Tag Archives: back pain

Yoga, ‘Core Strength’ and Chronic Lower Back Pain.

Releasing muscle tension to improve posture, alignment and movement is significantly more effective at reducing chronic or recurrent back pain than typical prescription treatment. (BMI 2009) According to Frederick Alexander, the founder of the Alexander technique, we “translate everything, whether physical, mental or spiritual into muscular tension”. The resulting poor posture compresses the neck and spine and can irritate the nerves leading out to various parts of the body. Painkillers do have their place in a treatment programme but only as short-term relief. What can we do to treat and prevent back pain in the longer term?

Many people advocate strengthening the ‘core mucles’. Whilst this might be helpful, in the sense that any exercise can be, it’s far too general to help people who already have a problem. People need specific advice and guidance on musculo-skeletal alignment: they need to feel its effects for themselves and re-train their bodies to adopt better habits under all circumstances, sitting, standing, walking, driving, exercising.

alignment1

Fitnessnetwork.com.au

Iyengar Yoga practice encourages us to use a range of postures to become more conscious of our alignment, and of the relationship between different parts of the body. This can be as obvious as the position of a leg or arm in relation to the trunk, or as subtle as our sense of the direction of an area of skin or the angle of a joint. In this way, by identifying and correcting our physical tensions and mis-alignment, we can have a corrective effect on many systems of the body. monkeyWe can easily release tension, thus correcting musculo-skeletal problems, preventing further injury and pain.

In terms of your ‘core muscles’, Geeta Iyengar had a lovely analogy for this. Think of a baby monkey clinging to its mother as she swings high up through the trees of the jungle. The relationship between the back of the abdomen and the spine, what we call ‘core muscles’, should echo this.

01-low-back-and-tummy-cropHere’s a quick and easy example – are you sitting comfortably? Consider the position of the front and back of your lower trunk. The position of the pelvis is the critical factor in supporting the weight of the abdomen: everything else, including ‘core strength’, is secondary. So here’s a test for you. Lift your pubic bone up at the front and draw the back of the pelvis (your Sacrum bone) down. Now roll your shoulders back and lift your navel area up and slightly back. It shouldn’t feel hard – this is not about creating a six-pack, which incidentally could just as easily pull a weak lower back out of alignment.

Yoga postures can help you to realign your pelvis, identify your core muscles and release lower back pain, one step at a time.

These yoga postures form a simple daily routine with three key benefits:

  • They help to keep your lower back muscles and your spine healthy and supple.
  • They help to re-align your pelvis, esp. the first three poses.
  • They will strengthen the longitudinal, transverse and oblique muscles around the front and back of your abdomen, to better support the weight of the abdominal organs.

You will feel some benefits immediately, but this kind of conscious re-training takes practice, so keep it up!

  1. Lying – lie down flat on the mat, and push your feet into a wall. (Have them 4-6 inches apart.) Feel how your thigh bones press down towards the floor. Become aware of the pubic bone at the front of the pelvis and the sacrum bone at the back. Draw your pubic bone towards your navel, your navel slightly inwards towards your spine, and lengthen your lower back and sacrum away. This realigns the pelvis and the thigh bones. Now fold your arms, hold your elbows, inhale and take your folded arms over your head. Breathe normally for 5-10 breaths. Change the link and repeat, lifting the chest and pressing the legs down as you go.
  1. 01 Urdhva hast sittingSitting – try the same alignment sitting on a chair. Draw your navel back towards your spine, lift your chest and take your shoulders back. Feel better? What you have just done is to lift your lower abdomen up and lengthen your lower back down, which levels the bones of your pelvis and puts the weight of the abdomen into the ‘bowl’ of the pelvis, where it belongs, instead of dropping over the front of your pubic bone and giving you a belly!Lifting your chest and taking your shoulders back makes more space around the front and back of your abdomen, keeping this girdle of muscles firm, and of course relieving the pressure on your digestive organs. REMEMBER: this is not about creating a hard abdomen: it’s about realigning the skeleton-muscular structure.
  1. 01 Bvajasana ChairBharadvajasana – sit sideways on the chair, feet flat on the floor and knees pressed together, with the back of the chair to your right. (If your feet don’t reach the floor, place a block under your feet.) Repeat the abdominal lift as above. Then, keeping your knees and hips steady, turn your trunk towards the back of the chair and hold with both hands. Keeping your knees and thighs together, push gently with the right hand and pull with the left, so your trunk turns and your spine revolves.Keep your shoulders level, breathe steadily, and keep your chin in line with your breastbone. Hold for 3 breaths. Slowly turn to the front and pause for a breath. Swivel round on the seat so the back of the chair is now on your left. Repeat to the right and left once more, pausing between each twist. (Ladies: Miss this one out if you have your period.)
  1. 01-navasanaNavasana – face the seat of your chair. One at a time place your heels on the seat, holding a strap round the soles of your feet. Begin to straighten your legs. Tightening your kneecaps and extend the backs of your legs, pushing your heels away, and pulling on the strap with your hands. Learn to lift your chest, waist and lower back away from the floor. Keep your head, neck and face relaxed. Breathing evenly and smoothly, hold for 3-5 breaths.Relax the pose, bring your feet down if you need to, then repeat twice more, rolling your shoulders back as you lift your chest. Try to perch on your buttock bones! If you find the chair too high to start with, use a wall and gradually work your way up to chair height.
  1. J01 Jatt Parvatasanaatthara Parvatasana – lie down on your mat. Bring your knees up over your chest and push gently into your heels, keeping your legs firm, your feet and knees gripped together. Place your arms on the floor, straight out at shoulder height, backs of the hands to the floor. Keeping your knees together (that’s the tricky part!) and well bent, roll them slowly to your right and left, keeping a slow and steady rhythm to the movement and the breathing. Keep your face and jaw relaxed.Repeat this three times on each side, then rest with your feet hip width apart on the floor, knees bent and together. Repeat for three each side again.
  1. 01-urdhva-pras-padUrdhva Prasarita Padasana –lie down on your mat with your knees bent up. Lift your hips and put a yoga block under your sacrum. Bend your knees over your chest and put a strap over the balls of your feet, holding one end in each hand. Breathe in. As you breathe out push your heels up towards the ceiling, keeping your feet together and aiming to straighten your legs. The shorter your hamstrings, the more challenging this will feel.Hold this ‘L’ shape for 2-3 breaths, and then bring your knees back down to your chest on an exhalation. Rest for 2 breaths. Repeat this three times. If you find it difficult to straighten your legs, take your legs and feet further away from your face by using a longer strap. Experiment until you find an angle at which your legs feel comfortably straight, backs of the knees open. You can also rest your heels on a wall, as with Navasana. Finally put your feet down on the floor hip-width apart, knees bent and together, to allow your abdominal muscles to rest. Eventually, lift your hips and slide the block out, and rest your back on the mat.
  1. 01 Savasana with chairLegs over a Chair – lie with your back on the floor and your legs resting over the seat of the chair. (Put the chair sideways so you have room for your feet.) The edge of the seat should come right into the backs of your knees, so your calves rest completely on the seat. If you are less than 5’6” you might be more comfortable with a yoga block under your sacrum. If you are over 5’9”, you will find a well folded blanket on the chair seat more comfortable. Your thighs should be slanting slightly away from the chair. This particular pose relived a tight lower back and relaxes the spinal muscles.
  1. Savasana – To finish, lie with your back on the floor. It’s important to release the whole spine. You may be more confortable with your knees over a rolled blanket or bolster. Stay resting for 3-5 minutes, keeping the mind quiet and breathing normally.01 Savasana knees supported

Click HERE for a printable pdf version of this sequence.

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Iyengar Yoga Home Practice Sheets

These yoga routines are designed to be simple, effective and easy to use. You may need some equipment, but most can be substituted with things you have at home. Beginners can try any of the first seven sequences. The Level 1 and Level 2 sequences are for more experienced students.

Staying in the poses is part of the process, to observe the way the body adjusts, learn how to release pain and tension, and allow the body and mind to relax. So it’s helpful to have a timer for these sequences. If you use your phone put it in flight mode.

If you have any questions or comments, please use the box below.

With best wishes, Hannah.

 

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Iyengar Yoga home practice sheets.

These yoga routines are designed to be simple and easy to use. You may need some equipment, but most can be substituted with things you have at home. The first six sheets are suitable for all levels. The last two are suitable for more experienced students.
If you have any questions or comments, please use the box below.
With best wishes, Hannah.

DO YOU HAVE ANY QUESTIONS?

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Thinking of starting or resuming yoga in middle age?

Where to begin and how to practice yoga as you get older including general points on ageing, some risk factors, osteoporosis, balance, back pain, sciatica, joint pain, metabolism and the efficacy of Pilates.

To download & print an illustrated pdf, click HERE.

ImageFrom the article by Dr Loren Fishman, New York Times – 8th May 2013. Loren Fishman, MD is Medical Director of Manhattan Physical Medicine and Rehabilitation in New York City, author of seven books, author or editor of more than 70 academic articles, and a world-recognized pioneer in the treatment of piriformis syndrome and rotator cuff tear, for which he has developed non-surgical interventions. His ability to diagnose and cure all types of back pain has earned him wide acclaim. Dr. Fishman has applied yoga to the treatment of sciatica, scoliosis, rotator cuff syndrome, multiple sclerosis, osteoarthritis, osteoporosis, and shoulder pain. He has studied in Pune with BKS Iyengar.

To find an Iyengar Yoga teacher, see http://www.iyengaryoga.org.uk and use the search box. If you have a particular problem that requires remedial treatment, find a Senior Teacher for advice before proceeding.

Q.  What is the best way to begin or to resume yoga when you are over 50?

A. First, find out what your limitations are. This depends on the individual and might require a medical visit. The next step is to find an experienced and well-trained yoga teacher for a one-to-one class and assessment. Group classes came about through urban economics: many yoga teachers cannot afford to teach small numbers. But because chronic conditions are cumulative, when you’re older you need the individual attention that yoga has traditionally offered.

There are many other types of yoga, but the teachings of B.K.S. Iyengar are the most anatomically sophisticated and therapeutically oriented. (Iyengar Yoga Teachers trained to Intermediate Junior Level 3 are insured for one-to-one classes.) You will need a resourceful and sensitive teacher to assess your capabilities and to introduce you to an appropriate yoga practice that you can do every day. After six to eight weeks you should go back to your teacher for a re-assessment and suggestions about how to progress to the next stage. Your teacher will also be able to tell you when you are ready to join group classes, if you wish to do so.

Yoga, practiced consistently, does good things to your temperament and perceptions. You will find that after a period of six weeks’ regular practice, your views as well as your body will have changed. This is a good time to have another one-to-one session.

Q. Are there any aspects to yoga practice that the over-50 practitioner should give up if she/he is healthy and otherwise feeling well? How about after 70? What poses cause the most injuries, and which might help protect or rehabilitate common yoga-associated injuries?

A. Yes, there are things you may need to give up in your yoga practice as you get older. People age differently, and yet there are characteristic aspects to aging. Chronic conditions are cumulative. With osteoporosis you can do forward bends to as far as your hips will carry you without pushing, keeping your back slightly concave if possible, and preventing it from slouching forward no matter what. (See http://sciatica.org/yoga/12poses.html)

Beware taking the avoidance of forward bends to phobic extremes, however: good posture and sensible bending and lifting is an antidote to osteoporotic fractures; flexibility, coordination, balance and strength are the best prevention of hip fractures. Standing poses like Vrksasana (the tree), Virabhadrasana I, II and III (the warrior poses), and Ardha Chandrasana (half-moon pose) promote these positive traits and are some of the last poses one should give up as one ages.

Arthritis will respond to yoga. Supta Padangusthasana is as safe and as good as a pose gets, and will help with safe forward bending, too, by lengthening the hamstrings and stretching the hips’ capsule. We will come to many more suggestions and caveats in the questions and answers that follow.

Q. Any age-related additional risk factors with respect to the vertebral artery during Sarvangasana (shoulder stand) and Halasana (plough pose)?

Q. I am 55 and began yoga two months ago. I go every other day, but I still have problems with the balance poses. I did not have these issues in my youth. Is it typical to have more balance issues as you get older?

A. Most arteries become more brittle and are more easily injured, just as the skin gets more delicate with age. Sarvangasana (shoulder stand) and Halasana (plough pose), and poses like Parighasana (the gate) should be trimmed back from their extremes for safety after the age of 70. Ask your teacher for guidance.

The vertebral artery actually figures in nourishing a number of neurological structures critical to good balance and coordination, so it is worth taking great care of it. The three determinants of balance are the inner ears, proprioception (lowered awareness of position and relative location of parts of the body) and vision, and our sense of balance can also be degraded with age:

  • Decreased sensitivity in the semicircular canals (in the ears) to changes in direction and momentum.
  • Decreased proprioception  in the joints and in one’s feet.
  • Less acute vision.

Do the precarious poses against or very close to a wall. The wall is a wonderful, supportive teacher and use a chair on your mat, so it won’t move away from you!

BACK PAIN AND SCIATICA

Dr Loren Fishman and his colleagues discuss back pain more fully on their excellent web site  www.Sciatica.org. See also the book he wrote with Carol Ardman, “Yoga for Back Pain”, showing many poses modified for those in pain or unable to do the full pose. There are chapters on herniated disc, spinal stenosis, and how to tell the difference between the two. Yoga with physical therapy is an excellent choice for someone with either a herniated disc or spinal stenosis. But first, get a proper diagnosis.

Q. I am 48, in good shape cardiovascular-wise (runner), and decided to try yoga recently. All went well initially but of late I have had considerable back pain both when sitting and lying flat. Could I have an injury? If it’s just sore muscles, will it eventually get better if I keep doing it?

A. First, much back pain is discovered in yoga class but really has its origins elsewhere. Second, yoga can cause back pain, and then, as always, the question is: what is the diagnosis? Pain is a symptom, not a disease. Without a diagnosis you’re left to guess about proper treatment, for the same pain can have causes so different that treatments are diametrically opposite.

One way to decide if it’s sore muscles or a neurological injury is if the pain goes down one or both legs, or radiates. Does anything tingle; is some part of your leg numb? If so, it’s nerve pain, indicating an injury that merits further inquiry. If not, it’s probably a muscle spasm or strain, and stretching should make it feel better – I say ‘probably’ because someone could also have a spinal fracture, facet arthritis, spondylolysis or other problem. The bottom line is that you need a diagnosis before yoga or anything else can be used to help treat the problem.

Q. I have sciatica and a herniated disc so bad I want to cry. I’m on prescription pain killers but I’d rather be better and not drugged up. Will yoga help sciatica?

A. Sciatica is nerve pain that goes down the leg along the course of the sciatic nerve. It can be helped with yoga, but it must be done with extreme care.

  • A herniated disc responds to extension, and may be worsened by flexion.
  • Spinal stenosis improves with flexion, and is exacerbated by extension.
  • Yet both can cause sciatica, and the same exact distribution of numbness, weakness and pain.
  • About 5 percent of the time, the treatments reverse: extension helps stenosis, flexion is good for herniated discs.
  • Start tentatively, be sensitive to the changes you feel, and progress slowly.

Q. At a healthy 61, I took up Iyengar yoga last year with an experienced teacher and felt better and limber than I had in my whole life. Six months later, I experienced low back pain and sciatica. I have a L4-5 and L5 – S1 disk bulge. I had physical therapy and two epidural steroid injections. The pain and numbness is only marginally better and has kept me from yoga, which I miss greatly. I don’t think I overdid yoga. My doctors think I will recover slowly. Is there remedial yoga for sciatica, and what is the best way to get back to yoga once I am better?

A. Back bends will very likely help in this case. Find one of the excellent Iyengar teachers in your area and you will likely benefit from Salabasana (the locust), Setubhanda (the bridge) and Ustrasana (the camel), among others. Again, progress slowly.

JOINT PAIN AND METABOLISM
Q. I am 58 and a breast cancer survivor. I have been doing vinyasa yoga for about five years. In the last two years, I have had problems with my sacroliliac joint and I understand this may be the result of too much flexibility in the hip joint. In addition, I am interested in whether yoga can slow the metabolism. I would greatly appreciate advice on protecting the sacroiliac and whether the metabolism issue is a myth.

A. People often ask about sacroiliac joint pain. For those with this problem, I describe some unusual but easy versions of difficult poses, like the two-armed support in Pinca Mayurasana (the peacock), in the new edition of “Yoga for Back Pain,” which I wrote with Carol Ardman. Also helpful is Gharudasana (the eagle), Ghomukhasana (the cow), and “leaning” as described in my earlier book, “Low Back Pain.”

Several people have asked whether yoga slows metabolism. Yes, it does. It lowers blood pressure and reduces atrial fibrillation and in general calms things down. But that does not mean yoga cannot be used to trim your weight. Yoga does it differently, by stretching the organ, the stomach, which will then send turn-off signals to the appetite centres in the brain. Poses like Virabhadrasana III (the warrior III), Parivrtta Janu Sirsasana (the twisted janu sirsasana), and Parivrtta Parsvakonasana, done 10 to 20 minutes before a meal, will probably work. This requires a small amount of self-discipline, but then again, so does just about anything that succeeds.

Q. I had disk surgery in the 1990s and sciatica has returned. I have tried interventions to avoid additional surgery. I was told, however, to stop yoga and continue with Pilates on the reformer. I stretch my hamstrings and do a few poses daily after a hot shower. I walk a lot but want to maintain my upper body strength. What are your thoughts?

A. If sciatica has returned after an initial surgery, I would not confine myself to Pilates on the reformer. Pilates is good for the healthy, and there are people who describe themselves as Pilates therapists, applying and modifying Pilates practices to form a healing regimen. Still, I have not encountered the type of rigorous scientific work, nor the careful study of therapeutic benefit that you find in yoga. Instead of Pilates, I would do gentle yoga, restorative yoga, lift weights while lying down on your back (taking all weight off the discs) and continue walking a lot.

Q. Can yoga help in dealing with sciatic pain? Are there particular poses that can relieve sciatica?

A. First find the cause of your sciatica, then consider the suggestions given in the answer above.

Q. I have sciatica and also a herniated disc. I used to practice yoga years ago on a daily basis until my back started to bother me. I cannot do any forward or backward bends at all. I miss the yoga postures and how limber it made me feel. Are there any yoga postures that people with back problems can do?

In cases of sciatica with a herniated disk:

  • Avoid either forward or backward bends.
  • However, you can do sideways poses like Vasisthasana (side plank – LOY p.309-3011), which we have shown with M.R.I.s to reduce stenosis and herniated discs.
  • Also, beware of pushing too hard; consider trying the poses that used to make you feel good — but only 10 percent of the way — until you feel stronger.
  • Start back bends very slowly. Self-pacing is a critical part of any self-discipline, and applies to all parts of yoga, from beginning to end.

For Iyengar Yoga classes in Dorset and Somerset, Yoga Holidays in the UK and abroad, please contact Hannah Lovegrove.

Telephone: 07971 434336 Email: hannah@hannahlovegrove.co.uk

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