Yoga for a Healthy Lower Back (2 page)

Y
OUR SPINE IS ONE OF THE
most physically important and symbolically powerful areas in your body. It is, after all, the column of support that holds you upright, enables you to stand tall, and connects your mind to your body.

Your lower back looms just as large, as the point from which you are rooted to the earth and stretch up toward the sky. Your lower back unites the two halves of your body; without it, you literally could not stand on your own two feet.

But let's face it—in modern American life, we hardly treat this complex, miraculous area with the respect it deserves. Ours is a culture of sitting for hours at a time, collapsing onto the couch at the end of a hard day, and accepting stress as both emotional and physical facts of daily life. Many of us work too hard, worry too much, and can barely find the time to visit our doctors to collect a diagnosis of “you work too hard and worry too much.” Is it any wonder that lower back pain is an epidemic in America, the
lower back acting like a beleaguered tagalong in the body rather than an open, flowing source of energy and activity?

I—for simplicity's sake, as coauthors we decided to use the first-person pronoun to represent Liz's voice throughout this book—believe the lower back is the most neglected area of the contemporary American body. But I also believe—and have seen during more than twenty years of teaching—that yoga is a healing path that can help relieve chronic lower back pain and build and sustain consistent lower back health.

This book is meant to meet you wherever you are in your journey toward health. If you have never practiced yoga before, you will find clear and accessible instruction to get you started. If you are an experienced yoga student but are wrestling with a lower back issue, you will find ways to bring what you know about yoga to fruition in your lower back . . . and progress into an even fuller, deeper practice.

Most of all, this book is meant to be an open dialogue with your body and what it's trying to tell you about what will help it heal.

J
UST THE
F
ACTS:
Y
OUR
B
ACK
B
ODY

Reviewing some basic facts about your back and how it works (or how it can work) is the first step on your journey. Being educated about your basic anatomy is immensely helpful, both in identifying the sources and locations of your pain and in choosing poses and movements that bring relief and comfort to those areas.
¹

Your spine is divided into four main sections, each of which has a healthy, natural curvature (
illustration 1
). From top to bottom, they are:

•  
Cervical spine
—these seven vertebrae are at the top of your spine, at your neck. At their axis, the cervical spine connects your spine to your skull.

•  
Thoracic spine
—these twelve vertebrae are your “middle and upper back” and they roughly cover the area behind your rib cage.

•  
Lumbar spine
—these five vertebrae are where your “lower back” begins. Most of the movement your spine is capable of takes place in the lumbar area.

•  
Sacrum
—these five vertebrae, which are fused together into a single bone, are at the very bottom of your lower back. Sacral health is crucial to the health of the entire spine, and because of this, and because of the sacral bone's distinctive shape, I call it “the heart of the spine.”

Illustration 1. Your Spine

Below the sacrum is your coccyx, often referred to as your “tailbone.” There are four tiny, fused vertebrae that make up this bony area.

You know your back is capable of movement, but did you know that there are six distinct ways your back can move? We work with all of these in yoga:

•  Flexion, otherwise known as forward bending

•  Extension, or back bending

•  Lateral movement, or bending to the side, either right or left

•  Twisting, which can also be done either to the right or left

There are a few more terms you should learn, because they're referenced often throughout this book. The first is
myofascia
. The dictionary defines
fascia
as “a sheet of connective tissue covering or binding together body structures.”
²
Myo-
is a prefix used in medical jargon to denote that something has a relationship to muscle.
³
Thus, myofascia is the connective tissue that binds muscles together. Myofascia is crucially important in the process of opening your body by stretching; if your myofascia is tight, it will prevent the muscles it's connected to from lengthening and receiving the fresh, oxygenated blood they crave.

In medical and anatomy texts, the word
myofascia
is usually used when describing the function of an individual muscle and its surrounding and embedded connective tissues. Because yoga is a holistic practice, I think of myofascia as a continuous web of connective tissues and muscles through which the entire body acts, moves, and interacts among its various parts.
⁴

A few more terms to review: a
tendon
is a band of dense, fibrous connective tissue that connects muscle to bone and distributes the force that muscle exerts,
⁵
and for simplicity's sake, it is considered in this book to be part of the myofascial web. A
ligament
is a fibrous band of tissue connecting bone to bone or supporting an organ in place.
⁶
You'll see that ligaments are noted throughout the book as distinct from myofascia, because they relate to bones rather than muscles.

Illustration 2. Your Lower Back and Hips

From right where you're sitting, it's easy to feel how the parts of your body are connected in the holistic view I'm referring to as the myofascial “web”—just reach your right arm up over your head and stretch it over to the left as you lean slightly to the left in your chair. You should feel a stretch not only in your right arm, but also along your right armpit and the side of your trunk, maybe all the way down to your waist.

You'll experience the connectedness of your entire body as you practice the yoga poses in the book, feeling how a particular stretch or movement travels through you. And you will come to understand how movement, or tightness and tension, in one part of your spine affects its other parts. You'll come to see your spine as an organic whole, and to appreciate the role that your lower back plays within it.

Your lower back, as we're addressing it in this book, consists of two major parts: your sacrum and your lumbar spine. We will also work with the lower back's immediate neighbors, your hips and abdominal core, because these areas are all so connected. As
illustration 2
shows, the skeletal outline of your lower back is what's known anatomically as “the pelvic girdle,” plus the lumbar spine that rises out of it. Because this is not an academic text, you will notice terms like
hip bones
used throughout the book. The illustration shows the proper names of the bones and joints, as well as how I'll be referencing them. Please return to the list below whenever you need to reacquaint yourself with this vocabulary, and reference this “cheat sheet” for reminders when you need them:

•  Ilium: Hip bone

•  Ischium: Sit bone

•  Pubis: Pubic bone

•  Sacrum: Sacral bone

•  Iliac crest: Frontal hip bone

•  Sacroiliac joint: Sacral joint (see also
illustration 6
)

•  Coccyx: Tailbone

•  Femur: Thigh bone

Physically speaking, the goal of yoga practice for a healthy lower back is to increase the tone of the body's muscles and the flexibility of its myofascia by moving the spine through its six directions of movement. In addition to increasing your body's ability to support itself, movement encourages the synovial membrane, an inner membrane of tissue that lines each of your joints, to secrete synovial fluid, which serves to lubricate your joints and help you move with increasing ease.
⁷

If you opened this book because your lower back is achy, sensitive, or a chronic source of pain, you are far from alone. An estimated 80 percent of people will experience back pain during their lifetimes, and the most common complaint within this group is lower back pain.
⁸
Back pain is the most common musculoskeletal pain Americans bring to their doctors each year, and in the years 2002 to 2004, back pain came with a $30.3 billion price tag in direct health care costs.
⁹
Most lower back pain affects young and middle-aged adults, with eighteen- to sixty-four-year-olds making almost 75 percent of all health care visits for lower back pain in 2006, and it affects slightly more women (56 percent) than men.
¹⁰

Lower back pain can take many forms, some clinically serious and others “just” due to everyday stress and strain. The high number of people who suffer from lower back pain points to the diversity of its causes and consequences. Although I believe yoga can bring healing to the lower back, either on its own or in combination with medical treatment, I must mention certain scenarios in which it's crucial you consult a doctor. These include:
¹¹

•  If you have had strong, constant pain for two weeks or more

•  If your pain is accompanied by a fever

•  If your pain is the result of a traumatic incident, such as a fall or a car accident

•  If you feel numbness or tingling for more than a few days

•  If your pain gets worse at night, making sleep difficult or impossible

If you don't have any of the above issues but are not sure whether it is safe for you to begin a yoga practice, please consult your physician for confirmation. In the appendices at the back of this book, I have provided yoga sequences that are helpful for specific medical diagnoses, including herniated disks, sacral sprains, spinal stenosis, and spondylolisthesis. Wherever you are in your journey toward wellness, your practice is waiting for you!

S
TRESS AND
P
AIN: THE
R
ELAXATION
R
ESPONSE

Often, your experience of pain has to do with much more than the physical architecture and injury history of your body. Stress manifests itself in physical ways as well as emotional ones, and pain is often the way it rears its ugly head. Whether you see stress as a cause of pain in itself, or as the cause of chronic muscle tension and poor posture that in turn causes your pain, there can be no doubt—stress is a guilty party in the story of lower back pain.

You have probably heard that yoga can help you manage stress, and that is very true. But there's nothing magical or mysterious about why the practice of yoga can have a calming, centering effect on your stress level. Yoga simply signals your body—specifically, your nervous system—to deploy its own method of regulating the effects of stress. In short, yoga helps your body activate its “relaxation response.”

“The Relaxation Response” was named and made famous by Dr. Herbert Benson of Harvard Medical School in his groundbreaking 1975 book by the same name. The book is still in print today and has reportedly sold
more than four million copies. Benson was one of the first scientists to clinically study stress as a physiological phenomenon, and mind-body practice as having physiological benefits. His research led him to conclude that conditions including anxiety, high blood pressure, hypertension, and headaches can be improved using meditation and other mind-body techniques.