Many know the feeling. You are fit, healthy, strong and flexible. Exercise is part of your life, but despite being committed to a regular practice and a healthy lifestyle, there is one part of the body that seems particularly vulnerable – the back.
After the Christmas break many people are suffering from backache and looking for ways to return to fitness without escalating the problem. Most people are now aware that movement is essential for a healthy back, and look to yoga and other therapies to maintain strength and flexibility in this vulnerable area.
OOPS! And It’s Gone Again…
Yoga is increasingly seen as a way of strengthening this vulnerable area, with many doctors recommending it to their patients as conventional medicine fails to solve the problem. Back pain is now so common that it is estimated nearly 5 million working days are lost each year and that half a million workers report having back pain.
Perhaps the acceptance of this disabilitating and painful condition is that expensive invasive surgery is rarely prescribed. Most back pain eases within 8 weeks, but will often reoccur.
The crippling pain and disability that accompanies bouts of back pain, can affect life and work, leading to loss of employment and permanent disability. The body, out of balance, and in many cases locked in a painful cycle of pain and temporary remission, is unable to repair itself as the causes of the problem are never completely recognised.
A highly profitable industry has grown out of the suffering, with companies and therapists offering treatments and equipment aimed at helping those desperate for relief. Yoga practitioners are not immune to back pain, and it is not unusual for students to attend class in an attempt to relieve existing
‘Doctors are increasingly recommending
Yoga to their patients as they recognise the
limitations of pain relief and
symptoms and improve strength. Doctors are increasingly recommending yoga to their patients as they recognise the limitations of pain relief and conventional physiotherapy.
Yoga teachers are limited in a general class and will recommend caution to any student suffering from back pain. The financial constraints on GPs mean that it is unusual for yoga to be funded by the NHS so self-referral with the encouragement of the individual’s doctor is the usual route… This places a lot of responsibility on both teacher and student. Sufferers invariably are only aware of the symptoms, and have often only received limited investigation, and no advice on how the problem has been caused. A recent trial concluded that early intervention gave some benefits in physical improvement but greater improvement in ‘mood and quality of life’. A recognition that back pain affects all areas of a sufferer’s life.
Current advice from most GPs is to remain active and use some form of pain relief. Referral to physiotherapy is often delayed due to hospital waiting lists, meaning that few are able to access the therapy that is known to be beneficial in the early stages.
Yoga is increasingly seen as offering the long term recovery and stability that sufferers require – a modern affirmation to a traditional practise.
Back To Recovery
Both teacher and student need to investigate the causes of the problem and agree a long term plan that can be incorporated into the individual’s life.
Before designing an individual practice it is important to look at the sufferer as a whole person. By taking the time to look at the person and not just the symptoms, a long term strategy that may be devised that will bring more than just improved structure and pain relief.
Observation. Many sufferers turn to yoga on the advice of their GP or other professional. Observing how the body is used and any abnormalities, will reveal any potential stresses and suggest possible changes. It is important to spend some time analysing the complaint and considering general health issues. Strong painkillers or other medication or treatments may have been prescribed and these will also have an affect on the body. If other therapies are being used, such as treatment from a chiropractor, it is advisable to leave at least 3 days between the treatments to allow for any reactions to settle.
Discussion. It is rare for back pain to be the result of a single incident. It is more likely to be the result of longer term imbalances. Often these are hard to identify as they are often the result of day to day wear and tear and 21st century life – bad posture and lack of use. It is useful to consider how the challenges of daily life can affect the body. Minor changes and adjustments may be needed to facilitate long term improvement.
Dealing with pain. Many sufferers are locked in a cycle of pain and find relaxation impossible. The tension that the pain causes can affect the body in a way that even though the original problem may have reduced the mind cannot ‘unlock’. Recent research has shown that acupuncture is effective in reducing this pain retention and the body and mind are able to work in unison again.
As the body is not a machine that can be taken apart and rebuilt, it is often impossible to know exactly what the physical problem is. Doctors rarely use expensive investigative techniques to investigate those complaining of back pain.
There is a general acceptance within the profession that a certain amount of ‘wear and tear’ and arthritis in the spine is acceptable as the body ages. It is important to have some understanding of how the spine works in relation with the rest of the body as the imbalances that can cause back pain may have little relation with the site of the pain.
In yoga the importance of the spine is not just about its physical characteristics. An awareness of its relationship with the mind and the breathe helps us understand the relationship of our centre with the rest of the body.
The parts of the spine that are most flexible are also the most vulnerable. The cervical and lumber vertebrae receive little support meaning that the neck and lower back are more likely to suffer from injury or pain. The spine is naturally curved with each vertebrae balanced in a line with the muscles providing support to keep the back in a ‘neutral’ position.
The natural curves in the spine differ between individuals with posture and the affects of daily life causing changes as the body ages. Abnormal curvature may be the result of disease, injury or congenital disease. Other factors such as weak ligaments and poor posture can also result in excessive curvature.
The nerves that emerge from the sides of the vertebrae supply specific groups of muscles and areas of the skin. The relationship between the spinal nerves and the rest of the body explains why problems within the spine cause pain, numbness and discomfort in other areas of the body, as in sciatica.
Moving with the Breath
One of the most effective and simple ways of improving posture and developing an awareness of the relationship between the spine and the breath is to take a few moments standing in Tadasana (Mountain pose). While standing in the pose feel the inhalation opening the ribcage, then allow the exhalation to lengthen the spine and feel the lumber and cervical areas opening. By making these subtle adjustments with each breathe the spine will be encouraged to develop a supported ‘neutral’ position.
Back to the Mat
Exercises lying on the mat will help provide stability and support. Be aware of the relationship of the spine with the rest of the body and try and keep the spine in the centre of the mat.
Setu Bandha (modified)
Lie on the mat with the knees bent and the back lengthened. Keep the knees hip width apart and feel the space in the hips and lower back. On the exhalation draw the navel in and press the feet into the mat allowing the lower back to start to tilt away from the mat. Gently roll up and unroll down onto the mat. If comfortable place some blocks under the lower back and relax. As the condition improves hold this modified position for a few breaths.
Supta Padangusthasana (modified)
Lie on the mat with the knees bent. Draw the right knee into the body and supporting the weight of the thigh stretch the leg. Hold the stretch for a few breaths then gently release. Repeat with the left leg. As the condition improves straighten the bent leg onto the mat and keeping both hips low work towards lengthening the lifted leg.
Lie on the front with a soft rug under the hips. Bring the legs together keeping the soles of the feet facing the ceiling. Roll the shoulders back and down and stretch the fingers back along the thighs towards the heels. Lengthen the neck and keep looking towards the mat. Keeping the spine long, inhale and allow the legs and upper body to lift away from the mat. Slowly unfold back onto the mat. As strength and flexibility improves move deeper into the position and hold for more breaths.
Kneel with the buttocks resting on the heels (place supports under the buttocks if they do not reach the heels). Stretch the arms forward feeling the release in the lower back. As the back starts to release, increase the stretch by gradually stretching the arms further and lengthening the back and releasing the hips.
Gentle Seated Twist
Sit on the mat with the back straight and the knees bent. Keep the legs and feet close together drawing them close to the body. Place the left hand behind the back to support the spine in an upright position. Place the right arm round both legs and gently twist towards the left. Lengthen the back, open the chest and look over the left shoulder. Hold for a few breaths, slowly return to the centre and repeat on the other side.