Are Yoga classes bad for your back?

Thank you for posting “Breaking 3 Common Myths About Back Pain”. Since coming across McGill’s research I’ve started questioning every pose I do and it makes my regular yoga classes quite tricky. Yoga Journal seems to be ignoring his research which is a great shame as I’d like to see responses from the yoga teaching community! Have you modified the postures you teach to remove the poses that threaten the back and what do you exclude/include? – Rosh

Thanks Rosh, these are great questions.

I don’t think that many of the poses that have been around for a long time do threaten a healthy back, or necessarily even one with a disc injury, if practised and taught with care and skill, and sequenced intelligently.

There is guidance on these issues from the great teachers if we look for it. In “Light on Yoga”, BKS Iyengar says that in the full standing forward bend Uttanasana, “slipped (sic) spinal discs can only be adjusted in the concave back position…” In other words, instead of taking the head down into a forward bend, the practitioner looks ahead, extending the spine instead of allowing it to flex. While having had great success relieving disc injury symptoms with this form of Uttanasana, he wisely cautions against trying this without the guidance of a master, as it is very difficult to attain the concave back position in Uttanasana without careful training. He also cautions against bringing the head down at all in this asana if you have a disc injury (although I’ve certainly come across Iyengar-style teachers who are unaware of this and believe that bringing the head down into the forward bend will be good for all lower backs).

Despite these teachings, many teachers simply assume that lower back pain is always due to stiffness, and that “stretching” it will help. I have a lumbar disc that bulged in my early twenties and I’ve been along to classes where the first few poses were all quite strong forward bends. Even trying to good-naturedly to go along with the teacher by bending my knees in these asana would still result in quite a lot of pain later. This is mainly because I need to mindfully and slowly lengthen and extend (back-bend) and then lengthen my spine again before I can do full forward bends, especially in the first few hours of the day when the discs are more fully hydrated. I have learned to “do my own thing” in a class if I believe the sequence is not appropriate for my body, and to even do my own mini-yoga practice to prepare my back immediately before a class with some teachers.

Even for those without disc injuries, I’m not sure that an evening class beginning with forward bends is a good idea considering the amount of students who are sitting at work all day with their back already in flexion and with tightening hip flexors. The Yoga asanas were evolved mainly by people who did not sit at a computer all day. A Yoga practice should help provide balance, so for our culture and our times we need to choose appropriately and with good sequencing. If you sit at a desk all day, choose poses that lengthen and extend (back-bend) the spine. You would also need more hip flexor openers than most classes provide. However, if you spend your day with your back in an upright and occasionally extended position, (rare unless you paint ceilings for a living), then you’re going to benefit more from lots of forward bends.

Many of the poses given in Yoga classes to provide “core strength”, and especially those with no scientific support (of which McGill is rightly critical), are poses that have been absorbed into the body of known asana over time from many sources, including physiotherapists, teachers picking up things from exercise classes, and even British weightlifting culture earlier last century. This isn’t necessarily a bad thing; I believe that Yoga can be an organic, living breathing practice that grows and changes with the culture it is imbedded in. However, when we add in poses or practices that we learn from other teachers I think we need to question them, use them mindfully with good sequencing principles, and ask ourselves if they are providing balance and quieting the mind (and if not then why are we adopting them?).

So to answer your question Rosh, I’ll modify a pose when needed and this varies for everyone. If students don’t yet have enough hip and shoulder flexibility to safely do a sitting forward bend, I’ll get them to work on their hip flexibility first and bend the knees while sitting on the floor before they even think about forward-bending. For some, just sitting on a high enough stack of folded blankets works, but for others it may be more appropriate to sit up straight while others practise the forward bend, although this sometimes involves a real struggle with the student’s ego. It’s often hard to convince people that they need to practise for hip mobility and lengthen the hamstrings daily before they can expect to do Paschimottanasana safely (a full sitting forward bend, with legs straight out in front). I also encourage students to bend their knees in forward bends to allow their spines to lengthen more easily. Many teachers will disagree with this but I haven’t yet found the spot in the Sutras where it says you must be able to keep your legs straight in Paschimottanasana in order to become enlightened.

I’m very careful with sequencing. Most of my classes start with simple arm raises done lying on the back on the floor, just to make sure that all those office workers lengthen out before we start to move the spine in other ways. Before back-bending we lengthen the hip flexors, and before forward-bending we mobilise the hips and lengthen the hamstrings. McGill recommends that if we’re going to lengthen the hamstrings, we should do so uni-laterally, and we have the perfect pose in the asana vocabulary: Supta Padangusthasana, lying down and lengthening one leg up at a time with the assistance of a strap to push the foot up into (my students will also recognise this as a regular warm-up pose).

I never do double leg raises. Nor do I teach exercise style sit ups. (I suspect that leg raises and sit-ups are 20th Century, Western-influenced additions to the asana repertoire anyway). We do practise cat balances and pelvic tilting, which are based on good research, and for stronger students, traditional asana like Plank and Vashisthasana (side plank) are a very effective and safe way to build strength and protect the lower back from injury. One thing I would never do with a disc injury is a strong forward bend with a twist, like the Prasaritta Padottonasana (wide-legged standing forward bend) with a twist to the torso from the lumbar that I’ve seen some teachers adopt. (Again, I have doubts about this being a traditional and well-tested version of the asana anyway, but I’m happy to be corrected). If a student has a laterally bulged disc, then some lateral movements may be inappropriate. It helps if students come to class with some knowledge of their own bodies and postural history, and more importantly, a willingness to not always do every asana in the same way as everyone else.

It would be a shame if we became afraid of the asanas. Even with my past lumbar disc injury I can almost always do Uttanasana (standing full forward-bend) very safely and with no repercussions in my own practice because I carefully practice to maintain good hip flexibility, and because I’ve learned how to move into the pose from the hips without rounding my lower back until my upper body is inverted. I also make sure I’ve lengthened and when necessary, extended (back-bended) my spine first and I practise with as much sensitivity as possible to any sensations of nerve compression. Personally, I love the benefits I receive from the pose too much to give it up completely: the nourishing of the brain, heart and lungs, and the benefits to the nervous system…the way it quietens down a busy mind. I’ve found that even Sun Salutations can be practised safely, as there are opportunities in the sequence to carefully lengthen and neutralise the spine before swapping between flexion and extension. It takes time and patience, and depends on the day, or on previous activities, but I find it’s well worth it.

Yoga asana can be of so much benefit to anyone with a back injury, given a teacher who is willing to do some research; to not just follow blindly what have become conventional approaches due to popularity, rather than carefully researched and practised knowledge, as offered by the masters. Given enough time and practice, a practitioner with a disc injury can even become sensitive to minute amounts of pressure on a spinal nerve, and know when it’s a good time to practice a forward bend or when it’s necessary to do a back bend to relieve that pressure. This practised, relaxed mindfulness becomes a great help during every day activities for someone with a back injury and then Yoga practice flows into every aspect of life, as it was meant to do.

Unfortunately we are running the risk of compromising the reputation of Yoga and its incredible benefits if we continue to put students with back injuries at risk. I’ve lost count of the number of times I’ve heard a story about a Yoga class that made a condition worse, or heard a teacher give the dangerous universal response to all lower back pain: “just lie on your back and hug your knees to your chest”. Having said that, as a teacher what I struggle with most is getting people to slow down, understand the mechanics of their body, and spend time regularly practising for basic hip and shoulder mobility before going into certain asana. For some unknown reason, people just seem desperate to touch those elusive toes.

When someone has been suffering from a back injury, I much prefer to work with them individually than in a class, so that the practice can be tailored to the person and achieve the well-being that Yoga is meant to bring.

Join the Healthy Happy Back tribe here  or come and visit me at alisoneastland.com for more information and free Yoga resources for relief from back pain, with a welcome pack that includes :

  • 10 Tips for a Resilient Pain Free Back E-Booklet
  • 3 Restorative Yoga Poses for Back Pain Relief
  • a Breath Mindfulness audio recording, an audio guide to standing with grace & ease in good posture
  • short videos of 2 releasing poses that are essential for a healthier, happier back 

Check out my  Healthy Happy Back E-Course for manageable step-by step techniques that you can choose from and slowly incorporate into your daily life. It’s completely suitable for beginners and anyone willing to slow down and take a gentle, easeful approach to rediscovering a healthier, happier back.

References/Resources:

“Low Back Disorders”, 2nd edition, and  “”Ultimate Back Fitness and Performance” by Dr Stuart McGill

“Light On Yoga” by BKS Iyengar.

14 replies

  1. As usual a very thorough exploration of answers to a very big question Ali-chan. Well Done!

    As you have addressed it seems that backs are not the problem here but egos. That is, the ego of a teacher that would force a student (or even encourage them), to do something unsuitable and secondly, the ego of the student with the injury. It is a form of violence and also ignorance that enables these actions to take place.

    You incorporate the practice and acknowledgement of the yamas and niyamas into your classes so well. This is essential, especially when it comes to the two previously mentioned hurdles (violence and ignorance). To be addressed effectively, ahimsa (non-violence) and swadhyaya (study of the self) really need consistent attention and application.

    Practical tips are necessary and that is what you also offer Ali-chan. You are one of the most well versed and practiced on the topic of back-care. I do feel (as Im pretty sure you do to) that what really is at the heart of it is the relationship the person has with not only their respective injuries but themselves as a whole. So when the pressure is on in a class and everyone is doing pacshimottanasana, while the teacher explains how straight legs produce the best ‘results’, is that person with a disc injury strong enough to resist that instruction and likewise tuned in enough to know that that is a compromising position for them. Therefore, we arrive once again at the ultimate aim of a yoga practice; increased clarity and depth of awareness.

    Toe touching is so much easier to teach than awareness. Toe touching has visible results, it a mission accomplished type of feel. Whereas the illusive goal of awareness is not quite so visible. Perhaps that really is where yoga teachers (and magazines) need to continually step up to the plate and continue promoting awareness.

    Yes Rosh, I commend you too for your questions and once again, Ali, for your contribution and perspective on the matter. Deep respect to you both.

    Abby

    • Thanks Abby for your well-considered comment…which leads me to more questions!
      When a student has a disc injury (and they’re more common than is generally thought), can we rely on building their awareness given that:
      1) a back that is over-used to flexion (one of the common pre-cursors to a disc injury) will feel much more comfortable in flexion than anything else, and
      2) there may not be even the slightest murmur in their lower back until they’re already half way into a forward bend, at which point the disc compresses the nerve and they’d be in excruciating pain without having had any warning half a second before?
      Should we ask students who have experienced lower back pain to find out the exact cause before they come to class? So many come to class thinking that starting Yoga will fix lower back pain. But consider this scenario:
      A student comes in who has Spondylolisthesis. Hugging their knees in could be a great idea because it would encourage the upper vertebrae to move backward over the lower ones. They’d probably need to avoid arching their lower back. However, the next student who comes in has a lumbar disc injury, and as much as they’re probably going to love hugging their knees in (because the pain receptors in their lower back get a nice stretch and feel great) they’d be wondering why they’re in agony much later on. And they would need to start getting some gentle extention happening in their lower spine even though that may feel very uncomfortable and even “wrong” for a while.
      So what do you do when someone comes in and says they have lower back pain but they don’t know why, and they hope Yoga will “fix” it?
      Sometimes I wonder if everyone should have an individual session before they join a class. How do we practise and teach Ahimsa when we can’t rely on body awareness?

  2. GREAT ARICLE ALI!!!!!!!

    Wow, you’ve really sunk your teeth into the marriage of scientific back care principles and yoga. I’m really impressed and super proud of you for the way you approach this stuff. Hopefully more teachers, instructors and coaches from other arts, modalities and sports will embrace such a measured, objective and passionate approach to the wellbeing students. To this day when people ask me about whether yoga can be good for their back I tell them about how well structured your classes are and how you were so quick to embrace objective research way back during that course I conducted those years back .

    Great work Ali, your students are lucky to have you watching over them.

    Matt Jones
    Founder & Head Coach
    ISOHEALTH
    http://www.isohealth.com.au

  3. In the US yoga studios/teachers never mention the limitations of an asana for anyone and back-related yoga injuries are on the rise. Swami Satyananda and Satyananda Yoga was well ahead of its time in cautioning and using asanas in therapeutic ways–see “Asana Pranayama Mudra Bandha”. (See review on http://www.mahasriyoga.com/bookreviews) Perhaps this blog post “What Really Works for Back Pain” may be of some help http://yogamedblog.wordpress.com/2011/07/21/what-really-works-for-back-pain/. I am going to read McGill’s book!

  4. Reading your post again, it is clear that you are a very thoughtful and curious teacher. This is rare in my 30 years of the yoga world. A teacher willing to spend time doing research (or having the time to do it) is so necessary for the teacher’s growth as well as the student’s benefit. I hope your students appreciate this! In the past when I taught 120-150 a week, many would leave when cautioned about various positions because they said that no other teacher had done this. Why should they believe me and not them? This is not a complain but an observation and an understandable confusion. If you have hyperacidity, GERD, heart problmes, high myopia/retinal issues, to me it is common sense not to practice deep inversions particularly head stands and hand stands. Someone does not have to say this to make sense. Retinologists ask their patients if they are doing yoga inversions and holding them as they see so many yoga related injuries to the retina. More yoga teachers need to be observe their bodies and their students, be curious and educate themselves.

    • Thank you for visiting and for your comments MM. Your site, http://www.yogamedblog.wordpress.com is a wonderful resource.
      I’m not sure how to reach people better with the principles of non-violence, non-grasping and non-competitiveness before they even get into the asanas. As much as I try with new people to explain that these principles come first, it’s just not easy to change culturally embedded approaches and I find that many people automatically strive to do every pose on offer, even if it is not right for them individually. I think it’s to your credit as a teacher that you do continue to caution people if an asana is not right for them, and continue to foster the principle of ahimsa, even if it means we have less participants sometimes. Sometimes I think we can only help to plant a seed of awareness, or a new idea, even if we can’t continue working with someone we’d really like to offer the practice to.

      • Dear Alison,

        For some reason, I am just seeing this reply of yours! Thank you. I have really stopped teaching now for the most part, except for a couple of senior classes. A few friends still want to come as they now do not find a good fit anywhere for yoga. More time is spent on my own simple asana practice and meditation. There will be a special in July, Yoga: A Journey Within, to raise funds for malnourished children in India.

        It is really wonderful now to just see a few people every now and then and spend time on the blog and the website http://www.mahasriyoga.com. As the site is not associated with any particular teacher, center, ideology, there is complete freedom to look at everything objectively, without attachment. As yoga is becoming more standardized, franchised, much more commercial (not a judgement), it is helpful for people to have an alternate or additional resource that is free. They can take it or leave it, as they choose. There are 20 free audio tracks on beginning pranayama and meditation (some Yoga Nidras based on Satyananda teachings but my own interpretations) and we are doing some in Gujarati, an Indian language. The book reviews are objective and there is total freedom to say what I want to say–it is hard to find a real book review on yoga and meditation here. They are summaries, almost blurbs from the back cover of the book. No one dares to really review a book in the yoga and meditation world! I don’t do too many as it can take a couple of months sometimes for one book between the reading, researching, reflecting. Many books are not worth reviewing as I don’t want to spend that time on books that truly are of no interest or value to me or potentially to readers. So all this is very engaging and takes up a good chunk of the day.

        Some of the therapists I have spoken to have said the same as you heard–lots of yoga injuries and the people go right back to doing the same things again! This used to bother me but now it does not. People make their choices and it is up to them.I do firmly hold back a couple of seniors when they want to overdo it and those with whom I have a long-standing, comfortable relationship.

        It helps that I have no interest in whether they accept my way or not, I am not marketing myself, or have to grow a yoga business. My former students see that very clearly now that they have been trying to find a new “yoga home” and see the huge difference in teaching for the love of it and teaching to fill classes till they are overflowing. For me, yoga has never been a way of making a living and that gives tremendous freedom, it is something one does like passing on the baton. If my own ego gets caught up, then it is a problem. But if it does not, then all the other stuff becomes irrelevant. People have to figure out themselves what yoga means to them personally and my meaning is mine, not theirs, not anyone else’s. This took me a long time to figure out! It must be one’s own epiphany to be meaningful. There is no judgement. It sounds like your own approach is very dedicated, thoughtful, respectful.

        Life is yoga and the asana part is just a small part that uses physical movement to illustrate and experience the still space from which the breath, the movement, the thought, the body manifest and dissolve.

        I read passages, poems, and stories from Eckhart Tolle, Krishnamurti, Thich Nhat Hanh, Rumi, Hafiz, Attar, etc. to seniors and participants at the beginning of class. Often, not always, a class serves to illustrate a passage or poem–the theory and the practice. It helps them and it helps me see through in-grained conditioning. We have a wonderful, close-knit group and do not see myself as a “teacher” but see it as a group of like-minded people together finding our way to understanding our minds and the stillness of being. But this takes a great deal of time, research, thought, practice for one class! It will probably never appeal to large numbers and never has–you can read this in Milarepa’s story, what Sw Vivekananda and Nisargadatta Maharaja had to say. I am sure it would make me quite uncomfortable if larger numbers turned up and would want to leave for some solitude–too much attention!

        To some extent at a personal level, the thing is it does not matter what anyone else gets or does not get, as long as you get it. Does that make sense? At another social level, it is sad to see people, families, communities in this self-destructive, painful, violent way of life that affects all of us. But I do believe that slowly and steadily the seeds of peace, of self-awareness are taking root and growing globally.

        Keep in touch!

  5. So happy to see this dialogue. I have been sharing this message for years and chastised by yoga teachers for using scare tactics. mcGill is my go to and the foundation. Of my workshop anatomywithclay.com forbackhealth. More and more teachers are catching on and gravitating toward my message yet there are still those resistant to change. Thank you and so happy to have founded this.

  6. hi
    u have answered lot of doubts in my mind. I have been facing same issues and yoga was not helping and rather it made it worse. Now i am have been trying to practise on my own. Do u have a guide or book or video which can help people with herniated disc?
    thanks

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