Lower Back Pain
Treating Chronic Ailments with Yoga - Lower Back Pain
By Sam N. Motiwala and Rajvi H. Mehta
The spine is the most subtle part of the gross human body. It not only controls all the anatomical movement of the body but also regulates the movements of the skull and the head and thereby the state of one's mind. The spine is a chain (vertebral column) which is made up of 32 links (vertebrae) which work in tandem.
The strength as well as weakness is transmitted from one link to the other. If one of the links in the chain is overworked then it weakens and gradually wears out and then other links are forced to take up the extra burden until they too also collapse.
A detailed explanation is given here in order to have a better understanding of its functioning. The spine is divided into the cervical, dorsal and lumbar regions. The cervical and lumbar are the most used and also most susceptible parts of the spine and are the most common locations of back pain.
The lumbar spine (the lower back) bears the load of the entire body and 80% of the population experience pain in the lower back at some point of time in their life. Can we not live without experiencing this pain and can we not learn to endure this damage without undergoing suffering? The pains that are existing and those that are yet to come could be avoided by a practitioner of yoga.
Heyam duhkham anagatam - Yoga Sutras 11.16
The pain gradually sets in though one is initially unaware of it and only when it becomes acute does one realise about the possible damage.
Sage Patanjali explains the pain as,
avigya ksetiram uttaresam prasupta
tanu vicchinna udaranam - Yoga Sutra 11.4
I e., "Lack of knowledge is the source of all pains and sorrows whether dormant, attenuated, interrupted or fully active".
The pain thrives in the fertile field of ignorance and grows into a chronic dull ache leading to bouts of severe pain. It is a common tendency to blame an extraneous event or object for such attacks of pain - "Oh my back hurts because I lifted this heavy bag" or "My back suddenly started aching after I lifted my head from the sink". One needs to understand that this extraneous event or object is just a Nimitam (efficient course or expression) of an underlying defect which will someday express itself in the form of fully active (udaranam) severe pain necessitating immediate action. One should not ignore the pain in the dormant state and nip it before it reaches the debilitating fully active state.
The major cause of backache is strain on the back due to bad postural habits, lack or improper exercises or wrong ways of lifting weights. Such habits weaken the spinal muscles affecting the function of the shock absorbers (inter vertebral discs). In some extreme cases, such strain could end in a "slipped disc" even after some minor trauma to the back. Techniques of preventing and curing such chronic backaches can be grasped better after a clear understanding of the architectural structure of the spine. Infection, injury, fractures can also cause backaches but these are not being dealt with in this article.
The lumbar spine
The lumbar spine is the most extensively used part of the spine and bears most of the weight of the body. The lumbar spine is made of 5 vertebra of which the last one articulates with the pelvic bone.
Intervertebral discs
The intervertebral discs are present between the vertebral bodies. Each disc is composed of a capsule of ligament (called the annulus fibrosus) which encloses a jelly-like fluid (called nucleus pukposus). The entire disc acts as shock absorbers for the spine by compressing when weight is put upon them and assuming their original shape when the weight is taken away. If the spine were without discs, the vertebrae would grind against each other and wear out quickly. The gelatinous structure of the disc evenly disperses the pressure on the spine.
There is a constant pressure on the discs in the lumbar region when one is in a sitting or standing positions. The discs in the lumbar spine are much thicker than in the cervical spine and they prevent any damage to the vertebrae even if there is any friction.
The spinal cord
The spinal cord begins where the brain ends at the base of the skull and continues down for about 18 inches through the tunnels in the center of the vertebra. Parts of nerve roots emerge as branches of the cord on either side of the body. There are 31 pairs of spinal nerves originating from their nerve roots and the vertebra. The course taken by the spinal nerves originating in the lumbar region is depicted in the sketch. Numbness, tingling sensations or pain in the different regions of the back and limbs reflect on the lumbar segment that has been affected.
Mechanics of back pain, disc strain or disc bulge
The intervertebral discs compress and return to the original position naturally during the different movements of the spine. Imagine the disc to be a cap placed over the head (which is the vertebra). If the cap gets tilted it has to be straightened. Similarly if the disc is tilted it should also be straightened out. The movements of the spine itself are not well balanced. Some people tend to extend the left side of the spine more than the right and for the others it is the reverse. The muscles of the side of the spine which is overextended get strained and that which is under extended get weakened. The muscles of the over extended side just give way and then the intervertebral disc faces more strain.
To visualise the mechanics of the vertical column, one can observe one's own index finger. The knuckles represent the vertebra and the bones between the knuckles represent the discs. If one critically observes then one notices that the space between the knuckles is not the same in the inner (side closer to the little finger) and outer side (side closer to the thumb) of the finger and the knuckles appear tilted. Friction between the knuckles occurs on the side of the tilt and is commonly termed as arthritis of the knuckles. The muscles and the discs are not as hard as the bone between the knuckles and a constant over extension on one of the sides of the spine results in strain to the muscles and the discs.
A portion of the disc may protrude out and pain results if the protrusion compressors any of the nerve roots. There may be no pain in the initial stages of the protrusion. The symptoms follow the bulging of the intervertebral disc will depend upon the amount of the disc that is protruding and the surface that it is pressing against. The pain may occur exactly at the site of the protrusion but may disappear soon and the pain may also occur where the nerve root is compressed. The pain may even spread anywhere on the back, hip or the leg (depending upon the nerves that have been compressed). The discs that have the greatest tendency of being damaged are those located between the lumber vertebra 4 and 5 (L4-L5) and between lumber vertebra 5 and the sacrum (L5-S1).
Slipped disc or disc herniation
A bulging in the disc could culminate in the herniation of disc, commonly termed as slip disc. Here, the intervertebral disc does not slip out of position but the ligament of the disc weakens and tears off. The interior of the disc – the gelatinous material - extrudes and herniates out. The herniated portion compresses nerve roots. Therefore, 'slip disc' is a slip in the terminology and does not involve any dislocation of the intervertebral disc as it is often misunderstood.
Principles of yoga therapy for treating lower back pain due to bulging or herniation of the intervertebral disc
The aim of asana therapy is twofold. Firstly to ease the patient's pain and provide momentary relief and then to strengthen the back muscles which prevents the recurrence of the protrusion.
Yogic therapy is based on the principle of
maitri karuna medita uoeksanam sukha duhkha pun ya apunya visayanam bhavanatah cittaprasadan
yoga sutra 1.33
i.e., The affected region can be favorably disposed through the cultivation of friendliness, compassion, joy and indifference to the pain.
One needs to be friendly and compassionate not only to the patient but also to the affected part. In the early stages of therapy, one experiences symptomatic relief and expresses joy and encourages one to continue with the therapy. However, this sense of pleasure is accompanied by another form of pain as the weelsk, lazy and under-used side of the body is made to work. There is a healthy 'pleasurable' pain and one should learn to differentiate between the types of pain. A healthy pain is accompanied by signs of relief, it is treatable and does not continue once one comes out of the posture. This is the first sign of healing. An unhealthy pain is destructive, excruciating and continues even after one comes out of the posture. One should find out where one has gone wrong and is advised to take the guidance of an experienced teacher and ensure that it does not persist. The pain gradually disappears and it is that time that one should be indifferent to the affected part and no longer pamper it.
Back or limb pain following disc protrusion or herniation is due to the compression of the nerves and the pain disappears the moment the compression is decreased. All the postures recommended for such a disorder aim to increase the space between the vertebra so that the disc returns to its original position reducing the pressure on the nerves. In the early stages of practice, the posture's provides symptomatic relief for a couple of hours. Following regular practice of the recommended postures, the spinal muscles get strengthened and the space between the vertebra returns to normal.
Postures recommended
In all the postures, ensure that there is no constriction in the lumbar spine. Always keep the spine extended. For the basic technique to perform the postures, the reader is advised to refer to "Light on Yoga" by yogacharya B.K.S. Iyengar. Only the modifications, if any, are described in this section. All the poses describe below should be done gradually preferably under the guidance of an experienced Iyengar Yoga teacher.
Adho Mukha Svanasana (with a rope)
The rope extends the lumbar spine towards the wall while the hands extend the spine forward. These opposing movements bring about an extension in the lumbar spine decreasing the compression of the disc on the nerves and reducing the pain.
Half Uttanasansa
Standing postures:
Utthita Trikonasana
Utthita Parsvakonasana
Ardha Chandrasana
Hints:
Some people may get relief in Utthita Trikonasana and some in Utthita Parsvakonasana. You have to learn from your own experiences and start your standing poses with Utthita Trikonasana or Utthita Parsvakonasana depending on which pose gives you more relief.
Parivritta Trikonasana
Supta Padangusthasana
Supta Baddha Konasana
Baddha Konasana - with twisting
Sirsasana (on the rope)
Twisting postures:
Bharadvajasana
Standing Marichyasana 1
Utthita Hasta Padangusthasana 3
Half Supta Konasana
Interesting fact:
The tailbone is considered vestigial because it's a remnant of a tail that human ancestors once had and lost during evolution. As early humans evolved to walk upright, their tails became less important for balance, and the coccyx (tailbone) became a smaller, fused structure at the end of the spine, retaining only secondary functions like muscle attachment.
Loss of original function: The external tail was used by earlier ancestors for balance and mobility, especially when living in trees.
Shift in locomotion: Once humans began walking upright on two legs, the tail was no longer as crucial for balance and mobility, and there was an evolutionary advantage in not having it.
Embryonic development: In human embryos, a tail is initially present but is absorbed back into the body during development, leaving the coccyx.
Remaining purpose: Although the original purpose is gone, the tailbone still serves secondary functions, such as providing an anchor for pelvic floor muscles and ligaments. This is why it has not degraded further.
