There are several recurring conditions that I encounter on a regular basis as a physical therapist. One of which, and probably the most common, is low back pain. Patients often have many questions when it comes to low back pain, and one of the more frequent questions I am asked has to do with participating in yoga. Although low back pain needs to be treated case by case, rather than in broad generalizations, there are a few generalizations that can be made about low back health. One that is particularly relevant when it comes to yoga, has to do with the effects that full or extreme flexion (forward bending) of the trunk can have on the spine. This is essentially what I will point out to patients when asked about safely returning to yoga.Just to clarify, I am not bashing yoga. I like yoga, and feel it is very important for many people. Sometimes though, individuals need to make modifications. For example, consider the patient who can bend over so far that she can easily touch her palms to the floor, but when she does this it creates pain down her left leg and into her foot. That patient probably likes bending her back forward. She has probably been doing it for
years and finds that it “ stretches” her back and feels good. That may be true. But one thing we know for sure, through documented research, is that repetitive flexion of the spine is a mechanism that will eventually lead to injury over a period of time. Thismechanism of injury can be particularly harmful to the discs of the spine and result in nerve root compression, or what is commonly termed a “ bulging disc.” So my advice to
that patient would be simple - avoid excessively flexing (bending forward) your trunk. Obviously, it is important to avoid the movement that provokes symptoms in the above example. But also, I have to ask why it is that important to be able to bend so much? I even had a patient recently ask, “ Why then do we do this in yoga?” The truth is, I’m not sure. It is clearly important to have a functional range of motion, but for the general population an excessive amount of trunk flexion is not needed. In fact, it can, and usually
will, lead to an injury over time.
To speak in generalities once again, joints can be hypermobile (move too much) or hypomobile (do not move enough). Too much or too little mobility is potentially harmful. The spine is a complex structure, but if we move too much or too little from the lumbar spine we are setting ourselves up for injury. If I had to choose one option, either hyper or hypo mobility of the spine, I would go with hypomobility. Having an
excessively mobile lumbar spine can easily lead to injury while just performing daily activities. That is why you will hear so much emphasis put on core strengthening, which is essential training the lumbar spine to maintain a neutral position when the rest of our body is moving.
So, do not be worried if you can not bend over and touch the floor in yoga class. I always recommend this type of motion be avoided when performing activities of daily living, so why should we train for it? Unless you work as a contortionist, you do not need to flex your spine this much anyway. Some poses may not be appropriate for everyone. Especially when it comes to low back pain. Just something to consider.
Please contact me at Brad@JointVenturesPT.com if you have any questions, or would like to discuss your yoga practice and/or Low Back Pain.