Back pain is one of the most common medical problems, affecting 8 out of 10 people, according to the National Institutes of Health. The good news? Yoga-based therapeutics are affordable and accessible ways to alleviate and prevent back pain—acute or chronic—by improving the quality of your movements and by helping the left, right, front, and back sides of your body work together in a balanced way, on and off the mat.
First, it’s critical to understand good posture and put it to use; poor posture often leads to back pain. You can figure out if your vertebral column and pelvis are neutral—critical to good posture—by using several benchmarks. To learn, let’s look at Tadasana (Mountain Pose).
- The vertebral column is most stable when aligned in its normal curves. Generally speaking, and in relation to the front of the body, the neck and low back display concave curves (lordosis), while the upper and middle back together display a convex curve (kyphosis), as does the sacrum.
- The sacrum is a curved, bumpy bone that angles in toward the body at about 30 degrees, beginning at L5/S1; it does not point straight down.
- The pelvic rim, or iliac crest, which marks the top of the pelvis, is fairly level.
- The plumb line runs from the center of the ear opening (external auditory meatus), through the shoulder, outer hip (greater trochanter), outer knee, and outer ankle (lateral malleolus).
- The cavities (“open” spaces) of your pelvis, belly, chest, and head feel balanced in relation to each other.
See also Anatomy of the Spine
Once you understand proper posture, consider two key questions during asana practice: Does a body part need space? Does a body part need support? It could need both. Begin by creating space: Reduce the size of a movement or pose. For example, someone who habitually sits with a flattened or rounded back often experiences pain in back extensions. That means simply standing with normal curves might feel like a backbend; thus, Tadasana is the first backbending pose for them. Sometimes creating support helps: Instead of practicing Setu Bandha Sarvangasana (Bridge Pose) with the pelvis lifted, do it with a folded blanket supporting the bottom of the shoulder blades to the hips.
Bear in mind that seated asana are more likely to cause back injuries than standing, supine, or prone asana, if your posture is poor or you’re unable to engage the muscles of your legs and buttocks. Avoid them entirely if you have low back pain or disc injuries, and instead do other poses that achieve similar ends. For example, to stretch the hamstrings, practice Supta Padangusthasana (Reclining Hand-to-Big-Toe Pose) instead of Paschimottanasana (Seated Forward Bend). If you have a disc injury or sacroiliac joint dysfunction, avoid forward folds and twists, especially seated twists. It’s much safer to adapt twists to standing. Marichyasana (Pose Dedicated to the Sage Marichi) can be practiced with a chair at the wall, for instance. If you practice seated twists, you must allow your pelvis to move in order to maintain the form and force closure of the sacroiliac joints and to spread compression more evenly through the intervertebral discs. Bharadvajasana can be a safe seated twist, as long as the pelvis is not anchored to the floor. Gentle, small-range back extensions may help reduce disc-related pain and dysfunction. Salabhasana (Locust Pose) can be useful for developing strength in the back body and reducing load in the low back. It can be practiced with asymmetry to reduce strain and gradually build strength.
Ride the wave
Intervertebral discs and articulating facet joints, shown left (in teal) separate each moveable spinal segment of the vertebral column (except C1/C2). The discs create space between the vertebral bodies, allowing range of motion. The facet joints are bony connections between each vertebral body that guide direction of movement. They become more vertically oriented as you travel down the vertebral column. Generally, the more vertically oriented the facet joint is, the less range of motion you have in side-bending and rotation. Facet joints have a specific orientation in each region of the vertebral column:
Cervical: Almost horizontal. This orientation allows for a high degree of mobility, which is why the neck is capable of flexion, extension, side-bending, and rotation—as independent and coupled movements.
Thoracic: Almost vertical. This orientation allows for a high degree of rotation (limited by the rib cage), as well as flexion and some extension.
Lumbar: Vertical. This orientation allows for a high degree of flexion and extension, with limited side-bending and rotation.
Neighboring upper and lower facet joints differ in orientation at the spine’s three transitional segments, creating greater directional movement capability—and more potential for injury: C7/T1, T12/L1, L5/S1.
Dialogue between yoga teachers and students helps prevent back injuries.
Students: If you have been diagnosed with bulging or herniated discs, or experience radiating pain, numbness, tingling, or chronic muscle tightness, tell your yoga teacher before class. It is helpful to know the segmental level of an injury; for example, a bulging disc at L5/S1. Symptoms of numbness and tingling are of particular concern because they can indicate nerve damage that may affect function. Also share how long you’ve experienced symptoms and when you were evaluated by a licensed health care provider. If you do not have a diagnosis, please visit your doctor before you begin any yoga classes, especially if your pain is acute or has lasted longer than three months. Keep in mind that yoga teachers are not licensed health care providers. And health care workers who teach yoga abide by the ethical and professional boundaries created by their scope of practice, and do not diagnose on the mat.
Teachers: If a student says they feel pain, numbness, or tingling, take them at their word. If you don’t know how to proceed, teach what you know with an explicit invitation to opt out, or refer the student to a more experienced instructor with expertise in asana-based therapeutics (and continue to study anatomy, kinesiology, and asana-based therapeutics; education is empowering, so nerd it up!).
About our Expert
Mary Richards has been practicing yoga for almost 30 years and travels around the country teaching anatomy, physiology, and kinesiology. Mary, a hard-core movement nerd and former NCAA athlete, has a master’s degree in yoga therapy. Learn more at maryrichardsyoga.com.