Back Pain: A Yoga Perspective

Back pain is the leading cause of disability for people under forty five and is the second most common reason for doctor visits. Sometimes pain can be caused by minor events, like a sneeze or a quick movement. Severe pain can be herniated discs, sometimes compressing the nerves on the spinal cord causing pain down the leg (sciatica). Years ago the medical community would recommend rest for a back with pain. Now doctors realize being sedentary is counter-productive and the cause of more pain. Staying in bed promotes muscle loss (up to 3% a day). Loss of strength interferes with rehabilitation that causes other muscles to work harder. Today doctors do not usually suggest rest for back pain. They will use some gentle movement as soon as the first day in most cases. Unfortunately most physicians look at lower-back pain and sciatica from a one size fits all approach. The Yoga perspective is that the pain has many causes. Some of the causes are obvious like injuries or conditions like scoliosis and Arthritis. Some of the not so obvious causes may be strained ligaments, rib alignment and postural problems. Due to difficulty diagnosing and treating back pain; many with chronic conditions usually will require surgery. Many times operations do not work and may require multiple surgeries before some success is achieved. Sometimes surgery may not have been necessary at all since most back problems will eventually resolve themselves in six to eight weeks. Obviously serious injury or a long history of chronic pain would likely require surgery. If you have a serious back issue that is headed for surgery, it would be wise to seek a Yoga Therapist to find some of the root causes like posture, emotions and environment (work-living).

My favorite yoga asanas (postures) for a healthy back are two chair yoga asanas, malasana one and two (modifications of garland). These two asanas done together in sequence in my opinion are the best yoga modifications for maintenance of a healthy back. The chair modification of malasana has two versions. For the first one use a chair that is comfortable for you. If it is a folding chair or is very light, be advised to have a person to hold chair down from back so you do not tip. To start ground your feet, toes pointing straight out. Make sure your sit bones (buttocks) are even by rolling side to side, straighten the back, shoulders down and out a little, gaze (eyes) facing straight ahead, tuck chin slightly, inhale and raise arms over head then exhale out and down with hands out, palms facing up going under the seat of chair now take the tips of fingers rounding slightly up then inhale and exhale evenly a few breaths. To come out do everything mindfully and slowly. This asana engages the muscles in the lower back. Now for malasana two, do the same preparatory posture as in the first inhale, then take your right hand and place on right knee, exhale now fold forward gently turning your head to the right taking left hand around right ankle. Mindfully take a few even breaths. This posture engages all the muscles in the right upper back as well as the middle and lower. Now repeat on left side.

Carl is a fifty nine year old postal worker over six foot and two hundred fifty pounds with a metal rod in his left leg. Carl has been doing private yoga and meditation lessons with me for four years and has not once had a back issue. We do the malasana one and two every session along with a series of backbends, forward bends, twists, meditation and relaxation. Another client Curtis had complained of some back pain while lifting wood. We did a mild session using many modifications, meditation and relaxation; but we added the malasana one and two. I also eased him into the poses using more hands on bodywork. Two hours after the session he texted me telling me his back felt better. An asana that helps people soothe the back themselves is apanasana (knees to chest) because you lie on back bend knees up grab the knees and slowly roll back and forth on the mat. Most importantly any yoga postures should be cleared by a medical doctor or physical therapist if the person has any serious medical issues, injury or pain. As yoga practitioners our first responsibility is not to injure clients and always remember that as in choosing a medical person if you do not feel comfortable with your practitioner, it is your right and choice to find one you do. Due to the increase in technology many medical students are not taught a more hands on approach. That is why a Physical Therapist is a good choice for assessment of back pain and its causes. Some unconventional physicians will examine psychological tension and stress as a causation of muscle tension and back pain. Physician John Sarto (healing back pain the mind body connection) believes that when muscles spasm and there is pain that it is mental tension. So he believes if you get to the root causes of tension the pain will disappear. Herniated disks can be tricky. You could have a herniated disk but no pain and others with severe pain show no evidence of herniation. An MRI can diagnose a herniation but may require an extensive examination to correctly assess causation of the problem. Some yoga teachers believe that there is a connection between emotional difficulties and back pain. So if you are a person that writes keep a journal about your problems, if you draw or paint make art your therapy. When the nerves relax the balance in the autonomic nervous system shifts to the more restorative para sympathetic side; then the muscles start to let go just like we do with the mind in meditation.

Judith Hanson Lasater (Physical Therapist and Yoga teacher) believes most people with back pain need a program of stress reduction and postural education. Some others Judith believes need stretching and strengthening. As we age back pain increases with the onset of Arthritis and other age related conditions. Overlooked causes can be congenital, accident related or how we use our bodies (poor posture). Studying and asking questions about posture while standing, sitting, driving and sleeping can help you assess the problems and lead to a plan of correction. For example someone who sits much of the time might have weaker abdominal muscles, but there is a fine line between the correct amount of abdominal exercises and over doing it. Too much can tighten the psoa muscles that wrap around from the front leg (Reverse Trochanter) to the lower spine exacerbating the problem. Judith usually starts with a history then she will ask the client to get in a position that is pain free. Most clients will get on their back with the knees up. If a client says there is no position that is comfortable, Judith advises medical attention. Each client has specific needs in most cases Asanas are done from a table top (all fours), prone (belly), on back, standing and relaxation (savasana). Postures to be avoided are forward bends and twists. Clients with severe pain will avoid these postures as well, boat pose (navasana) an advanced core balancing posture, leg raises, staff (dandasana) and lotus (padmasana) an advanced seated pose.

David Coulter a former anatomy professor, Yoga teacher and author of “anatomy of Hatha Yoga”, has suggested that a supine posture on your back, knees bent and feet on wall allows a gentle motion on the lower spine which soothes the area. When in the position feel the small curve in the lower spine exhale; press the feet on the wall and coax the spine to flatten to the floor. Release the foot pressure inhale and the curve returns to the lower spin. Sometimes when you sit wrong posturally you flatten the lower back, the head goes forward from the spine, the chin tips up and the shoulders round forward causing the interscapular muscles (shoulder) not to work correctly so they do not hold up the shoulder blades. Pain running down the leg usually comes from either herniated discs or tight piriformis muscles (buttocks) pressing on the sciatic nerve.

Diagnosing the root cause of back pain can be extremely difficult to pinpoint so all medical solutions should be exhausted such as MD, PT or Chiropractor then some alternative solutions may be helpful. Yoga can help maintain a healthy back and reduce some of the pain by adding asanas, meditation, relaxation and pranayama (breath) to a steady practice. Yoga promotes a healthier diet and lifestyle to achieve weight reduction, as well as reduce pain and inflammation from arthritis. As always we suggest to use certified trained professionals to assist you. Good luck to everyone suffering from back pain and give yoga-meditation a try because I personally believe in its benefits. I have witnessed it first hand in my own practice and in that of my clients. Namaste!

John Cahill of East Northport N.Y certified Hatha Yoga and meditation instructor with training In Nidra Meditation Conducts both group and private instruction. Each private lesson is methodically planned to achieve goals specific to the needs of the client for improved health and wellness. Each client is individually assessed and provided a personalized program for optimal success. John may be reached at john@northshoremensyoga.com 631-560-0283 You may also visit his website at www.northshoremensyoga.com