Yoga for Low Back Pain

Cautions

Bulging and herniated discs may be treated conservatively, with physical therapy, exercise, and other noninvasive treatments, but a badly herniated disc is a serious medical problem which may require surgery and a lengthy recovery period. – Julie Gudmestad, Yoga Journal, Ease on Back

• Of course, there are vast differences in styles of yoga and not all will be appropriate for students experiencing low back pain. In particular, classes taught without individual adaptation would be a poor choice for such cases. A mindfully-chosen practice adapted for the individual student is recommended for addressing low back pain.
• In the case of low back pain, forward bending should be approached cautiously: often, seated forward bends will be best avoided (especially if student has tight hamstrings and flattened low back curve), and for all forward bending, learning proper alignment and movement patterns is vital.
• Consider core-strengthening asana and exercises other than sit-ups or crunches. When sit-ups and crunches are also practiced, be sure to include back strengthening to avoid imbalance.
• Avoid poses that are too strenuous for particular students or be sure to offer adaptations to meet students where they are.
• Some causes of low back pain (such as a particularly badly herniated disc) may only be safely addressed by a qualified provider. When in doubt, of course, refer out. For more support, see When to Refer Out and search out a qualified yoga therapist for more advice.
• Keep in mind that students may have complicated medical histories, particularly in the case of chronic pain, and so each student should be treated individually.
• Treating chronic pain effectively is different from working with acute pain.

Strengthen Back Muscles

Many who suffer from lower back pain have heard or read that strong abdominals are the key to pain relief. It is true that the abdominals are important support muscles for the lower back, especially for problems like arthritis and swayback. Problems arise, however, when the abdominals are strengthened with regular exercises like sit-ups or crunches, but the back extensors—the long muscles running parallel to the spine that support it and maintain and increase the normal lower back curve—are ignored. Over time, a muscle imbalance develops: The abdominals become stronger and tighter, while the back becomes relatively weaker and overstretched. – Julie Gudmestad

Complicated Physical & Psychological Medical Histories

[Students with chronic low back pain] may have complicated physical and psychological medical histories, so keep their needs in mind at all times during the classes. Give your support to each participant to guide them through beginning their own yoga practice and continuing on with home practice beyond the course. – Robert B. Saper, MD MPH

What Might Help*

Caring for your back means developing healthy postural and movement habits and practicing postures and exercises that can build the muscle strength that will give your spine the support it needs… If you suffer from back pain try putting down the pills (with your doctor’s OK), sitting up straight, moving about with more awareness, and hitting the mat for a strength-building, tension-busting yoga session to subdue that troublesome ache and find the joys of unimpaired motion once again. – Beth Spindler

• Knowing how to listen to the body and how to compassionately respond
• Building mindfully to ensure proper alignment, focus and adaptation, and to avoid poses that are too strenuous
• Knowing how to use the muscles that support the spine
• Strengthening back muscles
• Strengthening abdominals (using asana and exercises other than sit-ups)
• Strengthening glutes (Jenny Thomas)
• Stretching hip flexors / psoas
• Stretching hamstrings
• Strengthening and stretching QL
• Utilizing breathing fundamentals and practices; moving with the breath
• Massaging belly
• Including silence during practice to allow for a deeper experience
• Including yoga philosophy for stress reduction
• In the case of chronic pain, introducing students to the possibility of change may be a key first step