Yoga and the Management of Back Pain (Part 3)
Swami Bhaktipoornananda Saraswati
In the following practices, numbers denote the recommended sequence in
which the practices are to be done. Practices marked S are those that are sometimes indicated; ask your teacher for advice on the number of repetitions and whether they apply to you. Refer to the practice note later in this article for explanation of the symbols H, 1, 2, 3 and 4.
If you are on painkillers, then you will not receive the full pain warnings
from your body. Tune in to pain; use the friendly pain, but avoid anything
that produces sharp or increasing pain. If in doubt, don't.
A. Lumbar lordosis (sway back)
Stretch hip flexors, adductors, lower erectors, back muscles (latissimus
dorsi and quadratus lumborum). Strengthen hip flexors (sometimes), buttocks,
- Pelvic rock and clock: Lying on the back with the knees bent, the
pelvis is tilted forward then backward so that the back alternately
flattens and arches (see diagram). This is followed by movements where
the pelvis is rolled so that pressure against the back of the pelvis
moves in a complete circle several times in each direction.
An alternative is jhulana lurhakanasana (rocking and rolling): Firstly
rock from side to side, grasping the legs firmly to the chest. Then
roll along the length of the spine, making sure to use a thick pad to
protect the back from bruising.
- Supta pawanmuktasana (leg lock pose) (H): Bend
alternate legs, with the emphasis on extending the leg that is 'resting'
straight to bring a stronger stretch into the hip flexor muscles. Then
bend both legs.
- Once this is comfortable, shashankasana (moon or hare pose) is done
in stages, mastering each stage before moving to the next: static, then
bending forwards while breathing out and coming up again while breathing
The hands and arms are raised higher as strength increases.
- a) hands clasped behind the back
- b) hands held at shoulder level
- c) hands held at ear level, and
- d) hands held above the head.
Once the back is strong enough to do these practices, then more weight
bearing forward bends are explored to gently stretch the shortened fibres
around the discs. In the rag doll (pada hastasana) we stand and, gently
curving the spine, use the hands to walk down the legs and back up again
until confidence is gained. From the relaxed forward position, start
by contracting the buttocks, tightening the pelvic floor and tucking
the tailbone under. Then breathe in and use the breath and the stomach
muscles as a girdle to roll the pelvis back. Straightening the lower
back first, unfurl the back until vertical, raising the head last. This
combination of breathing in and contracting the abdomen into a girdle
(all around) increases the pressure in the abdomen, which in turn supports
the spine, transferring the weight from the ligaments to the back muscles.
This exercises the intrinsic (joint to joint) as well as the erector
muscles, making them stronger. The pelvic floor contraction is especially
important if you have had haemorrhoids we want the pressure to
move up not down!
- Body curls (1) or naukasana (boat pose) (4).
- Kandharasana (shoulder pose).
(S) Utthanpadasana (raised legs pose) (2),
or chakra padasana (leg rotation) (2), or pada sanchalanasana (cycling) (2).
(S) Side leg lifts: lifting the upper leg about
30 centimetres, and circling slowly.
(S) Shroni chakra (hip rotation) (2),
or ardha/poorna titali asana (half/full butterfly), holding for a count
of 10 in the relaxed position.
- Meru wakrasana (spinal twist) (H), or ardha matsyendrasana (half spinal twist) (H).
(S) Choose any side bending practice.
- Ardha or poorna shalabhasana (half or full locust pose) (H).
- Shashankasana (moon or hare pose) static for 35 minutes.
B. Flat back (lack of lumbar lordosis)
Stretch hamstrings, abdominals. Strengthen hip flexors, buttocks (sometimes),
abdominals (sometimes), lower erectors:
- Utthanpadasana (raised legs pose) (2), or chakra
padasana (leg rotation) (2), or pada sanchalanasana (cycling) (2), or janu naman (knee bending) H lying
down: grasp back of thigh, straighten knee and extend heel away until
a pull is felt in the back of the thigh (back must stay flat).
- Initially we explore a backward bend with asanas such as marjariasana (cat stretch pose), or kandharasana (shoulder pose). Then sphinx and
makarasana (crocodile pose) can be attempted. If these are painless,
then we can move on to stronger stretches such as utthan pristhasana (lizard pose), which gives a wonderful feeling of lengthening in the
lower back, and then bhujangasana (cobra pose) and other backward bends.
- Kandharasana (shoulder pose).
(S) Body curls (1); naukasana (boat pose) (4).
- Ardha shalabhasana (half locust) (H), or sarpasana (snake pose) (H).
- Side leg lifts lifting the upper leg about 30 centimetres,
and circling slowly.
- Shashankasana series (see above).
- Utthanasana (squat and rise pose).
C. Lordosis of the neck
Stretch neck erectors:
- Greeva sanchalana (neck stretches) forward and back.
- Kandharasana (shoulder pose).
D. Kyphosis (round shoulders)
Stretch abdominals, pectorals:
- Advasana (reversed corpse pose).
- Marjariasana (cat stretch), or kandharasana (shoulder pose). Then
sphinx and makarasana (crocodile). If these are painless, then we can
move on to stronger stretches such as utthan pristhasana (lizard), or
- Dwikonasana (double angle pose) H, or gomukhasana (cow's face pose) (H).
Strengthen buttocks (sometimes), abdominals (sometimes), mid erectors:
- Ardha shalabhasana (half locust) H (with arms
raised), or sarpasana (snake) (H).
- Shashankasana series.
- Utthanasana (squat and rise).
- Vyaghrasana (tiger) (3), body curls (1),
naukasana (boat) (4), side leg lifts: lifting the
upper leg about 30 centimetres, and circling slowly.
E. Protruding shoulder blades
Stretch pectorals and strengthen anterior serratus and lower trapezius:
- Advasana (reversed corpse pose).
- Utthan pristhasana (lizard).
- Skanda chakra (shoulder socket rotation).
- Ashtanga namaskara (salute with 8 limbs).
- Dwikonasana (double angle pose) (H).
- Sarpasana (snake) (H) with chin tucked in.
- Trikonasana (triangle pose) variations 1,2,3.
F. Scoliosis (sideways curve)
Stretch hamstrings (one will be tighter), back muscles:
- Any twists and sideways bends especially trikonasana (triangle)
- Janu naman (knee bending) (H) lying down,
grasp back of thigh, straighten knee and extend heel away until a pull
is felt in the back of the thigh (back must stay flat).
- Supta udarakarshanasana (sleeping abdominal stretch pose).
Strengthen abdominals, erectors, back muscles:
- Body curls (1) or naukasana (boat) (4).
- Sarpasana (snake) H or ardha shalabhasana (half locust) H (arms raised).
- Shashankasana series.
- Vyaghrasana (tiger) (3).
- Dwikonasana (double angle pose).
G. Unstable joints of the spine
Strengthen intrinsic muscles:
- Rag doll with support from arms, then breath and abdominals. See
Lumbar lordosis above.
(1) Body curls: Abdominal muscle exercises are always
done in a curling way with the knees bent. We are aiming to achieve a
controlled movement of each vertebra of the spine up and down, not sit
ups. Body curls have to be done properly or they will cause further injury.
- Beginners need to have the feet held down to begin with. Reach towards
the knees as you slowly come up off the floor, arms extended. Then it
is done with the shoulders turned, so that the shoulder comes towards
the centre line as you lift up. Repeat with the other shoulder forwards.
When 10 rounds can be done slowly and comfortably, we progress to the
- crossing the arms
- hands on shoulders
- hands on ears.
To prevent straining the back, we need good overall muscle control. Both
the longitudinal and oblique muscles need to be worked. A body curl taking
the nose towards the gap between the knees strengthens the longitudinal
group. The oblique muscles are worked when we twist as we lift and take
the shoulder towards the opposite knee. It is quality not quantity that
(2) Pawanmuktasana part 2: These practices will only
assist in building abdominal muscle strength if the lumbar spine is flattened
towards the floor (bending the non-moving leg to facilitate this flattening).
(3) Vyaghrasana (tiger pose): Do not swing the leg
up, instead hold it no higher than the top of the head.
(4) Naukasana (boat pose): Head and heels must be
less than 15 centimetres off the floor.
(H) Hold pose for as long as possible without pain
or excessive effort to allow full stretching and strengthening of muscles.
(When stretching a minimum count of 10 is needed.)
Mind, emotions and prana in healing
In yoga, we recognize that injury or trauma on the physical level is
also reflected in the levels of mind, emotions and prana. Healing of an
injury is prolonged if these aspects of ourselves (pranic flow, feeling
and emotions) are not also cleared of trauma.
Assessment of the mental state and posture
Correction of posture takes time and effort on the physical level. While
effort is made towards physical correction, there is a flow-on to improve
the general well-being too. As the body's posture reflects our attitudes
and feelings, we also need to consider psychological factors. Back problems
are mostly rooted in the unconscious mind and we need to work on releasing
unconscious and subconscious tensions. In yoga, we work to release these
tensions through yoga nidra. If we consider our standing posture, we will
find that an imaginary line drawn in side view from the ear through the
shoulder, hip and knee will either be vertical (perfect posture), in a
forward curve (indicating a tendency to worry or run away from things),
or in a backward curve (where we would rather face things bravely and
fight). These inclinations will predispose us to certain emotions. Practices
like antar mouna can help us to identify and deal with these emotions
and help us to correct our posture.
Awareness and prana
Yoga also sees pain from the pranic perspective. Pain is accompanied
by lack of prana, blocks in pranic flow and imbalanced flow. Because prana
is the stuff that interconnects every layer of our being, disease can
then manifest in any of those layers, and in more than one at once. To
bring about healing at any of these levels, we can work directly on that
level, e.g. asanas for physical disease, meditation for mental/emotional
disease, kriyas for disease of the psychic body. Or we can work through
prana. Where your awareness goes your energy flows, and by tuning in to
any form of pain our prana is directed there and healing can begin.
As healing starts, prana begins to flow again and its flow is vital to
complete healing. Blocks to prana are cleared by physical movement, and
bodyworking types of therapy. As joints and muscles are brought back to
full mobility, more prana will flow. When we gain mobility through yoga
asanas we clear the blocks more easily, and when we experience our prana
we have a chance of directing it to speed our healing through practices
like prana vidya.
We can also work on clearing blocked prana using the relaxation and meditation
techniques of raja yoga, the yoga of the mind. When we've gained
insight into our thoughts and mental patterns, we can then use our minds
in a positive and constructive way. Meditations specific to pranic flow,
strengthening, healing of injured tissue and clearing away the toxins
are easy to learn and powerful in speeding up and completing the healing
These images worked for me, but what you need to consider are the qualities
you need for improved health and what represents those qualities to you.
It's very personal to your own experience and your own mind. So don't
use an imagery that doesn't feel right. Learn as much as you can
about any disease you have and how it heals itself. On the practical level,
decide whether your body needs heat or cold, clearing away first or nourishment
for starved tissues (e.g. if there is osteoporosis, then we want to bring
calcium and collagen into the bones, so we may visualize bricks and mortar
to represent these two aspects of the cure).
Some suggestion for visualization
- Cleaning up
Damaged parts being cleaned up (buckets mops and brooms working
around the cells of bone, ligament and muscle). At the site of injury
it's a bit like a battlefield. (It's the same with viral illness or
cancer.) We need to find a way of imagining the inner scene. There are
dead bodies everywhere, so we need to clear all the dead bodies away.
Clearing the rubbish of war spent weapons (dead white blood cells
and their rubbish), old foodstuffs, excrement. At the same time we need
a good supply system bringing in supplies to the troops which are there
to heal, repair and fight any invading organisms.
Improving circulation to clear away inflammation and toxins.
The images could be of a whole gang of cleaners with their gear to clean
up the rubbish. We see all the wastes dissolving and being washed away
to be excreted from the body.
Rebuilding bones, tendons, discs and other soft tissues (builders,
ladders, cement, bricks and lots of tender loving care).
Massage for aches and pains to help circulation to and from the
What represents strength for you? It may be an oak tree, or a
steel bar or something completely different.
Prana and blood flowing easily in blocked areas. The prana flows
through the body in many different ways. In yoga, we are concerned with
distribution and circulation of prana and where your awareness goes
your prana flows. So, if we can move the awareness through the body
in particular patterns, we find that this can be very therapeutic in
removing blockages and distributing prana throughout the whole system.
Here are a few ideas to try. All should be done in a comfortable position
and a relaxed state of mind, sending love and respect with your awareness.
As you move through the parts of the body, there may come an experience
from time to time of vagueness, jumping, lack of clarity as you move
through a part. This can be a sign of blockage. So, we move more slowly
through that area, trying to discover how we can get a clearer pathway
through rather than skipping over it. Awareness and prana will eventually
flow smoothly. These areas of blocks can be areas that are painful,
that have been injured or deformed, or are holding physical, mental
or emotional tension. Do not judge yourself by the number of blocks
you have. Just work to remove them.
Alternate leg breathing: This is similar to alternate nostril
breathing, but the awareness is taken through the legs alternately in
the same pattern. Once a smooth flow is established, we can extend this
practice to bring the awareness up to the heart and chest area, or even
to the eyebrow centre before going back down the other side of the body.
Alternate arm breathing is similar. The awareness moves from
the right fingertips, through the arm into the chest and down the left
arm to the fingers. Then reverse with the next breath.
Movement of awareness through the spinal column. This is part
of meditation practice where mantra can also be repeated as the awareness
Remember, your healing is only limited by your own imagination and beliefs.
We also need to recognize the phenomenon of cellular memory. Each cell
remembers everything it has ever done! It is said that scar tissue can
be dramatically reduced by clearing the trauma from our cellular memory
through the power of the mind.
When we are comfortable with expressing our feelings, they no longer
have to be stored inappropriately, creating tightness and tension and
lack of pranic flow. As well as reliving the experience as a witness,
bhakti yoga can help us to learn to express emotions in a joyful way,
usually through music and singing. Never be embarrassed to break out into
Attitude to pain
Nobody wants pain. It wears us down, draining energy and often creating
a sense of hopelessness and depression. We can carry on as before and
resist it. When it interferes with our hopes and dreams, we become dispirited
instead of seeing the opportunities it brings. Sometimes pain gives us
the time and reason to rest instead of driving on through our lives. It's
worth keeping a journal and writing down all the advantages and disadvantages
of pain, and discovering how we can gain the advantages without having
the pain. We can learn to be more accepting and welcoming of the pain,
which results in an immediate decrease in the pain experienced. Resistance
to pain creates more pain.
Now, imagine for a moment that you can do anything you want to do. You
have all the resources you need money, connections, knowledge,
time, health, energy and so on. What would you do with the rest of your
life? No limits! What is important? When your list is complete, write
a new list just for the next five years. Then go for it! Let it inspire
you without inspiration we struggle. How inspired are you about
the future? Your progress will depend on this factor.
Note: When learning the practices of yoga, the guidance of
a qualified yoga teacher is recommended. Most of the asanas referred to
in this article are detailed in Asana Pranayama Mudra Bandha (APMB), published
by Bihar School of Yoga.