Easy on sitting forward bend:
Sitting forward bends are probably the best-known leg stretches, and are therefore likely to be included in a beginning stretch routine, whether in a public yoga or aerobics class, or in a book or video. Surprisingly, there seems to be widespread misunderstanding about the role of stretching in the care of back problems. And the irony is that certain types of stretching can actually worsen some back problems.
A yoga practice with too much emphasis on aggressive forward bending can be risky, particularly if the student has tight hamstrings and a flattened curve in the lower back. A well-constructed yoga routine, however, can be an ideal way to learn to stretch without creating or exacerbating back pain, and a chance to practice good alignment and movement patterns which help protect the back from injury.
To understand how stretching can improve or aggravate disc problems, let’s look at how a disc works and how it gets damaged. Intervertebral discs function as shock absorbers, cushioning the brain from jarring as we walk, run, and jump. Each disc consists of two parts: the inner disc, the nucleus pulposus, made of a shock-absorbing gel-like substance, and the annulus fibrosis, the rings of ligament that surround and support the center.
A normal lumbar spine has a mild curve forward, and in this position, weight is evenly distributed throughout each disc. During toe-touching, the lower back flexes, losing its normal curve, and more weight is put on the front of the discs. The gel-like centres get pushed backward, into the now stretching support ligaments. While this can happen during forward bending even if a person tends to have excessive lumbar curve (“swayback”), it is especially problematic if the spine has lost the normal curve and become flattened.
With repetition, or if great force is applied as in heavy lifting, the ligaments weaken and may “bulge” like a bubble in the wall of a tire. Or the ligaments may tear, allowing the gel-like inner disc to leak out, resulting in a herniated disc. The bulging or herniated disc may cause lower back pain or, if it is pressing on an adjacent nerve, pain can be referred into the hip and leg. Bulging and herniated discs may be treated conservatively, with physical therapy, exercise, and other non-invasive treatments, but a badly herniated disc is a serious medical problem which may require surgery and a lengthy recovery period.
While heavy lifting is a well-known cause of back injuries, disc damage is just as frequently caused by the smaller but repetitious forward-bending movements we make during daily activities at work and at home. For most of us, half of our body weight is above the waist. Just as a child “weighs more” as he or she slides away from the centre to sit at the end of a teeter-totter, our own upper body weight exerts greater force at the disc as we bend farther forward. This tremendous force on the disc, added to the strain on the supporting ligaments, sets the stage for damage.
In our society, opportunities abound for repetitive forward bending: child care, yardwork, housework, shopping. Even sedentary work may exert strain on the lower back; for example, someone bending and twisting from a sitting position to lift a heavy object out of a bottom desk drawer. The greater the weight being lifted (and the weight of one’s own body), the greater the pressure on the disc.
Forward bending activities, especially combined with lifting, are also the most common cause of back “strain.” While much less serious than disc injuries, back strain is responsible for most of our lower back pain, including the Monday morning ache after weekend gardening.
How Are Your Hamstrings?
Repetitive forward bending may also occur in exercise routines, including yoga. These routines can be particularly risky for people with tight hamstrings, the muscles extending from hip to knee on the back of the thigh that receive much of the stretch in forward bends. The hamstrings attach to the sitting bones—the two large bones at the base of the buttocks (called the ischial tuberosities). In a sitting forward bend, the pull of tight hamstrings keeps the pelvis from rotating forward over the legs. In fact, tight hamstrings encourage the pelvis to rotate backward, in a position called “posterior tilt.” If your pelvis is held in a posterior tilt and you reach toward your toes, all the forward movement occurs by hinging through the lower back.
Doing a series of sitting forward bends, then, can put prolonged or repetitive strain on the disc, causing or contributing to disc bulging or herniation. Ironically, the people who most need to stretch their hamstrings, to help improve posture and movement patterns, are most at risk for injuring their backs practicing forward bends.
Tight hamstrings affect posture and the health of the lower back by exerting a constant pull on the sitting bones, tipping the pelvis posterior and flattening the normal curve of the lumbar spine. Overly strong or tight abdominal muscles may also contribute to a habitually flattened lower back. Tight abdominal muscles pull up on the pubic bones, again contributing to posterior tilt, especially if combined with tight hamstrings. They also pull down on the front rib cage, contributing to forward-slumped posture. This posture, with posterior-tipped pelvis and forward-slumped trunk, puts chronic strain not only on the discs, but also on the lower back muscles.
Many who suffer from lower back pain have heard or read that strong abdominals are the key to pain relief. It is true that the abdominals are important support muscles for the lower back, especially for problems like arthritis and swayback.
Problems arise, however, when the abdominals are strengthened with regular exercises like sit-ups or crunches, but the back extensors—the long muscles running parallel to the spine that support it and maintain and increase the normal lower back curve—are ignored.
Over time, a muscle imbalance develops: The abdominals become stronger and tighter, while the back becomes relatively weaker and overstretched. Unfortunately, many current exercise routines emphasize several types of abdominal strengthening, and a series of sitting forward bends to stretch the legs. The end result of years of this type of exercise will be a rounded, slumped posture with a weak and vulnerable lower back.
When faced with challenging poses, students are likely to fall back on familiar positions and muscle patterns. If your usual posture is rounded forward, with a flattened lower back, posterior-tilted pelvis, and tight hamstrings, you are at risk for back injury in forward bends and need to take special care as you prepare to practice them. Your goal is to be able to stretch the hamstrings without a posterior tilt of the pelvis.
To check your readiness, lie on your back with one leg stretched out flat on the floor. Stretch the other leg up to the ceiling with a straight knee. Look in a mirror or have someone else check to see if you can bring the leg to vertical, perpendicular to the floor.
If you can’t get to vertical, your pelvis will be posterior tilted in a sitting forward bend, and it’s possible that you would strain your back muscles or injure a disc if you reached for your toes. You should avoid sitting forward bends, especially if you have a history of lower back pain or injury, until you can stretch your leg straight up to 90 degrees or more. If you are in a class where forward bends are being taught, you can always substitute some simple leg and hip stretches like Supta Padangusthasana (Reclining Big Toe Pose) and Supta Baddha Konasana (Reclining Bound Angle Pose).
Pass the Test
My plan for building towards safe forward bends involves six basic poses:
1. Modified Supta Padangusthasana (Supine Hand-to-Foot Pose, Variation I) practiced with the raised leg up the wall and the straight leg through a doorway
2. Utthita Hasta Padangusthasana (Extended Hand-to-Foot Pose) practiced with the raised leg on a chair back.
3. Prasarita Padottanasana (Wide-Legged Forward Bend)
4. Supta Baddha Konasana (Supine Bound Angle Pose) practiced with the pelvis against a wall and the feet up on the wall, pressing gently on the thighs.
5. Modified Supta Padangusthasana (Supine Hand-to-Foot Pose, Variation II) practiced with the raised leg extended to the side and the foot on a wall
6. Savasana (Corpse Pose) practiced with blanket support for the spine.
Taking only 10 to 15 minutes daily, these poses will begin to reshape your body by lengthening your hamstrings without compromising a normal lumbar curve. Included in the sequence are two poses that stretch the inner thigh muscles, the adductors, which can also factor into forward bends.
These gentle poses will help you progress toward forward bends. If, however, you have a history of lower back pain, known disc damage, or a recent lower back injury, it may not be safe to begin forward bends even after working with these preparations for some time. Check with your physician or other health care provider before starting. Remember, sitting forward bends put the spine into flexion, reversing the normal curve, and some lower backs will not tolerate that position without pain or strain.
Additionally, you may want to take instruction in forward bends from a teacher experienced in working with back problems who can give you expert guidance and feedback.
When you are ready to start, I suggest you begin with standing forward bends. The transition from neutral-spine Prasarita Padottanasana (Widespread Forward Bend) to the version with the head hanging down towards the floor (or on the floor) is a good trial. Next try Uttanasana (Standing Forward Bend). In both of these poses, gravity helps to take the weight of the upper body off the lower back, decompressing the discs.
If you have passed the 90-degree test and can practice these hanging forward bends without back pain, you may be ready to begin practicing sitting forward bends safely and reap their restorative benefits of introspection, relaxation, and flexibility.
Poses to relieve lower back pain:
Tight hamstrings can pull the pelvis from its normal position, which in turn pulls the spine from its, causing back muscles to fatigue quickly and pain to flair. Back pain can also originate in the spine itself, through poor posture or weakened unstable back muscles. Using yoga to strengthen your core, leg and back muscles can help cure and prevent chronic lower back pain.
There are many yoga poses that target these key areas, strengthening the muscles and allowing the body, and the back, to move freely without pain.
Use the following 2 yoga poses to stretch the hamstrings and ease tension on the pelvis and back.
Touch your toes like you did in grade school with a forward bend (Uttanasana). A forward bend will stretch the entire back side of your body, including your shoulders, hamstrings, and lower back. It is a very popular yoga pose, and is often used outside of yoga for warm-ups before exercise, or simple, daily stretching.
Seated forward bend (Paschimottanasana) is an alternative to the forward bend. Uttanasana relies on gravity to induce the stretching, and because of this, it may be better to use Paschimottanasana. Paschimottanasana forces your body to rely on its natural elasticity, not the tug of gravity to extend the pose, preventing over-stretching often associated with Uttanasana. You may not be able to stretch as far on the floor, but neither will you risk injury. [Exercises That Could Be Harmful]
Use the following 5 yoga poses that specifically target the lower back to strengthen muscle and increase flexibility.
Cobra pose (Bhujangasana) stretches the spine, especially at the base of the pelvis. Bhujangasana is an effective stretch for the lower back, and can also be done by itself as a stand-alone exercise for pain relief.
Child pose (Balasana) is one of only a few completely stationary poses in yoga. It requires no movement, or balance, and can be used as a soothing relaxant for achy back muscles. Balasana is a great pose for cooling down after your yoga routine, or as a warm-up to focus your mind.
Cat pose and cow pose (Marjaryasana and Bitilasana) are often done together. Standing on your hands and knees and alternately arching your spine upward (cat pose) , and downward (cow pose), gives your back two workouts in one. Cat pose is also a good substitution for the more difficult cobra pose.
If you’ve tried the above poses and would like a greater challenge, try an extended side-angle pose (Utthita Parsvakonasana). Side-angle poses’ twisting motion loosens the back muscles. The concentration needed to balance can also help relieve stress. Side-angle pose also strengthens leg muscles, including the hamstrings, and increases overall balance, giving extra support to your back.
Try combining cobra pose with extended side-angle pose for a deeper stretch. When you lunge, standing with your front leg bent at the knee, your back leg stretched behind you, reach your arms into the air and back, arching your spine.
Restorative pose for ease lower back pain:
Discomfort in the lower back is no fun and is definitely one of the most common complaints out there. Since massages are expensive and aren’t always convenient, here are some yoga poses you can do at home or anywhere that you have a space to yourself in order to get some relief.
1. Hamstring Stretches. Using a strap (or, if you don’t have one, use a regular towel or belt from home), lasso the right foot with your strap while extending the left leg down in the opposite direction. Take advantage of these forces of opposition: flexing the bottom heel, driving it away from the body, and “kicking” the top heel towards the sky. Put as much bend in the top knee as necessary to prevent tugging in the lower back. You want to feel the stretch in the meat of the leg, not the tendons behind the knee. Repeat on both sides, holding for about a minute on each.
Why this works: Let’s talk fascia. The fascia is everywhere, but on the back of the body it’s continuous from the head to heel, covering the calf, hamstring, sacrum, and the erectors, all the way up to the back of the head, like a stocking. With this stretch, you’ll loosen that portion of the fascia, which will put some slack on the lower back to relieve some of that discomfort. By releasing the back and spine here, we can allow the discs to reset.
2. Low Bridge. From lying down flat, bring the feet hip-width apart, as close to the butt as possible as long as it’s comfortable to do so. Place a block width-wise between the upper thighs near the pelvis, and squeeze the block hard. Place the arms down at the sides, pressing the palms into the floor. Lift the hips off the floor and avoid putting pressure on the neck. Keep your bridge low, so the ribcage remains pretty low. Relax the upper glutes near the sacrum and engage the lower glutes, which feels like squeezing your sit bones together.
Why this works: By engaging the lower glutes (think of squeezing the area that granny panties would go to!) and releasing the area around the sacrum, you allow the lower back to open up and unravel all the muscles that are usually tight in that area. It’s not going to feel like the deepest bridge you’ve ever done and will be more subtle than you might be used to. Remember, this is about feeding the back so we can do more rigorous practices that serve us.
3. Lying Supine Twists. Lying down with a long straight posture, stack the knees over the hips. Let them drop to one side, and gradually unfold the opposite shoulder away from the knees. Sometimes it feels better to anchor the knees or shoulders to the mat, but that’s your choice. Gently engage the belly and breathe, switching sides after a minute or so.
Why this works: This twisting action helps to maintain the health of our spinal discs, and the feel of this pose is all about release. The muscles in the lower back are stimulated and lengthened in this pose, which assists us in our ability to move more freely. I’m sure I won’t bring every yoga teacher along with me on this one, but for twists in general, as long as it feels good, keep doing it however you’re doing it. Don’t worry about forcing your knees to the floor or pressing both shoulders into the mat. If you have a gentle, free-feeling twist, you’ve got the right idea.
4. Child’s Pose with Arms Down. From kneeling, bring your feet together and knees apart. Drop your hips back towards your heels and pitch the chest forward, laying the chest down between the thighs. Bring the forehead down to the floor. Rest the arms down at the sides with the elbows soft and palms facing up. Lengthen the tailbone away from the pelvis and breath, holding the pose as long as you like.
Why this works: Restoring the length in the spine as well as bringing symmetry to all the muscles on both sides of the spine that supports our every day movement. The placement of the arms is a matter of preference and will be totally subjective. In my and many of my students’ cases, the arms being down at the sides’ offers a different release of the spine and low back then with the arms stretched overhead. But, remember, yoga is meant to feel good. So if it feels good for you to have them up, keep them stretched overhead.
****Chiropractors and some osteopathic doctors use spinal manipulation to treat low back pain by applying pressure with their hands to bones and surrounding tissues. This treatment is not appropriate for everyone.
**** A study funded by the government suggests that massage may help relieve chronic low back pain. After 10 weeks, people who had weekly massages had less pain and were better able to go about their daily activities than people who got traditional care. That was true no matter what type of massage they got, and the benefits lasted at least six months.
****** Can acupuncture treat back pain? The evidence is mixed. In 2009, a study of several hundred people with long-lasting back pain found surprising results. Those who had simulated acupuncture (involving toothpicks tapping the skin) got the same benefits as those who had real acupuncture with needles. After eight weeks, both groups had greater relief than people who did not have acupuncture.
***** check for Reiki treatment http://reikiinmedicine.org/clinical-practice/12-years-of-back-pain-relieved/
***** Preventing Low Back Pain
There’s no sure way to prevent back pain as you age, but there are steps you can take to lower your risk:
Stay at a healthy weight.
Lift with your legs, not your back.
Make sure your work station position isn’t contributing to your pain.
Restorative class for back pain due to nerve compression:
All yoga is therapeutic and many people will find relief from back pain by attending a Hatha, Vinyasa, or Anusara yoga class. People with herniated disks and back pain due to nerve compression will in most cases not benefit from a general yoga class, as forward folding and twisting will contribute to the nerve compression, and cause greater pain. Restorative Yoga class will be gentler class than most general classes, so it’s appropriate for people who have never done yoga before and/or have limited mobility, and are not in very good physical shape. The poses in Yoga with Yaga for the Back are safe for most back pain issues and focus on relieving tension in the back, strengthening the core, and releasing tightness in hamstrings and hips.