A Gentle Yoga Sequence for Back Pain

“Happy families are all alike,” Tolstoy wrote. “Every unhappy family is unhappy in its own way.” The same thing— or something quite similar—might be said of our backs.

As long as they’re “back” there doing their job, holding us up and keeping us mobile, we usually don’t give them too much thought; we can’t even see them. We take them for granted. They’re just backs—our posterior sides, the very definition of strength and silence.

But as soon as our backs go out, we all have stories to tell. Suddenly our lives—once so pain free—are limited and defined by our own personal brew of sports mishaps and mistimed sneezes, of sleepless nights and missed workdays, of social lives curtailed and family activities indefinitely altered. We each become unhappy in our own excruciating way the moment that lower back pain comes creeping into the picture. And eventually, it
almost always does. (To find out why, see Garden-Variety Back Pain.)

For Terri Stoecker, 54, the moment came one day last year while she quietly worked in the garden at her summer home in Chestertown, New York. She was planting a row of hemlock trees when her lower back suddenly seized up. “I could barely move; my back was just completely locked,” she remembers. A neighbor helped her into the house, where she rested up enough to return to Florida and begin an odyssey of doctor’s visits, MRI scans, prescription refills, and physical therapy sessions.

As it so often does, back pain snuck up on Stoecker and took her by surprise. She couldn’t quite believe what was happening to her. “I was a marathon runner and a competitive tennis player—I was an active person,” says the former flight attendant, who worked a total of 28 years for TWA and American Airlines before recently retiring. “I thought I was strong, but it turns out that I wasn’t strong in the right places.” Plus, she says, “I was absolutely devastated. I couldn’t imagine what I would do if I couldn’t find a way to get my life back.”

Luckily, she did. By happenstance—or what Stoecker now sees as synchronicity—she found something that she believes truly healed her back: a Viniyoga class taught by a physical therapist named Emily Large, who bases her instruction on the work of Gary Kraftsow, author of the seminal Viniyoga book Yoga for Wellness. “After the first class, I knew this was for me,” Stoecker remembers. “Relief came quickly. The combination of physical movement, mental awareness, concentration, and breathing just worked.”

Yoga Works

In 2005, a groundbreaking study found that patients with chronic lower back pain who participated in a 12-week series of yoga classes had less pain and more improved function than those in the study’s other groups. One group took conventional exercise classes (a combination of strength training, cardio, and stretching based on physical therapy techniques). The other group cared for themselves at home using a provided back-pain handbook.

What’s more, the benefits of yoga extended well beyond the scope of the classes. When researchers followed up with the participants after 26 weeks, they found continued improvement in function and pain relief. The patients also used less medication.

Karen Sherman designed the study, which was funded by the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health. She is an epidemiologist and a researcher for Group Health, an integrated health care system in Seattle with upward of 500,000 patients. Sherman’s idea was to test yoga as a treatment not for experienced yoga practitioners with specific injuries, but for the kinds of people that doctors were seeing in their offices every day. “To make these results the most relevant, we were looking for what most people have—general, nonspecific lower back pain. We weren’t looking for people who were into yoga,” she says. “We were looking for people who were into making their back pain better.”

She found 101 patients willing to participate in her study, and most of those who were in the yoga course experienced relief. But when Sherman discusses her work, she’s circumspect. “In my view, one study never proves anything,” she says. “But this does suggest that for people who have garden-variety lower back pain, it’s totally worthwhile to give yoga a try.”

Rich Panico is more enthusiastic about Sherman’s results. As founder of the Mind Body Institute at Georgia’s Athens Regional Medical Center and designer of the Back Care Yoga program there, he’s a physician in the business of communicating the power of yoga to other physicians. “This is big news,” he says. “It’s one of the first meaningful yoga studies. We live in the era of evidence-based medicine, [and] everybody’s looking for proof. Doctors can see that this study has the statistical power to draw meaningful conclusions: Yoga helps people with back pain, and it’s an enduring phenomenon.”

There have been other studies about yoga helping to relieve back pain that have been published in smaller medical journals, such as the International Journal of Yoga Therapy. But this study really gets doctors’ attention, Panico says. “It was methodologically rigorous, well constructed, and published in a prestigious peer-reviewed journal,” he explains. “It’s just good science. You can’t ignore it.”

Function over Form

If you’re reading this magazine, Panico’s efforts to sway the skeptical might seem, well, familiar. Chances are you already know all about yoga’s potential to heal. But maybe you, too, have experienced frustrating resistance from your cranky aching co-worker or incapacitated aunt—people in your life who you know could benefit from yoga but who still think of it as something too fringe or too difficult. This evidence is for them, too: Yoga does work.

Which is not to say that all yoga works for back pain. Before Sherman set up the study, she had to identify a form of yoga that would be accessible to a wide range of people. “It had to be something people could really do; I didn’t want anything overly difficult or esoteric,” she explains. “I also didn’t want any adverse events. I wanted something safe.”

Sherman began interviewing yoga teachers in the Seattle area, looking for the best fit. She found it in Robin Rothenberg, director of The Yoga Barn studios. Rothenberg was knowledgeable, experienced, and intelligent. Better yet, she was teaching a form of yoga that was perfect for the study: Viniyoga.

Yoga for Every Body

A gentle style, Viniyoga emphasizes the breath, simple and repetitive movements, careful sequencing, and the use of yoga as a therapeutic tool. Viniyoga has been popularized in the United States by Gary Kraftsow, whose main teacher was T.K.V. Desikachar, son of the great Indian yogi Krishnamacharya. Kraftsow, in turn, is Rothenberg’s teacher.

“Viniyoga is simple and accessible to everyone,” says Rothenberg, a certified Viniyoga therapist who’s also been a certified Iyengar teacher. “If you can move, if you can breathe, if you can get down on the floor or sit in a chair, you can do Viniyoga. Downward Dog is a complex pose; Triangle is a complex pose. But people can understand bringing their knees into their chests.”

Kraftsow worked with Rothenberg to develop asana sequences, which they based on Kraftsow’s yoga therapy and Rothenberg’s Iyengar background.

“Viniyoga is easy for people who aren’t so yoga oriented and tuned in to their bodies,” Rothenberg says. “During the course of the study, we had people who came to our classes and said they’d never considered doing yoga, but they were in so much pain. They were able to do it, and they got results. They felt better; they slept better. They were able to do things again, like hiking or gardening or playing tennis. They were getting their lives back.”

Exactly why Viniyoga works is a matter of some debate. The study itself did not draw any clear conclusions. Theorizing that the results were due to a combination of mental focus and physical movement, the study simply noted that more research was needed to identify “mechanisms of action.” (Another Sherman-led, NCCAM-funded, Viniyoga-focused study on this subject is currently under way.)

“The protocol Robin and I developed is about adapting the postures to reduce symptoms,” Kraftsow says. “It’s aimed at strengthening what’s weak, balancing what’s asymmetrical, releasing chronic contraction, and building proprioceptive awareness. It is not about mastering the forms of the postures.”

Still, Kraftsow says that caution is needed before one embraces the results of this study wholesale. “Viniyoga is a sophisticated science of sequencing,” says Kraftsow. “The right sequence can heal you; the wrong sequence can make things worse. The medical community should be aware that just because this study is evidence based doesn’t mean that all yoga will be good for back pain. Not even all Viniyoga will be good for back pain. Yoga that is adapted intelligently for the purpose of working with back pain, as our sequence was, will be good for back pain. Other yoga can send you to the hospital.”

In the world of yoga—even therapeutic yoga, unfortunately—it’s caveat emptor. Looking for a teacher whose name is followed by “C.Y.T.” (certified yoga therapist) is a good place to start, Kraftsow suggests. If that’s not possible in your area, look for a gentle form of yoga in which jumping or intense forward bending are not part of the class. Talk to your teachers beforehand to ascertain their level of experience, and make sure that individual needs can be accommodated. And, if possible, take a private lesson before you sign up for a class.

Back Off the Mat

Emily Large, Terri Stoecker’s yoga teacher, has her own theory about how and why yoga works so well. Large, who is a physical therapist and certified Viniyoga therapist practicing in West Palm Beach, Florida, as well as Atlanta, transformed her physical therapy practice when she started adding yoga into the mix. “Yoga provides people with a tool for self-discovery,” she says. “The postures, combined with the breathwork and meditative qualities of the movement, lead to self-awareness in the body. The repetitive movements that are unique in Viniyoga warm the body and increase circulation, which is important in healing. They also break poor movement patterns and introduce healthy ones.”

“Overall,” concludes Large, “it’s a more holistic approach to rehabilitation. It lets people heal themselves. When you learn healthy habits in yoga, it carries over into your daily life.”

Stoecker believes that the techniques she has learned in Large’s class have allowed her to return to her active lifestyle. “You can let your back control you and change your life into something sedentary and painful, or you can find something that can keep you healthy and get you back to 95 percent normal. I was told I would never run or garden again. Now I can do those things. I have to be careful, I have to take care of myself, but I live my life. Yoga has done that for me.”

This assessment makes Kraftsow a very happy man—it is the perfect realization of his intention. “It’s important to remember that the study of yoga is not about anything external to you,” he says. “It’s about studying yourself and learning tools to reduce the undesirable things in your life, like back pain, and increase the positive things, like happiness. It’s about refining yourself at all levels.”

“We’re not talking about fancy yoga or power yoga here,” he adds. “You don’t need an hour-long class or a special outfit or a fancy mat to do this. This practice is available to everybody. You can learn it easily and use it to feel better and really begin to manage your condition.” Try it for yourself.

Watch Your Back Pose Sequence by Gary Kraftsow
Dvipada Pitham (Two-Footed Pose)

Benefits: Warms up the back muscles, stretches the iliopsoas and thighs

Lie on your back with your arms extended along the floor at your sides. Bend your knees and place your feet flat on the floor, comfortably close to your sitting bones. On an inhalation, engage the belly muscles and press through your feet to lift your hips as you unwind your spine off the floor, vertebra by vertebra. On an exhalation, reverse the movement, rolling the spine back down to the floor, vertebra by vertebra. Do 8 times.

Apanasana (Knees-to-Chest Pose, variations)

Benefits: Opens the iliopsoas muscles and stretches the lower back

Lie on your back with the left leg straight and right leg bent, holding on to the right knee with both hands. On an exhalation, draw the navel inward, bend the elbows, and pull the right knee toward the belly. As you inhale, release. Repeat 4 times. Then bend the left knee and extend the right leg, and repeat 4 times.

Next, bend both knees so that you’re holding one knee in each hand. On an exhalation, pull both knees in toward the belly, tucking the chin slightly down and gently pushing the lower back and sacrum toward the floor. On an inhalation, release to the starting position. Repeat 4 times.

Supta Baddha Konasana (Reclining Bound Angle Pose)

Benefits: Strengthens inner thighs and increases circulation to the sacrum

Lie on your back with your knees bent and your feet together and comfortably close to the buttocks. Inhale and open the legs, bringing the soles of the feet together as the knees come apart. On a long, slow exhalation, draw the knees back together as you tighten the belly muscles and push the lower back down.

On an inhalation, open the knees again. This time, take the space of 2 exhalations to close them, pausing halfway up to inhale.

Inhale and open the knees again. Take the space of 3 exhalations to close them, pausing one-third of the way up, and then two-thirds of the way up before returning to the starting position.

Inhale and open the knees again. Finally, close the legs over the course of 4 exhalations, pausing to inhale at one-fourth, one-half, and three-fourths of the way up before returning to the starting position. (Don’t worry if your legs begin to tremble—this is natural.)

Cakravakasana (Ruddy Goose Pose)

Benefits: Helps create a healthy pelvis-lumbar relationship

Come to your hands and knees, with your shoulders positioned directly over the wrists and your hips over the knees. As you inhale, gently pull back with the heels of the hands, lifting the chest away from the navel and stretching the belly. Exhale, moving the hips back toward the heels as you gently pull the navel inward and round the lower back. Bend the elbows, keep the upper back relatively flat, and lower the chest toward the thighs. As you inhale again, come back to the starting position, lifting the head and stretching through the belly. Repeat this sequence 8 times, creating a smooth, flowing movement and breathing evenly throughout.

Bhujangasana (Cobra Pose, variations)

Benefits: Strengthens the muscles that support the sacrum

Lie face-down with the forearms and palms resting on the floor alongside the chest, and turn the head to one side. The legs should be extended, toes pointed, thighs touching yet relaxed. On an inhalation, pull back slightly with the hands, and use the muscles in the lower back to lift your chest off the mat, extending through the sternum as you turn your head to center. Exhale and lower to the starting position, turning the head to the opposite side. Repeat this sequence. Then spread your legs about 4 inches apart on the floor, and repeat the sequence 2 more times. Next, spread the legs 4 more inches apart (to 8 inches) and repeat twice more. Finally, spread the legs 4 more inches apart (to 12 inches) and perform 2 final repetitions. Then return to the starting position and relax. These movements strengthen the gluteal muscles which will help support the sacrum.

Cakravakasana (Ruddy Goose Pose)

Flow through this posture again: Start in a tabletop position and move the hips back to meet the heels. Repeat 8 times.

Jathara Parivrtti (Abdominal Twist, variations)

Benefits: Stretches the lower back and stretches and strengthens the hip abductors

Begin by lying on your back with your knees bent and lifted toward the chest, thighs together. Extend your arms out from the shoulders, palms down. On an exhalation, lower your knees toward the floor to the right, twisting through the abdomen as you turn your head and look to the left. On an inhalation, return the knees and head to center. On the next exhalation, lower the legs to the left as you turn your head to the right. Inhale and return to center. Repeat these movements once more on each side.

Now, on an exhalation, lower the knees to the right and hold the position. Maintaining that relationship of the hips and the bend in the knees, lift the left leg several inches off the right leg on each inhalation, and lower the left leg on each exhalation. Repeat 4 times. Return to the starting position on an inhalation. On an exhalation, lower the knees to the left and do the leg lifts with the right leg. Repeat 4 times. Return to center, place both feet on the floor, and relax.

Supta Padangusthasana (Reclining Hand-to-Big-Toe Pose)

Benefits: Stretches the inner thighs and stabilizes the pelvis

Lie on your back with the knees bent, hands behind them, and elbows slightly bent. As you inhale, extend your legs as much as possible, flex your feet, and reach the heels up toward the ceiling, letting your arms straighten and resting your hands on the front of your legs. As you exhale, press the lower back toward the floor, bend your knees, and pull the legs in toward the belly. Repeat 4 times.

Next, move the hands to the insides of the knees and open the legs as wide as possible on the inhalation. On the exhalation, bring them together while keeping them extended. Repeat 4 times.

Dvipada Pitham (Two-Footed Pose)

Repeat Dvipada Pitham, which you did at the start of the sequence.

Savasana (Corpse Pose)

Benefits: Relaxes the whole body and allows it to integrate the benefits of practice

Lie on your back with your arms resting comfortably at your sides, palms up, and your knees resting over a bolster or pillow so that you feel no pressure in your lower back. You can also rest your legs on a chair, sofa, or bed. Try to find a position in which your body can rest deeply, so that it absorbs and integrates the effects of your yoga practice. Let yourself go into a state of total relaxation for at least 5 minutes. Slowly roll to one side to come out of the posture, and rest for a minute before moving on with your day.