of the thoracic spine. A lordosis of the lower back is often accompanied by a kyphosis of the thoracic spine (round shoulders) and a lordosis of the neck. Scoliosis is a sideways curve, 'C' or 'S' shaped when viewed from behind. Many people have a 'short leg' or a flattened back in the lumbar region. These too have their own patterns of wear and tear and pain.

Role of exercise in correcting posture

Exercises are done to address the structural problems in the joints and the spine as a whole. They can be therapeutic or preventative. They keep the muscles in good tone and prevent contraction, so that the muscles can allow complete movement and lubrication of the joints. Tone is the amount of tension in a muscle when it is at rest. The more tone there is, the less you can extend it, so a muscle that is highly toned becomes shorter. It may appear strong, but it can't let go and release to a full stretch. The joint consequently cannot go through its full range of movements. Conversely, the weaker muscles become longer. Paired muscles become of equal length and equal strength. For example, with the elbow joint, if weight lifters do more work with the muscles that bend the elbow than with those that straighten it, they will eventually not be able to straighten the elbow completely.

Postural correction standing

Practise relaxing in the standing position with correctly aligned posture:
Bring the feet a few inches apart (10 cm) and parallel to each other. Then bring the awareness into the soles of the feet and gently rock backwards and forwards coming up onto the toes and back onto the heels. Then return to a standstill and feel the contact with the floor through both feet. The body sways and the weight moves forwards and back and left and right quite naturally. Be grounded through the feet and allow them to take the weight evenly.
Make sure that the knees are unlocked and pull up the kneecaps. If they point in towards the centre then rotate the thighs outwards and tighten the buttocks.
(The following exercise can also be practised in your sitting posture). Now tilt the pelvis backwards and forwards finding the balance so that the spine can grow comfortably upwards out of the hips.
Bring the shoulders up and back, and let them go wide with the arms hanging loosely.
Hold the head and neck upright so that the ears are above the tops of the shoulders and the head feels lightly balanced on top of the neck.
Imagine that a string is attached to the top of the head and that someone is lifting the head up and out of the shoulders. Feel how your posture alters when you 'let go' of this imaginary string.

General notes

Forward bending: Pressure within a disc is at its lowest when we are lying flat on our back. It is at its greatest when we tip forwards and pass through 20 degrees from the vertical. After that point it decreases again and we can curl forward comfortably. It is at this 20 degree angle that an unhealthy disc is likely to bulge or herniate (e.g. me putting my trousers on!). As we bend the spine forwards 20% of the bend comes from the joint between the 4th and 5th lumbar vertebrae and 60–70% from the joint between the 5th lumbar and the sacrum. This makes this part of the body highly at risk of being damaged.

Bending the spine forwards needs to be done with care as it is risky when discs have deteriorated or been damaged. If we know there is an unstable joint or a whole section in the back that doesn't move from degeneration, then it is important to take care when coming up from a forward bend (standing or kneeling). Use the hands to 'walk' up the legs and support the body so that it does not feel like it is going to give way or go into spasm.

Backward bending: When we bend backwards the lumbar spine takes the curve and the thoracic spine tends to flatten. In most cases backward bends can assist in relieving pressure on a disc. The exception comes when the lumbar spine is already curved back and any extra bend pushes the facet joints further into each other. This can lead to pain.

Twisting the spine: When we twist the body it is the thoracic spine that twists most, not the lumbar spine. When we have one leg shorter than the other we get a lot of wear and tear on the junction between the 12th thoracic and the 1st lumbar vertebrae because the twist on the pelvis is imbalanced as we walk. The lumbar spine does not turn much so this lob-sidedness increases wear and tear on the first vertebra designed to twist (i.e. 12th thoracic).

Meru wakrasana and ardha matsyendrasana are important twisting practices which keep the whole spine supple without straining ligaments. They should be practised initially with one hand resting close to the sacrum and the arm straight so that it lifts the back upright and supports it.

Sideways bending: The whole spine can bend to the side. Inhibition comes from the muscles away from the spinal column (latissimus dorsi and quadratus lumborum and muscles in the sides of the trunk). When scoliosis occurs, the major work needed comes from sideways bending. The muscles that require strengthening are on the outside of the curve and the muscles that require stretching are on the inside of the curve.

The tendency in bending sideways is always to twist the pelvis or the shoulders. We can help prevent this by flattening the lower back and tucking the tailbone under before doing postures like trikonasana variation 3 (triangle sliding the hand down the side of the leg). Another way to fix the pelvis so that it cannot rotate is either by squatting against the wall, or by beginning in shashankasana (child pose) and bending to the side. Tiryaka tadasana must be practised with caution as the arms over the head provide great leverage to each side especially in tall people.

Other practices

A combination of practices is vital in the management of back pain. Pranayama techniques help pump lymph and remove toxins from the site of inflammation. They assist in the movement of the cerebro-spinal fluid that bathes the nervous system and keeps it healthy. The following practices should be learnt from a competent teacher.

Abdominal breath and full breath activate the abdominals and massage the spine from inside, especially when done lying prone as in advasana, jyestikasana and makarasana.

Pranayama that requires forced exhalation and agnisar kriya work many of the postural muscles especially the pectorals, back muscles (latissimus dorsi and anterior serratus) and the abdominals. Agnisar kriya also helps activate and clear the bowel.

The practice of moola bandha is useful in decreasing pain levels (see Moola Bandha – the Master Key, published by Bihar School of Yoga).

Yoga nidra works to release mental tensions as well as bring about a deep state of rest where healing can take place.

Antar mouna and antar darshan (see Yoga Darshan, published by Bihar School of Yoga) are practices to help with self-knowledge and acceptance.

Prana vidya (see Prana Pranayama Pranavidya, a Bihar Yoga Bharati publication) is used to direct prana for healing.

Constipation and impaction of the faeces are common with chronic back pain. The removal of all faecal matter often brings pain relief. Practice of laghoo or poorna shankhaprakshalana is important once the body is strong enough to do the asanas.

Movements to be avoided

Anyone who is unfit or with a history of back pain should avoid the following movements as they cause undue strain on the body:

Sit ups: When the bones of the lumbar spine are habituated to a backward curve (lordosis), there is minute damage of the intervertebral ligaments. If we lie on the floor with the knees bent and bring the upper body off the floor taking the weight on the buttocks in a sudden way, the shearing force across the bones can be enough to increase the damage already done.

Pawanmuktasana part 2 practices 1 to 3 will cause strain if the back is arched. The hip flexors (if already strong) pull the lumbar spine into more of an arch. Avoid double leg raising unless the back is flat and abdominal muscles are strong.

Neck stretches: Avoid circling the head and dropping the head back to look at the ceiling (better to keep the teeth together to prevent over-extension).

Halasana (plough pose) or sarvangasana (full shoulder stand) because of the pressure on the neck and lumbar spine.

Forward bends that swing up if you have low back pain.

Gatmatyak meru wakrasana (dynamic spinal twist) and trikonasana variation 4 twisting to the opposite foot and variation 2 with the arm stretched over the ear – if you have low back pain (too much leverage on the spine).

Lying on the side and lifting both legs up.

Shalabhasana (full locust pose) or star pose (with arms above the head).

Dhanurasana (bow pose) can be done with knees remaining on the floor.

Vyaghrasana (tiger pose) is OK if the leg being raised does not go past 15 degrees above the horizontal – the lumbar spine is stressed beyond this point especially when the movement is done too quickly

Paschimottanasana (back stretching pose) is not recommended to stretch hamstrings.

Squatting and vajrasana to be avoided where knee problems exist.

Note: When learning the practices of yoga the guidance of a qualified yoga teacher is recommended. Most practices referred to are detailed in Asana Pranayama Mudra Bandha (APMB), published by Bihar School of Yoga.

(Part 3 of this series will suggest specific practices for managing back pain.)

(The final part of this article will appear in the next issue.)