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Yoga for Back Pain: Restoring Balance and Wholeness
If you have ever suffered from back pain, you know what a painful and even debilitating experience it can be. An estimated four out of five people will experience back pain at one point in their life, so not surprisingly, back Pain is the single leading cause of disability worldwide and the second most common reason for physician visits in the US.
The standard medical treatments for back pain remain painkillers or surgery. So not surprisingly, many people are looking for alternative ways to treat their back, including acupuncture, chiropractic, physical therapy—and yoga.
Indeed, a growing body of studies indicates that yoga can be a powerful tool in the treatment and ongoing management of LBP.
In a recent study of 320 back pain sufferers of diverse backgrounds conducted at the Boston Medical Hospital, researchers found that yoga practice reduced pain and disability at a rate similar to physical therapy. Half of the yoga group also reported reduced use of pain medication.
In another study of 150 military veterans living with chronic low back pain conducted by the Veterans Affairs San Diego Healthcare System, the group practicing yoga reported larger improvements on measures of pain, disability, fatigue, physical function, and quality of life over usual care measures. Researchers also pointed out the relative cost-effectiveness of yoga over more traditional interventions.
How does yoga help relieve back pain? According to yoga therapist Lillah Schwartz, author of Healing Our Backs with Yoga, yoga practice may address various musculoskeletal factors that contribute to back pain and help manage the underlying conditions that cause it.
Over 30 plus years of practice and working with hundreds of clients, Lillah has augmented a strong Iyengar-based background with a comprehensive study of anatomy, kinesiology, and functional movement. But her greatest teacher was her own experience with a broken tailbone, the result of a horseback riding accident, that led to asymmetry in her pelvis and SI joint, dysfunctional movement in her other major joints, and chronic back pain.
Self-study, acceptance, and experimenting with postures geared to create optimal alignment in her body relieved her pain and helped her to understand the needs of other back pain sufferers.
“A certain level of maturity has to come where you recognize that, ‘This is the structure that I have. And if I perform my yoga this way, I can be really strong and pain free. But I have to be careful not to do it that way.’”
Lillah explains that an alignment-based approach geared to each individual’s needs can help people living with chronic back pain safely harmonize the structures in their bodies and come to a place of greater functioning, especially as joint space is tight and unforgiving.
Eric Small, one of her teachers and a person who lives with MS, encouraged her to explore the subtle movement of every joint in every conceivable way.
“If alignment is off just by a little bit, it can create a negative pinch or an increase of inflammation on that herniation, rather than relief that allows the inflammation to recede,” she says.
That said, Lillah advises against rigid adherence to rules of alignment. “Go with the lines when possible and deviate from them when deviation creates a greater connection to the whole. There must be flexibility and adaptability in alignment, adaptability where the pieces can connect,” she counsels.
One important lesson from her studies with Mr. BKS Iyengar was to investigate and observe the results of each action, and then give her students and clients adequate time to observe what’s changed. “It’s really that sense of action and reflection, action and reflection,” she says. “And then it’s practice and learning to listen to the body as an intelligent organism.”
“The beauty of yoga is that it connects one part of the body to another,” says Lillah. “You can discover in your practice, not only is your big toe mound connected to your inner groin, but it’s also connected to the origin of the psoas muscle at T12. When you expand your arms, they also connect at the psoas. It’s the beauty of how yoga can lead us to those connections in our body. The fluidity can be brought back in to how we move through our life.”
As a teacher trainer, Lillah advises her students to keep instructions simple in the beginning for their students with back pain. “If you are focusing on your breath, and it’s a long smooth inhalation and a long smooth exhalation, the mind is captured by the breath first. The mind connects to the breath, the breath to the body, and then the body communicates back to the mind through the breath.”
Lillah says that a well-crafted yoga practice can be the mechanism for increasing spinal strength and stability, cultivating length and space in the spine, and intelligently applying breath to movement, all of which will lead to increased functioning and reduced pain. She advocates starting from the ground up:
“If someone doesn’t know their body and how it works, you start with baby steps. You start with basic alignment, basic connections, how to use the breath, a simple sequence of poses that is anatomically balanced. And once they have the fundamentals you can lead people to the broader, bigger connections.”
One go-to tool is based on the principle of reciprocal inhibition–where contracting one muscle group automatically relaxes the muscles on the opposite side. For example, in a student with a
back spasm, she suggests having them lie down and do gentle tummy crunches that don’t exacerbate the issue.
Lillah points out that a great advantage of a yogic approach to back pain, is that it addresses the whole person, not just one small biomechanical issue:
“When I teach I am interested in the fluidity of structure and what can create that fluidity. A person with low back herniation may not have fluidity in their hips or shoulders. So, you start with the base, but you also have to account for muscle structures that are weak.
“In this way, “Their mind can start wrapping around how to live in their body, how to listen to their body and how to be their own best friend by knowing the map of this beautiful body that we have.”