Yoga Based Programme for Back Injury Prevention and Rehabilitation of Chronic Backache:
The following illustrates some postures taught in a session and gives the reasons for doing them. The theme here emphasizes work pertinent to preventing and rehabilitating chronic backache. The text is aimed at yoga practitioners and teachers with basic knowledge of the postures and access to the pertinent literature. Postures are presented in a sequence congruent with a yoga practice session. Grades of difficulty are offered and should be attempted within pain free range of movement and strength. It is intended to indicate appropriate postures and exercises without offering full descriptions that are available in the indicated texts.
Disclaimer: Do not practice these postures without having been to a session. Do not do exercise or postures without seeking advice from your doctor especially if you have been unwell. The author cannot be responsible for consequences of doing these postures or exercises if done without his direct supervision.
Tadasana (above) is the basic posture from which all standing postures begin and return to. It should achieve correct standing lordosis that is carried into the appropriate movements of other standing postures.
Yoga ‘Standing Postures’ starting in Tadasana requiring correct lordotic positioning that is taken into an intermediate stage whereby the legs and arms are abducted and the feet and legs rotated in preparation for a variety of final positions.
One of the salient features of the Iyengar method of yoga is its use of props to enable postures to be performed with due accuracy and alignment without risk of injury by those whose restrictions or strength may be restricted. The alternative versions illustrated are more suitable if there are serious limitations in flexibility and illustrate how props may be used in remedial work. Modification is reduced as range of movement and strength are developed or recovered.
The triangle posture develops range of movement in the hip joint. The pelvic girdle is tilted laterally resulting in a rotation of the hip socket over the head of the femur. The spinal muscles are strengthened by the work needed to maintain the positioning of the trunk.
In the reverse version of the triangle pose (Parivritta Trikonasana) spinal alignment facilitates rotation around a straight axis from occiput process to coccyx. This enables the trunk to be rotated without inducing uneven pressure on the intervertebral discs. Forward flexion from the hips rather than the spine also keeps an even pressure on the discs. The combination of forward flexion of the spine combined with rotation is particularly precarious for the lower back and puts pressure towards the posterial-lateral aspect which is the most vulnerable area to disc protrusion. Hip flexibility and alignment are therefore essential to perform this Reverse Triangle posture safely.
The spine, including the correct lordosis, maintains its original relative position to the hips as much as possible. In the Standing postures all postural muscles, including those of the back and the abdomen, are strongly involved in the control of the pose. Support of the trunk by the hand on a prop enable the posture to be done with less demand on the back if necessary in earlier stages of remedial work. The posture promotes flexibility of the hip joints. Variations of this position include abducting the legs further to increase the stretch on the abductors whilst bending the right (front) leg and including rotational and balancing movements.
Parsvakonasana (Side Flank Stretch) facilitates greater stretch for the hip adductors whilst developing lateral side flexion in the hips.
The same qualities apply to the reverse version of the posture but with trunk rotation added.
Many postures involve balance and therefore develop proprioception and core stability as postural muscles of the back and abdomen are strongly engaged to maintain balance. Developing postural muscles of the trunk is key to protecting and rehabilitating the back as the muscles form a corset that protects the other soft tissue structures around the spine. The simplest balance pose is Vrksasana (the Tree) can be done with the back to a wall if necessary to maintain balance whilst maintaining the correct lordotic curve.
Lateral hip flexion and abduction ,strengthening of front thighs, stretching of hamstrings and the development of proprioceptive skills are achieved in Ardha Chandrasana (Half Moon Pose). The posture may be supported by a prop to maintain suitable spinal alignment and avoid hip strain.
virabhadrasana III (Warrior posture III) is more demanding but can be used in the late stage of rehabilitation. It develops strength in the back extensors of the raised leg and the spinal muscles to hold the trunk in place as well as demanding excellent proprioception.
Aerobic conditioning in yoga can be achieved by performing Sun Salutations or a sequence of postures performed with dynamic movement. Accuracy is important and a problem back should be supported by placing the hands on the thighs when raising or lowering the trunk. Postures may be walked into rather than jumped into to reduce jolting of the spine. The speed and duration of Sun Salutations may be reduced to accommodate beck rehabilitation but this may diminish the aerobic quality.
Variations may be incorporated into the sequence but a suitable example starts from Tadasana, raising the arms and flexing the knees into ukatasana, taking the trunk to the legs in uttanasana which may be done with bent legs with the trunk supported by the legs if the back is a problem, followed by chaturanga dandasana which develops strength in the arms, shoulders and abdominal mscles, Uhdva Mukka Svanasana (dog head up) or elbow dog (a compromise version of dog head up that trains the back in back extension postures whilst facilitating easier control of the lumbar spine), dog head down, which brings flexibility to the joints of the shoulder girdle, movement into virabhadrasana I which brings flexibility to the hip joint and strength to the back muscles, back thorough chaturanga dandasana, elbow dog and dog head down before jumping through to ukatasana and the final standing position. This sequence may be practiced several times per session and may incorporate other postures.
Ukatasana Uttanasana Chaturanga Dandasana ‘Elbow dog’
Uhdva Mukka Svanasana (dog head up) Arhdo Mukka Svanasana (Dog head Down)
Control of the hips to maintain a healthy lordotic curve is more demanding in Warrior I (Virabhadrasana I). The position of the hips should be maintained through to the final position so the posture is valuable in training control of the hips and maintaining good lordosis. It also stretches the illiopsoas muscles of the back leg in the posture and the buttock muscles of the front leg in the posture.
Raising the arms above shoulder level can induce excessive lordosis and aggravate backache especially if there is restricted range of movement in the shoulders. Rehabilitation therefore needs to include training for shoulder flexibility. Most postures include an element of flexibility training for the upper limb but shoulder abduction and flexion need to be done whilst maintaining correct standing or sitting lordosis as appropriate. The final position should retain a similar lordosis and other spinal curves achieved in Tadasana or a good standing position.
The lordotic curve need to be maintained in the inverted balancing postures headstand, shoulder-stand and full-arm balance.
The lordosis should be maintained in sitting postures although it is flatter as the hips are in flexion but can be maintained for example when rotating the trunk in an upright position.
Forward flexion can be done with varying degrees of intensity by using props for support (below) and eliminating the pull of the hamstrings by maintaining bent legs (below, cente).
Yoga postures demand a lot of work from the back muscles and weak areas of the back subject to repetitive movement are prone to over-use injury. Back rehabilitation should include strength and endurance training of muscles providing core stability. These are postural muscles of the back and abdomen providing a ‘corset’ to protect soft tissues around the spine. They are developed functionally when balancing as in Virabhadrasana 3 and Ardha Chandrasana amd can be strengthened either isotonically by abdominal crunches and dorsal raises either held isometrically or with controlled rhythmic concentric and eccentric movement.
Oblique abdominal muscles can be worked by rotating the trunk to the side on lifting. Repetitions to relative exhaustion for each exercise performed three times per week should be sufficient to develop endurance. The deeper transverse abdominal muscles can be strengthened by holding in the abdominal region as though pulling the navel towards the spine and corresponds to the yoga practice of uddiyana bhanda. Pelvic floor muscles whose strength also contributes to back health will be strengthened by practicing mula bandha which basically is pulling the perinium upwards towards the body.
Setubanda Sarvangasana (below left) with back support extends the back in a similar manner to Elbow Dog and is useful in rehabilitating disc conditions. The posture may be modified necessary by reducing the height of the support under the low back or providing support under the heels to raise the legs and reduce the extension of the back.
Back pain resulting from conditions affecting the facet joints of the spine may benefit from forward flexion such as Malasana placing the facet joints in an open packed position.
Lordosis will obviously be lost when flexing the spine. Forward flexion in most postures requires full flexion of the hips so the spine is flexed only moderately. The lordotic curve, standing or sitting as appropriate, should be maintained during initial hip flexion when appropriate to the posture is added towards the end of the movement. The erector spinae are passive during spinal flexion so a rehabilitating back needs support on return from flexion such as placing the hands on the floor or legs to help raise the trunk.
Forward flexion can be done with varying degrees of intensity by using props for support (below) and eliminating the pull of the hamstrings by maintaining bent legs.
Savasana should always be performed for five or ten minutes at the end of a yoga session This is a relaxtion posture that is useful train the mind to be quiet whilst enhancing postural awareness – an aim common to all yoga practices. It should reduce muscle tension that may contribute to back pain. It. When rehabilitating the back the least strenuous position is with knees bent and raised so the lower back is flat on the floor. This will naturally eliminate the lordosis which should remain in place if the relaxation posture is done with the legs straight and placed on the floor.