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Ease on Back

Make sure your yoga practice is helping, not hurting, your back.

By Julie Gudmestad

A young woman sat uncomfortably in my physical therapy office, her face drawn with pain. "I had heard stretching would help my lower back pain," she said. "But after a few weeks of daily stretching, my pain only got worse. What did I do wrong?"

With further questioning, her whole story came out. She had experienced intermittent lower back pain for two years before starting the stretching program she remembered from a P.E. class—a sequence consisting primarily of various leg stretches performed sitting on the floor, bending over her legs, and reaching for her toes. When the back pain became worse and was further complicated by severe hip and leg pain, she consulted her physician, who diagnosed her problem as a bulging disc in her lumbar spine.

As a physical therapist, I have heard this unfortunate story many times. Sitting forward bends are probably the best-known leg stretches, and are therefore likely to be included in a beginning stretch routine, whether in a public yoga or aerobics class, or in a book or video. Surprisingly, there seems to be widespread misunderstanding about the role of stretching in the care of back problems. And the irony is that certain types of stretching can actually worsen some back problems.

A yoga practice with too much emphasis on aggressive forward bending can be risky, particularly if the student has tight hamstrings and a flattened curve in the lower back. A well-constructed yoga routine, however, can be an ideal way to learn to stretch without creating or exacerbating back pain, and a chance to practice good alignment and movement patterns which help protect the back from injury.

Under Pressure
To understand how stretching can improve or aggravate disc problems, let's look at how a disc works and how it gets damaged. Intervertebral discs function as shock absorbers, cushioning the brain from jarring as we walk, run, and jump. Each disc consists of two parts: the inner disc, the nucleus pulposus, made of a shock-absorbing gel-like substance, and the annulus fibrosis, the rings of ligament that surround and support the center.

A normal lumbar spine has a mild curve forward, and in this position, weight is evenly distributed throughout each disc. During toe-touching, the lower back flexes, losing its normal curve, and more weight is put on the front of the discs. The gel-like centers get pushed backward, into the now stretching support ligaments. While this can happen during forward bending even if a person tends to have excessive lumbar curve ("swayback"), it is especially problematic if the spine has lost the normal curve and become flattened.

With repetition, or if great force is applied as in heavy lifting, the ligaments weaken and may "bulge" like a bubble in the wall of a tire. Or the ligaments may tear, allowing the gel-like inner disc to leak out, resulting in a herniated disc. The bulging or herniated disc may cause lower back pain or, if it is pressing on an adjacent nerve, pain can be referred into the hip and leg. 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.

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Reader Comments

maryann

this article really spells it out for me - I have been practicing yoga for over 10 years and recently developed a herniated disk - after reading this article I realize what happened - I was in an advanced class doing forward bends and twists - I usually have a little lower back pain after classes which goes away by the next day - not this time - the pain remained and became increasingly worse and by the 3rd day I had to see a doctor - serious herniated disk L3 L5 and thankfully cortisone gave me the ultimate relief. I had no idea that I could have caused this damage, particularly because I feel so good doing yoga - and practice several times a week - It seems that instructors should be more forthcoming w/this information - I will pass this article on as the information is invaluable. Thank you!

John

I had Lumbar spinal stennosis with superimposed extruded disc herniaton right L3-4 and right L4-5 with a right foot drop. I had microsurgical decompression surgery, 5 years ago. I have been working with a yoga therapist for 4 years whose knowledge and skill have helped my recovery enormously. I can't emphasize enough the importance of a skilled instructor when trying to recover from spinal surgery or to reduce the continuous back pain that comes from just normal activities, let alone the more strenuous ones. I found that trying to go it alone can create more problems than it solves.

Tamanna

I have L4-L5 prolapse which was dormant for 6years but just came back while i bent down to pick up my baby's toys. In these 6yrs i had started all exercises..aerobics,weight training and yoga. What should I do now and how? Am very keen to resume my exercise and yoga regime..please help and guide me...Thanks

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