Yoga and the Management of Back Pain (Part 3)

Swami Bhaktipoornananda Saraswati

Suggested practices

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, abdominals:

  1. 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.
  2. 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.
  3. 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 in, with:
    • 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.
    The hands and arms are raised higher as strength increases.
    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!
  4. Body curls (1) or naukasana (boat pose) (4).
  5. 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.
  6. Meru wakrasana (spinal twist) (H), or ardha matsyendrasana (half spinal twist) (H).
    (S) Choose any side bending practice.
  7. Ardha or poorna shalabhasana (half or full locust pose) (H).
  8. Shashankasana (moon or hare pose) – static for 3–5 minutes.

B. Flat back (lack of lumbar lordosis)

Stretch hamstrings, abdominals. Strengthen hip flexors, buttocks (sometimes), abdominals (sometimes), lower erectors:

  1. 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).
  2. 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.
  3. Kandharasana (shoulder pose).
    (S) Body curls (1); naukasana (boat pose) (4).
  4. Ardha shalabhasana (half locust) (H), or sarpasana (snake pose) (H).
  5. Side leg lifts – lifting the upper leg about 30 centimetres, and circling slowly.
  6. Shashankasana series (see above).
  7. Utthanasana (squat and rise pose).

C. Lordosis of the neck

Stretch neck erectors:

  1. Greeva sanchalana (neck stretches) forward and back.
  2. Kandharasana (shoulder pose).

D. Kyphosis (round shoulders)

Stretch abdominals, pectorals:

  1. Advasana (reversed corpse pose).
  2. 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 bhujangasana (cobra).
  3. Dwikonasana (double angle pose) H, or gomukhasana (cow's face pose) (H).

    4. Strengthen buttocks (sometimes), abdominals (sometimes), mid erectors:

  4. Ardha shalabhasana (half locust) H (with arms raised), or sarpasana (snake) (H).
  5. Shashankasana series.
  6. Utthanasana (squat and rise).
  7. 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:

  1. Advasana (reversed corpse pose).
  2. Utthan pristhasana (lizard).
  3. Skanda chakra (shoulder socket rotation).
  4. Ashtanga namaskara (salute with 8 limbs).
  5. Dwikonasana (double angle pose) (H).
  6. Sarpasana (snake) (H) – with chin tucked in.
  7. Trikonasana (triangle pose) – variations 1,2,3.

F. Scoliosis (sideways curve)

Stretch hamstrings (one will be tighter), back muscles:

  1. Any twists and sideways bends especially trikonasana (triangle) variation 3.
  2. 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).
  3. Supta udarakarshanasana (sleeping abdominal stretch pose).

    4. Strengthen abdominals, erectors, back muscles:

  4. Body curls (1) or naukasana (boat) (4).
  5. Sarpasana (snake) H or ardha shalabhasana (half locust) H (arms raised).
  6. Shashankasana series.
  7. Vyaghrasana (tiger) (3).
  8. Dwikonasana (double angle pose).

G. Unstable joints of the spine

Strengthen intrinsic muscles:

  1. Rag doll with support from arms, then breath and abdominals. See Lumbar lordosis above.

Practice note

(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.

  1. 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 next stage:
  2. crossing the arms
  3. hands on shoulders
  4. 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 is important.

(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 process.

Healing visualizations

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

  1. 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.
  2. Rebuilding
    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 area concerned.
  3. Strength
    What represents strength for you? It may be an oak tree, or a steel bar or something completely different.
  4. Flow
    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 moves.

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 song!

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.

Motivation

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.