backache asana christine carr

The Layers of Back Pain

Back pain may limit your ability to participate in any activity, including yoga.   If you injured your back in yoga, why didn’t the person next to you also get hurt? Why do some people heal fast and others do not? Practicing safe yoga is important. This requires body awareness, mindfulness, and good instruction on technique.   If these points have been covered and you still hurt your back, perhaps the reason is a bit more personal.

As a yoga practitioner you may be familiar with the Kosha model.   The Kosha model forms an ideal framework for the therapeutic side of yoga. The five layers of human existence move from tangible to subtle.   The layers include physical, energetic, psychological, intuitive and spiritual and are all equally important.   Unity of mind, body and spirit requires us to consider these layers individually and as a whole.   Our perception of these layers within our own body can guide our recovery and keep us safe on our mat.

Pain is a physical response to a noxious stimulus, but pain can also occur without stimulus. The complicated nature of low back pain is due to the fact that we are human beings. Many books have been written with various perspectives on causes and proper treatment for back pain.   As a physical therapist, my education has developed around a biomedical model. From this lens, I offer suggestions on preventing back pain specifically from the first layer of the Kosha model. Keep in mind, this layer cannot easily be peeled from the others.

The Physical

The physical layer includes the anatomical structures and physiological processes of the body. Your anatomy and structure will dictate your preference for back bends or forward bends. Your overall physical condition may impact your susceptibility to back injury. How your treat your body (food, sleep, exercise and hygiene) influences your immune system and your resilience. With that said, there is a pretty high probability that you will experience back pain at some point in your life[1].

Despite advances in science we often cannot find a specific (pathoanatomical) cause for low back pain[2]. In physical therapy, we tend to classify back pain clients based on what type of treatment would be of most benefit based on their signs and symptoms[3].   Currently the following categories are helpful in classifying types of back disorders with the understanding that a person may not easily fit in any one category.

  • Manipulation: If your back is on the stiffer side of normal. Your pain is not chronic, it is on one side of your body, and does not refer past your knee.
  • Stabilization: You are <40 y/o. You are hypermobile or have been told you have instability. You lack spinal control and tend to hitch with movement.
  • Movement specific or centralization exercises: Movement specific or centralization exercises. You have a directional preference. Certain motions consistently make your pain worse.
  • Traction: Your nerves are compressed. no movement makes it feel better. You have a stable condition and no life threatening pathology.

You may straddle two categories. You may have a more substantial condition such as scoliosis or a movement dysfunction that requires a customized approach.   I provide this simplified summary to help you determine where you might fall in terms of treatment or therapeutics.

For the Inflexible

Those in the first category, manipulation, tend to be more stable. Stiff generally equals stable. You are less vulnerable than the others and will tolerate a more strenuous class. However, I encourage you to try a restorative class to let go of tension. Holding poses for longer may help you to release, lengthen and create space in your body and mind.

For the Over Adaptable

Those in the second category need stability. They are too mobile in their spines and lack control. Doing a type of yoga that encourages deep stretching could be injurious. It is generally recommended you work in midrange of a pose and not push into full updog or binding poses that require control and stability. Remember the rules of stretching (see my past blog https://smartsafeyoga.com/stretchasana/) and avoid passively holding poses that may overstretch your ligaments and injure your joints. Move from a place of stability and control.

For Those That Prefer Moving In One Direction

If you fall into the third category, movement specific, then it is useful to have an understanding of what motion makes you feel worse.   Listen to your body. Experiment in a gentle class and practice with awareness.   Some conditions will require you to avoid certain movements. Conditions such as spondylolisthesis (no back bending), disc herniation (no forward bending) and osteoporosis (no forward bending) require modifications.   Months or years after an injury, you may need to learn to move back into the painful direction to restore normal function. Working with a professional may be beneficial to get you on the right path.

Finding the right class is important for those who have been through the health care system and are still experiencing pain. Talk to your healthcare provider, friends, or visit smartsafeyoga.com for ideas on finding the right class and instructor.

Deja Vu

Over sixty percent of people that have experienced back pain will have recurrence of symptoms[4]. This high rate of recurrence has to do with the complexity of back pain. The common biomedically directed treatments for low back pain are directed at functional limitations.   Gaining knowledge of the physical contributors to your back pain and dysfunction can help you avoid harmful positions. If your back pain has returned or you continue to hurt months after an injury despite your physically directed efforts, the reason may be more subtle.

Heal Yourself

Stepping on a yoga mat can provide a sanctuary for healing. Unlike other forms of back care management, yoga is a process. Practicing yoga encourages constant introspection. Even in a restorative yoga class, you are challenged to let go as you lay supported on your mat. Whether your back pain arose from physical, emotional or spiritual reasons is not important. What really matters is your ability to learn from it and manage it in a way that considers all aspects of who you are.

References:

[1] Non-specific low back pain. Ballague F et al. Lancet 2012. 379 (9814: 482-91)

[2] Nachemson, AL. Advances in low back pain. Cinical Orthopedics 1985 200: 266-278

[3] Delitto A, Cibulka MT, Erhard RE, Bowling RW, Tenhula JA. Evidence for use of an extension-mobilization category in acute low back syndrome: a prescriptive validation pilot study. Phys Ther. 1993;73:216-222; discussion 223-218

[4]http://www.jospt.org/doi/pdf/10.2519/jospt.2012.42.4.A1

 

 

 

 

 

 

 

4 Comments

  1. Tianna Meriage-Reiter on February 29, 2016 at 1:58 pm

    Hi Christine, what are your thoughts on your comment, “Conditions such as spondylolisthesis (no back bending), disc herniation (no forward bending) and osteoporosis (no forward bending) require modifications”? As a physioyogi, I will use caution with these particular issues, but not outright suggest “no ______.” Because I think we each need to be able to do these motions, but perhaps with “awarefulness.” A person is going to bend backwards and forwards sometimes to be functional. Even if someone performs a squat with “good” positioning (hips back, spine flat), there has been found to be 40 degrees of L/s flexion. And I will reference Greg Lehman’s write up on disc herniations occurring in flexion, extension and even neutral. It seems to depend on the load. http://www.greglehman.ca/2016/01/31/revisiting-the-spinal-flexion-debate-prepare-for-doubt/
    I had a client diagnosed with sondylolisthesis, and he loved doing cobra because it felt so good. I cautioned/educated him, but never told him to stop. I just told him to be mindful while performing it and use his breath throughout.

    Anyhow, I think we need to be cautious and yet educational at the same time. But not to instill fear into people. Thanks for the overall discussion–I appreciated the addition of the koshic model.

    • Christine Carr on February 29, 2016 at 3:32 pm

      Hi Tianna and thank you for your comment! I agree that people need to practice awareness and that moving functionally (in all planes of movement) is important. With those conditions mentioned, I think it essential that teachers are aware of possible contraindications and to err on the side of caution. I did say no backbends for spodylolithesis and no forward bends for disc herniation and osteoporosis as these are known contraindications in severe cases. In a group setting I think it is wise as a teacher to remind students they are responsible for their own bodies, but also to guide them in a safe practice. We do not want to say NO forward bends etc and instill fear in students, but I like to remind students that folding forward should be gentle and the movement should come from the hips and to bend the knees in most cases for safety. You and I have the advantage of the physio background, but for those with less knowledge in kinematics and pathology, understanding the precautions is important. Students want to trust that their teacher will keep them safe. As we get to know our students and them us, we can dive a bit deeper.

    • Christine Carr on February 29, 2016 at 6:14 pm

      One more thing Tianna. My associate just got back from a course with Greg Lehman. Cool stuff and very practical! Thanks for the link. This is one of the reasons yoga works, right? We focus on moving through barriers and building strength in all layers of being. If someone is told they can’t they may believe it to be true. Awareness can help us determine if these barriers are movable or require a little more investigation.

  2. Tianna Meriage-Reiter on March 4, 2016 at 5:59 pm

    Appreciate your responses Christine. Yes, when I am so inundated by this information, it would seem that everyone else knows too. But moving forward with caution as a curious, guided exploration seems to be best.

Leave a Comment