Beyond the Spine – Yoga and Back Pain

If you have back pain, or indeed any other musculoskeletal pain, the first port of call is likely to be a visit to the doctor to try and establish where the problem lies and to discuss the treatment options. If you’re lucky, you might be referred to a good physiotherapist, or an x-ray or MRI scan might be suggested to investigate the source of the problem. GP’s in the UK have now been advised not to give steroid injections, which used to be a common treatment for back or joint pain, because research has shown little long-term benefit from this intervention; but non-steroidal pain killers like paracetamol and ibobrufen are often recommended. Occasionally, if everything else has failed, surgery may be proposed. This tends however to be a last resort and only for the most extreme cases, owing to the attendant risks of this type of surgery. All of these approaches have their place, but we as individuals are responsible for our own well-being. Consequently, we should investigate proposed treatments and understand that medical solutions for musculoskeletal pain may have limitations and side effects.

Musculoskeletal conditions, and particularly back pain, are a serious problem for us all; the health, social and economic burden of low back pain on a nation is well established. Even if you are not a sufferer yourself, the national economy is affected by the prevalence of these conditions. In the UK, annual total costs attributable to low back pain have been estimated at over £12 billion, and it’s also the primary cause of disability globally. It is not surprising then, in the face of such a large financial burden, that alternative solutions are being investigated. UK government bodies such as the National Institute for Health and Care Excellence (NICE), the NHS information website, and Public Health England are now actively promoting regular yoga practice and other mind/body activity as a strategy for dealing with back problems, as well as other health issues.

A consoling fact for sufferers of back pain should be that, in the majority of cases, the pain will not be as a result of their bones or joints being damaged. More frequently, it is due to muscle spasm, nerve impingement or bulging or prolapsing discs. Excruciatingly painful as these conditions might be, muscles can respond to resting and stretching, inflammation of the nerves and the tissues surrounding them can be reduced with over the counter medication and heat/ice packs, and 90% of slipped discs will resolve by themselves over time.  A cautionary statistic for those bent on a more radical treatment approach is that, on average, the long-term outcomes for those undergoing spinal surgery are no better than for those patients treated with conservative interventions.

When you suffer from pain in your back, it is important to realise that the pain site is not the only target for therapy. If you have tenderness in your sacroiliac joint, it is not just this region which needs to be relaxed, opened and stretched; suppleness needs to come in the upper back, the neck and the shoulders, as well as the lumbar region; the whole spine should be flexible. This mobility needs to be paired with stability which comes from strength. So strengthening the deep abdominal muscles and the muscle groups around the spine is another important component in recovery. Beyond the spine, if you have back problems, you will also need to ensure that the muscles in the legs and pelvis are elongated and released. Tight hamstrings in particular tend to limit the natural movement of the pelvis and can cause misalignment in the lumbar curve, which will have a negative impact on spinal function. But, like the spine, mobility in the legs and the front and back pelvic regions needs to be tempered by a strength which is not rigid, but has a soft element to it.

Yoga is a holistic practice. We don’t treat the body parts in isolation, either from each other or from the mind and the nervous system. Yoga asanas have an effect on the entire body and its organs, including the brain. In addition to toning the muscles, nerves, ligaments, and joints, the different asanas work on all of the body’s systems. The body has eleven systems: muscular, skeletal, integumentory, nervous, circulatory, lymphatic, respiratory, endocrine, urinary/excretory, reproductive and digestive. Yoga functions to harmonise and balance these systems, bringing equilibrium to the body, peace to the mind and a clarity and lightness of being.  Classic yoga poses certainly may need to be modified for those coping with back pain, but results can be both successful and enduring. Ideally, asanas need to be adjusted for the individual according to their specific condition and situation, which is why it’s particularly important for those with problems to find a class and a teacher who can accommodate the requirements of their particular issue. Dedicated remedial yoga classes are scarce, but for those living in Kent, Maidstone Iyengar Yoga Centre holds one each week on a Friday.

The benefits from yoga are not just bio-mechanical ones. The nervous system, and in particular the brain, plays an essential role in the perception, management and experience of pain. In addition to improving your postural habits, yoga teaches you how to cope with stress, and learning about the power of conscious breathing helps both to reduce pain and give you a sense of control over your pain.

If you have back problems, a suitably qualified teacher should be consulted before undertaking a programme of yoga, but the Iyengar Yoga sequence below shows several key actions that can help to open out the body, create freedom in the spine and help to prevent and alleviate minor back issues.

Uttanasana (Forward Bend) – Modified with the use of a chair and a wall. Elongates the hamstrings and stretches and strengthens the paraspinal muscles. Lean the buttocks back to the wall. Take the feet wider than the hips, ensuring that the outer foot bones line up with the outer edges of the mat, and place the hands to the back of a chair. Lift your kneecaps and thigh muscles and press into the outer foot bones to lift the inner legs. Move the abdomen firmly towards the spine and keep the ears between the arms. Open out in the armpit region. Take long, slow, inhalations and exhalations. Hold for one to two minutes.

Essential Preparatory Action based on a modified version of Ardha Bhekasana (Half Frog Pose). Stretches the quadriceps and hip-flexors. Stand to a wall and place the pelvis against the wall, drawing the heel towards the buttock. Ensure that the inner thighs stay together and that the pubis moves towards the wall. Lift your chest and breathe evenly. Hold for 30 seconds to one minute.

Parivrtta Trikonasana (Revolved Triangle Pose) modified by taking the hand to a ledge, wall or a table. Gently rotates and releases the spine. Stand in Tadasana (Mountain Pose) Turn your left foot out very slightly and step the right foot towards a table or ledge. Place the hands on the hips and level them by drawing the right hip back and the left hip forward. Slowly rotate the spine to the right and take your left hand to the ledge in line with your right foot. (Note – in order to keep your spine in the correct alignment, you should be able to see your front foot but not your back foot.) Keep extending the spine to the crown of the head. Soft inhalations and exhalations. Hold for 30 seconds to one minute. Repeat on the other side.

Adho Mukha Svanasana (Dog Head Down Pose) – modified by taking the hands to the wall. Elongates the spine and lengthens the muscles in the backs of the legs. Be on your hands and knees with the thumb and index fingers to the wall. Press the heel of the hands into the floor and slope the arms back slightly. Take the knees beneath the hips and then lift the sitting bones towards the ceiling. Don’t try to place the heels down, but be on the backs of the balls of the feet. Move the abdomen firmly towards the spine and extend the root of the thighbones back. Let the head and neck completely release. Hold for 30 seconds to three minutes breathing slowly and evenly.

Savasana (Corpse Pose) modified by taking the lower legs to a chair, having a blanket for under the head and a cushion or foam pad (if required) under the pelvis. This is an essential pose to allow the lower back to relax. Place a blanket under the head and place the lower legs on the seat of a chair. Have a firm cushion or yoga pad and lift up the pelvis (if possible) and see if releasing the pelvis to a support feels better than working without that lift. Adjust for comfort. Take the arms out at a 45-degree angle from the body with the palms upwards. Relax the whole body and observe the breath as it flows through the nostrils. Stay in the pose for 3 to 10 minutes focusing on your breathing.