Anatomical drawing of person practicing yoga forward bend paschimottanasana.

Yoga Anatomy: Preventative Strategies for Lower Back Strain

By: 
Ray Long MD, FRCSC

In this post, we take a look at one of the leading causes for emergency room visits from yoga—lower back strains—and examine preventative strategies that may help in reducing the risk of this injury while enhancing the benefits of Hatha Yoga practice. This series begins with info on joint rhythms and how understanding them can help in preventing injury.
 
Back strains are also a common workplace injury and much research is focused on the prevention thereof. Nevertheless, people still often strain their back at work, especially during situations in which they forget or are unable to implement preventative measures.
 
There is never any reason to rush or force oneself into a yoga pose, so it is possible that many of the back strains that have occurred were preventable through working with proper technique, using modified poses where indicated and not rushing. Then, the practice becomes potentially therapeutic, rather than injurious, for the lower back.

Preventing Low Back Strain in Forward Bends

Since I suspect that a percentage of these yoga-related lower back strains may have arisen during forward bending poses, let’s begin by looking at the concept of lumbar-pelvic and pelvic-femoral rhythm in the forward bend Paschimottanasana (Seated Forward Bend Pose).  

Paschimottanasana, forward fold, tight hamstrings, forward fold variations, anatomy of forward folds, forward fold modifications, lumbar -pelvic and pelvic-femoral rhythm

(Pashimottanasana illustrating lumbar-pelvic and pelvic-femoral rhythm.)
 
Lumbar-pelvic rhythm refers to a type of joint coupling whereby tilting the pelvis in one direction produces a corresponding movement in the lumbar. Tilting the pelvis back (tucking the tailbone) produces flexion of the lumbar vertebrae. Tilting the pelvis forward produces extension. 
 
Pelvic-femoral rhythm refers to joint coupling at the hip whereby flexing the femur produces a corresponding forward tilt of the pelvis, and vice versa for extending the femur.
 
I access these rhythms when I work with yoga poses, especially forward bends, by gently engaging muscles that improve hip flexion and anterior tilt of the pelvis (joint coupling between the pelvis and the hip) and releasing the muscles that can limit hip flexion. In this manner, the forward bend comes more from the hip than the lumbar spine.
 
The hamstrings, for example, are hip extensors. They can limit hip flexion. Contracting the quadriceps contributes to releasing them through reciprocal inhibition. One head of the quadriceps, the rectus femoris, is also a synergist of hip flexion (and anterior tilt of the pelvis). Thus, engaging the quadriceps helps to produce forward bending from the hips rather than the lumbar. In general, when practicing forward bends, movement of the pelvis on the hips should be equal to or greater than the movement of the lumbar spine in relation to the pelvis, otherwise, flexion is concentrated in the lower back.

Paschimottanasana, forward fold, tight hamstrings, forward fold variations, anatomy of forward folds, forward fold modifications, lumbar-pelvic and pelvic-femoral rhythm, Pachimottanasana with joint rhythm with quadriceps engaged

(Pashimottanasana illustrating joint rhythm with quadriceps engaged.)

As an aside, I also use the periodic gentle muscular engagement of the quads when I am practicing a longer duration relaxed forward bend that is directed toward lengthening myofascial sheaths. Periodically engaging the agonists—or yang side of a stretch—does not diminish the lengthening on the antagonist (yin) side. In fact, it can enhance it both biomechanically and physiologically. This engagement also re-establishes alignment and mental focus.

How Misguided Theories Can Cause Possible Harm 

Now, let’s look at what happens when we eliminate engaging the quads, for example, out of fear that the rectus femoris will cause “congestion.” We lose reciprocal inhibition of the hamstrings, which remain tight through the action of the muscle spindle in a stretch. This limits hip flexion. We also lose the contribution of the rectus femoris to hip flexion and forward tilt of the pelvis. The result is that the forward bend is produced more from the lumbar than the hips, which may contribute to lower back strain. Thus, avoiding an imaginary problem potentially causes a real one. 

Paschimottanasana, forward fold, tight hamstrings, forward fold variations, anatomy of forward folds, forward fold modifications, Paschimottanasana joint rhythm without engaging the quadriceps, increased lumbar flexion, potential back strain

(Pashimottanasana illustrating joint rhythm without engaging the quadriceps. Note the increased lumbar flexion.)
 
Unsound theory is like a fly in the ointment. These things become “memes” that get circulated as if they were based on truth. And although such theories are often not based in reality, they can have manifestations in the real world, including a potentially increased incidence of back strains and other injuries. These problems then get sensationalized in the media and so on. Ironically, such media coverage can lead to well-considered analysis, which then helps to identify and eliminate potentially harmful disinformation and implement an affirmative strategy of prevention.
 
If you suffer from back pain, be sure to consult your physician to determine the cause; work under the guidance of a physician to manage your pain.

Read more on the topic from Dr. Ray Long:  Yoga Anatomy: Preventative Strategies for Lower Back Strain - Part 2
 

Doug Keller, Yoga Teacher, YogaUOnline Presenter, Keys to Healthy Hamstrings


 
Reprinted with permission from Daily Bandha.

 

Author Ray Long MD, FRCSC, is a board-certified orthopedic surgeon and the founder of Bandha Yoga. Ray graduated from The University of Michigan Medical School with post-graduate training at Cornell University, McGill University, The University of Montreal, and Florida Orthopedic Institute. He has studied hatha yoga for over twenty years, training extensively with B.K.S. Iyengar and other leading yoga masters.

 

Chris Macivor3d Graphic Designer / Illustrator Chris Macivor has been involved in the field of digital content creation for well over ten years. He is a graduate of Etobicoke School of the Arts, Sheridan College and Seneca College. Chris considers himself to be equally artistic and technical in nature. As such, his work has spanned many genres, from film and television to video games and underwater imagery.  

 

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