Welcome back Yogis!
In Part II of our series on the Most Common Injuries in Yoga and How You Can Avoid Them, we’ll be taking a look at the lower back. This is a pretty common area of injury in yoga. It’s more likely, though, that a student has a non-yoga related low back injury from activities in their daily lives. Awareness of the mechanisms described later will help to mitigate any injury in class, and provide information to not exacerbate any pre-existing conditions.
Given my education and experience as a Chiropractor, I had a lot to write about this subject. It will be divided into two parts: in part A we’ll look into the prevalence and mechanisms of how a student can injure their low back in a class. In part B, we’ll look more into how twisting postures can be injurious, and offer some yoga and knowledge that is effective for treating lower back pain.
Lower Back Pain Prevalence
Lower back pain is a pretty common problem in most industrialized countries. According to the World Health Organization, it’s one of the top injuries/diseases that accounts for the highest amount of days missed from work worldwide!
For some of these people, yoga is an excellent way to provide relief for a distraught lower back. A lot of primary care physicians recommend it to not only alleviate back pain, but also to prevent it. This is great news! In the meta-analysis Yoga for chronic low back pain: A meta-analysis of randomized control trials Holtzman and Beggs found that yoga can be an efficacious adjunctive treatment for chronic lower back pain with a “medium to large effect on functional disability and pain.” However, due to the wide range of yoga styles and a high range of variability, it’s hard to pin down the exact way yoga is beneficial for your lower back.
In general, yoga stresses our body in a variety of different angles. Movement is medicine, and one of the beautiful things about yoga is that, regardless of the style you practice, you’re likely moving a lot in a bunch of different vectors. Like any form of movement though, yoga can be injurious and lower back injuries are pretty common.
Mechanism #1: Strength vs Stretching
In yoga we looooove to stretch! That sensation of length is probably half the reason why many of us hit our mats. If something on our body hurts, as a yogi, our first instinct is to jump right into stretching it. That makes it temporarily feel good, long, and full of bliss, (hell, it might even better the alignment of your chakras haha). This sensation is often short lived, and we often go back into hurting a few hours later, or needing to stretch the area again, because sometimes areas of our body don’t quite need length/stretching.
Ponder this question:
“How do we determine if an area of our body needs to be stretched/elongated?”
The answer is often answered by our posture, or what position do I commonly find myself in?
The lower back is an area that is often pre-stretched. Take a look at this skeleton:
The lower back is commonly put in an elongated position from sitting.
- The erectors that run from our sacrum to our skull are often elongated.
- Our glute max is also stretched from sitting, and often inhibited as a result.
- The hamstrings are a mess because they cross two joints, and end up long at the pelvis, and short at the knee (more on this in a future article).
As you may have concluded, for many people, stretching this area is often not the answer! The whole posterior chain of muscles along the spine are in a lengthened position for extended and repetitive periods of time. While stretching may feel good, the back of our body often benefits most by putting tension back into it. Strengthening via back bending postures (such as Cobra Pose) can work wonders and help to keep the pain/discomfort in your lower back away.
Now I will mention that some people have what is called “Open Scissor Syndrome”.
See how the ribs flare up, and the front of the pelvis flares downward.
In this position, the lower back is shortened, and can use some forward fold stretching to lengthen it. Open Scissor Syndrome is a whole article within itself, but know that the person whose posture looks like this is going to have their diaphragmatic breathing impaired big time!
Breath is huge when it comes to alleviation and prevention of back pain, and is likely one of the best ways yoga helps.
I like to teach my class under the assumption that everyone was sitting with an elongated lower back before they arrived. (I will note that I do live in southern California where most people drive and commute to their yoga studios). Therefore, I sequence in some spinal extension (back bending such as a few repetitions of Cobra Pose) towards the beginning of class, just to give yogi’s low backs a bit of strength and awareness so that they don’t strain it as we move into different postures throughout class.
On a final note, I almost always start class by having people lie on their backs. One of my mentor doctors when I was in Chiropractic school said that sometimes the best treatment you can give someone, is the opportunity to simply lie on their back. You would not believe how therapeutic lying on your back is, even for just a moment.
Whether your back was long from sitting, or short and open scissored from standing, lying on your back helps to neutralize both!
After we lie on the ground for a few moments (to give the back muscles a moment to decompress & set up breathing), I like to sequence in a little bit of core bracing and strength to properly prepare the lower back. Here’s a great pose I call “Box Legs”
Start: Lie on your back.
- Lift your legs and bend your knees
- Bring every joint (hip/knee/ankle) of the lower body to 90 degrees. (Stack your knees over your hips, bring your ankles in line with your knees, flex your toes)
- Hold to feel your core brace (feel the front of your abdomen from your pelvis to your lower ribs engage)
- The 90 degree placement of the hips should position your pelvis so that your back can be comfortably flat on the ground.
Mechanism #2: Repetitive Strain & Muscling Through
Most yoga injuries fall into the category of repeating a motion over and over, and eventually straining the associated muscles/joints/ligaments/tendons. For the lower back, this often deals with the large amount of forward bending we do. If you look at a traditional Sun Series A, there’s a forward fold after almost every movement!
Forward folds are generally not bad. As with any motion they fall into the mildly dangerous category when we do too many of them, and when we go too deep into them.
Take into account what we learned in the first article about knees: always keep a bend to your knees!
Straight leg forward bending puts a lot of strain on the lower back because the hamstrings are pulling the pelvis one way, while the upper body is pulling on it the other way.
While this may not hurt right away, or even after a few times, constantly loading your lower back like this can really mess you up in the long run. As I stated above, protect your back and take out some strain by bending your knees, even if you don’t feel like it’s that bad in the moment. You’ll thank me in a few years.
The counter to this is straining the other way, or pushing through too much extension. We have a wide range of forward folding because the hips, pelvis, and lower spine are all involved with the range of motion in our forward fold. Extension falls primarily on the lumbar spine, and if we are ignoring the sensations of our body, we can push through normal range and aggravate the joints of our spine.
In larger back bends, like Camel pose or Wheel, we can often find ourselves in a space where we can really jam these spinal joints. If we go too fast and too far all at once this can fracture them, which is not fun but also not very common. Instead what often happens, is that we can aggravate them, or cause some inflammation to these joints, which will often result in a pesky bout of localized lower back pain. Ever felt a little back pain after a big back bend/heart opener class? This is likely the reason why.
This fix is simple:
- Respect the curve of the spine! Focus on lifting up when you go into a back bend to ensure that the muscles are engaged and safely protecting the spine.
- When you’re looking at the posture or doing it think of your spine in an arch, not an angle. Look for a C curve, rather than a V curve.
Final notes on this mechanism:
- I work under the principle, discussed by Dr. Eric Goodman in his Foundation Training, that you should have 4 spinal extension, or back bending, exercises for every 1 spinal flexion, forward bending, exercise. Remember that forward spinal flexion is a common position for the modern human, therefore we don’t need a large amount of it because we already are doing that off the mat!
- Timing also plays a part. Stuart Mcgill discusses how in the morning our spinal discs are more hydrated from us being stationary while we sleep. This means that our discs have less mobility (they are stiffer when they are full of water) in the morning, and are more subject to injury with deep forward bending and backbending. Modify your practice according to the time of day, save the deep stretching towards the end if you practice in the morning!
That about wraps up part A, and is a hefty bit of information to digest. What I hope to leave you with at the end of this part, is to do everything in moderation and balance for your body. Any movement can be harmful if done repetitively or without proper counter movement. Meet yogis where they are at when they enter your studio’s, and assume that they probably spent some time sitting before class. No harm will come sequencing in early light back bending even if they didn’t. As a student, take the time before class to lie on your back, decompress, and focus on your breathing, or do some light stretches/exercises.
A lot of modern asana is movement based, and in thus is considered exercise. With that comes a responsibility to do a proper warm up. Even if your definition of asana is sitting in lotus pose to meditate, I’d recommend moving your spine around a few times to help keep things comfortable.
In Part B we’ll look a bit more into twisting postures and also discuss some mobility/stability strategies to really get your lower back feeling good, strong, & healthy!
Dr. Yogi Gare
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Illustrations by Ksenia Sapunkova.