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.
Reverse Triangle
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.
l 
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.
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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.
Pascimottanasana
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.
