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.
- 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.
“Low Back Disorders”, 2nd edition, and “”Ultimate Back Fitness and Performance” by Dr Stuart McGill
“Light On Yoga” by BKS Iyengar.