Yoga for Low Back Pain

Bare Facts:

80 % of adults have experienced low back pain. It is the most common cause of job disability. Back pain that lasts more than 3 months is Chronic Back Pain.

Twenty percent of the Chronic Pain Group will have pain that can persist  for more than one year.

Back pain is not a diagnosis. It is a symptom of various conditions. Symptoms may feel the same but they can be caused by different underlying conditions. For example a herniated  disc and spinal stenosis can have the same symptoms such as tingling and pain going down the leg but the treatments  are totally different.  Herniated disc is best treated  by extension  with poses such as bridge pose or camel. Spinal stenosis should  be treated with  flexion  such as forward bends as in Child’s Pose. A person with glaucoma or retinal detachment must not do forward bending poses. People with osteoporosis should avoid complete forward bends.

Of course there are hundreds of yoga poses with benefits and contraindication.  To complicate things, many people have more than one condition. The knowledge and guidance from your yoga teacher is paramount. That being said, “you are your own best teacher.” So please  avoid any pose that is painful. Gradually increase effort, always balance effort with ease, honoring  your age, and remembering that  less can be more. Yoga is meditation in motion. The breath is  always  your anchor and guide. Movement and breath always go together.

There  are seven major causes of low back pain: (Dr Loren Fishman)

Neurological-Herniated lumbar disc, spinal stenosis

Musculoskeletal-  lumbar muscle spasm, facet syndrome, sacroiliac  joint derangement (SI joint)

Mixed-Piriformis syndrome, Spondylolisthesis.

Very Basic Knowledge

The spinal column (vertebrae) is comprised of 33 individual bones that interlock with each other. There are 7 cervical, 12 thoracic and 5 lumbar. The top 24 bones are moveable-the vertebrae of the sacrum  and coccyx are fused. Intervertebral discs-maintains the space between the  vertebrae-are round rubbery, gel filled pads.  They act like shock absorbers to cushion the body as it  moves.

. Tendons-attach the muscles to spinal column

. Ligaments- bands that hold vertebrae in place

. 31 pairs of nerves are rooted in the spinal cord. They control body movement and transmit signals from the body to the brain. The spine has a normal S shaped curve-Cervical-concave. Lumbar-convex. Lumbar-concave.

. Curves work like a coiled spring to absorb shock, maintain balance, and allow range of motion.

. Each vertebra has 4 facet joints
. Sacrum- 5 fused vertebrae connect spine to hip bones (iliac)
. Coccyx (tailbone) is the attachments for ligaments and muscles of the pelvic floor.

Sciatica caused by Piriformis Syndrome

Keep in mind that sciatica is not one diagnosis but can be caused by various underlying conditions although the symptoms can be the same. Pain, numbness or tingling can be felt anywhere along the sciatic nerve pathway including the back, buttocks, back of the thigh and the calf. This article will focus  on the Piriformis Syndrome.   According to a study in the 2005 Journal of Neurosurgery, 70 percent of sciatic nerve cases  are caused by the following muscle:

PIRIFORMIS Muscle- located deep in the buttocks behind gluteus maximus. It runs diagonally from the lower spine to the upper surface of the femur with the sciatic nerve running underneath or through the muscle. It helps hip rotation, turning the leg and foot outward.

Sacroiliac joint-formed by the connection of the sacrum and the right and left iliac bones-connects the spine to the pelvis and is held together by strong ligaments and are needed to support our weight when we are standing

Sciatica symptoms range from tenderness to severe pain anywhere along the sciatic nerve. There are two sciatic nerves-one for each leg. They are the longest nerves in the human body. They pass between layers of deep buttock muscles, through the deep muscles of the back and of the thigh, and down through the outer edge of your leg to your foot. Sciatic pain flares up while bending over, running, sitting and during many everyday movements.

Sciatic pain can be caused by a herniated disc in the lumbar spine pressing against the sciatic nerve. If this is suspected, evaluation by your doctor is  paramount. If you are having pain in your mid-lower back, and especially painful electric shocks , burning, weakness, and numbness in your legs and feet, a medical evaluation to rule out an acute herniated disc with nerve compression is needed. A medical evaluation is always helpful so your Yoga teacher will know what poses are safe and which poses are contraindicated. This article does not cover herniated discs in detail. However it is good to know that  a herniated disc does not always require surgery and Yoga can help you manage and reduce the problem by a series of gentle progressing poses.

If the piriformis muscle is tight it puts pressure on the sciatic nerve and pushes it against the tendons beneath it, which causes pain known as piriformis syndrome. The symptoms are similar to sciatic pain caused by disc problems but  please refer to the Yoga International Article for complete details.  You may have difficulty walking on your heels or toes with pain in the back of the thigh and buttocks with piriformis syndrome.

The following yoga stretches are specific to relieve pain caused by this syndrome. Again keep in mind that the approach should be to start gently  and progress slowly. Overworking the muscle can lead to muscle spasms and increased sciatic pain.

A short tight piriformis muscle will cause sciatic pain by pressure on the nerve so the goal would be to stretch the muscle without overworking it.

Yoga poses:

1. A simple half spinal twist will give the muscle a mild stretch that will encourage it to release and lengthen. However it is important to start slowly using the following variations and adjusting the pose to avoid discomfort. Begin by doing a simple seated twist. The poses and explanations are illustrated in the Yoga International article.
2. Standing twist- This is a milder standing version of the above . It brings the thigh into adduction and internal rotation. This is done by placing your right foot on a chair positioned against a wall, with your knee bent to a 90 degree angle. Come to the mounds of your toe and turn your body towards the wall, using your hands for balance. Exhale and lower your left hip to the floor, maintaining the twist. Allow your right hip to to descend, keeping your hips level and hold for several breaths- Repeat with left leg. Again please refer to the Yoga International article.

Hamstring stretches and Hip Openers play a role  in easing sciatic pain(again see Yoga International article for some of these).

Other Hamstring Stretches:

Seated forward bend-with one leg bent so bottom of the foot is on the inner side of the opposite thigh with outer knee of that foot on the floor or on a block. Bend forward  and hold the pose for several breaths. Repeat with other leg and then with both legs out straight-you will feel a gentle stretch in back of your thighs but stop the pose if there is any pain. Keep your legs straight with  knees pointed to the ceiling with a very slight bend. Remember that extension poses are OK if you have a herniated disc but contraindicated in spinal stenosis .

Standing forward bends, hinging at the hips. Again it is contraindicated for spinal stenosis, and glaucoma and uncontrolled blood pressure issues. It is best to place your hands on your thighs, come to a flat back and/or place hands on thighs and come to stand. In most cases do not roll up slowly.

Using a wall to do the runner’s Hamstring and Calf Stretch.

Supine -straight leg lifts.  Helpful to use a Yoga tie held with both hands and placed on the ball of your foot.

Hip Openers– include seated and supine spinal twists, bringing knees to chest in supine with hands under thigh or below knees  and slowly opening the hip by circling the knee. Supine pigeon pose, (No. 4  pose)  is an excellent hip opener.

Cat and cow pose and Child’s pose can be very helpful for some but check with your teacher first. Extension may not be the best pose for you while flexion can be and of course vise versa.

Fire hydrant pose in prone is usually relaxing and restorative and it is best to retain the pose for 5 or 6 breath cycles.

Remember the importance of breath-usually initially coming into the pose with an inhale and holding the pose as you exhale.

A nice long Savasana is essential after a Yoga Class where you notice  and feel the effects of the practice and then simple Rest in Awareness.

Note: to understand and visualize the above poses, it is best to consult the Yoga Journal website for complete instructions and demonstrations. Contraindications on various poses can be found here.

 

References:  Dr. Loren Fishman, Yoga for Back Pain

Dr. Loren Fishman, Yoga for Back Pain webinar

Dr. Loren Fishman,  Healing Yoga

Leslie Kaminoff, Yoga Anatomy

In general, Dr. Loren Fishman is an international expert and diagnostician. He incorporates yoga in his treatment of various muscular-skeletal issues. He has authored many books and articles on these topics.

 

 

 

 

 

 

 

 

 

 

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