Disc Injury & Yoga
Educating yourself is a vital step toward healing.
There are seven cervical, twelve thoracic and five (sometimes six) lumbar vertebrae along with the fused vertebrae within the sacrum and the coccyx. The vertebral bodies are separated by 23 intervertebral discs made up of fibrocartilaginous material which provide cushion and shock absorption for movement. The spine has primary (kyphotic) curves along with secondary (lordotic) curves. This precise combination of curves and shock absorbing discs is vital for load bearing. Without this design, we could not run, jump, or stand on our hands and land back on our feet without breaking.
The musculoskeletal body balances under the principle of tensional integrity. Imagine a tall flexible tower being supported by surrounding cables tethered to the ground on all sides. If one cable becomes overly tight or overly loose, the tower (the body) will be pulled off of its center. This is precisely what happens in the spine. Daily postural habits combined with your unique musculoskeletal makeup, can cause soft tissues to become overly tightened or overly lax. Once the tower of the spine is pulled off center, uneven distributions of force and pressure land in the discs, eventually causing weak points, typically in the posterior wall of the disc. If not corrected, this imbalance leads to degradation, pain, and chronic injury. Degradation can present its self in the surrounding soft tissues, the nerves, the bones, and or the intervertebral discs. In order to move toward healing, it is vital to move back toward balance. An intelligent yoga practice can be an effective tool for encouraging musculoskeletal balance.
I get regular e-mails, phone calls, and personal inquiries from people seeking out yoga for relief from back pain. The majority of them have an intervertebral disc herniation. Some of them come to class because their doctors have recommended it and others have friends or acquaintances who sing the praises of yoga. Maintaining the health of the spine is multifaceted. First off, we should never dismiss the basic components of nutrition, hydration, sleep, and mental health, which all have an impact on the wellbeing of spinal structure and function. When seeking out holistic healing from any modality, it is important to address the WHOLE. Luckily, yoga not only addresses the physical structure, but also cultivates mindful awareness and the use of breath as a means to invoke parasympathetic tone and overall nervous system balance. Sympathetic tone increases our ability to minimize the negative impacts of stress and anxiety on the body. This is paramount when addressing any physiological healing.
If yoga is approached without awareness, it has the potential to exacerbate your injury. If it is approached with a tuned in awareness, it has the potential to help you find long-term relief. The key is to slow down and tune in. I also highly recommend learning more about your body and your unique injury. Know what it looks like, where it is located, and how it responds to movement.
Although pain and discomfort are urgent messages from the body, it is important to note that pain is not always felt with injury. Pain is subjective and is not always the best indicator of severity of injury. I am also not claiming a one-size-fits-all protocol here. You are the ultimate authority on your body, your injury, and your yoga.
Things to consider with your yoga practice if you have a lumbar disc herniation, bulge, or inflammation:
1. Always avoid postures that cause pain. This may mean pain in the moment or residual pain, hours or days after.
2. Be cautious with any postures that create a forward flexed (rounded) lumbar spine. Look at the lumbar disc image here. Notice how the bulge pushes back toward the spinal cord. Forward rounding would move the anterior edges of the vertebrae more together, while the posterior edges of the vertebrae would expand apart. Sort of like the two graham crackers of a s'more squeezing together on one edge while the marshmallow in between squishes back. This movement encourages the disc to push farther in the direction toward the spinal cord, possibly exacerbating the problem. All forward folding should either be avoided or cautiously approached with bent knees. Bending the knees will release some back of body tightness (posterior chain) and lend toward keeping an elongated spine rather than a rounded one. One thing that I have seen help students with this injury is the use of 2 tall blocks at the front of their mat. If you try this, while the rest of the class is forward folding, keep your finger tips on the blocks and focus on an elongated spine in Halfway Lift position and skip the forward fold. Keep your knees very bent here to allow a release in the posterior chain. Keep in mind that Halfway Lift is also a forward folding position. Depending on how severe your injury is, this might be too much at first. If so, just stay upright in a pose like Mountain or Chair while the class is in Halfway Lift and Forward Fold.
3. Elongate the spine, elongate the spine, elongate the spine. Stand tall, sit tall, bring the elements of Mountain pose into everything you do on and off the mat. This will help wire in the invitation to your spine to return to its naturalness. It will bring spaciousness between the vertebrae and discs, increase blood flow, stretch the spinal muscles that need to be stretched while strengthening those that need strengthening.
4. Strengthen your core, but not with sit-ups and crunches. These can be beneficial at times, but what you need in order to heal this injury is overall, functional balanced strengthening in the trunk stabilizer muscles. Practice sitting upright, nice and tall, as in a meditation position, without leaning on a chair back. Don't let yourself slouch forward. Feel the muscles that have to work just to maintain this awakened, upright position. Visualize a string pulling you up from the top of your head, connecting the entire length of your spine. Set the timer for 3 minutes and slowly increase your time. Practice longer, deeper, slower breaths while you are here. This will build a gentle, solid foundation of strength that will be supportive of healing.
5. Slowly work towards incorporating spinal extension/backward bending poses. Earlier I mentioned the s'more marshmallow squishing toward the spinal cord in forward rounding. Just the opposite happens in spinal extension, the marshmallow (disc) squishes away from the spinal cord. See the image below of a spine in extension.
Keep in mind that your severity of injury will determine when and if these movements are appropriate for you. The simplest of backward bends can be approached first. Sitting tall in a chair while arching into a slight backbend or lying on the floor for Sphinx pose is a good start. Backward Bends can be a vital part of healing a lumbar disc injury when approached slowly with a tuned in awareness. Each person and injury is unique--if and when this is beneficial can only be determined by the individual. The book: Cure Back Pain With Yoga, by Loren Fishman, M.D., and Carol Ardman, has great information on using backward bending to heal lumbar disc injury.
6. With disc herniation, the soft tissues surrounding the hips will be reactive, tight, and imbalanced. Practice gentle stretches for the lower body, and remember---a little goes a long way. Try Pigeon poses or variations of Pigeon that are accessible. Hamstring stretches done on the back are effective because the pelvis and spine are stabilized, eliminating the probability of spinal rounding. Use a strap or towel looped around your foot and go only to the point of mild stretch. Use longer, slower, deeper breaths.
7. Use your Doctor and Physiotherapists instructions to design a new practice that works for you along your path of healing.
8. Trust yourself to understand your own body and what is best for you. Use your injury as an opportunity to slow down, tune in, and learn.
For yoga teachers!
I am leading a program this Fall in Thailand for Yoga Teachers to advance their knowledge and understanding of: The Spine, The Trunk, Yoga & Autonomic Balance. It is one of three modules for our 500 Hr. Advanced RYT certification. These modules can be taken in any order. Each day you will take a class aimed at refining your personal physical practice and deepening your understanding of posture variation. Mindfulness Meditation, Breath Practice, self-inquiry, and journaling will be included each day. Each module contains a specific anatomical focus in which we will study structure, function and applications in sequencing. Common injuries and their implications with yoga will be included. Thailand Dates: September 22-October 2 and more information