Backbends are an integral part of any Yoga practice.  The intention for backbends is to open the chest and rib cage in preparation for pranayama (breathwork).  For some, backbends are exhilarating and freeing while for others, they can be somewhat daunting and anxiety-producing.  For the first few years of my Yoga practice, I would experience back pain in most back bending postures and assumed that it was a ‘normal sensation’.  The truth is, if done correctly, backbends should be challenging but comfortable.  If you are not experiencing freedom in our backbends, it is a sign that you may be compressing our lumbar spine instead of increasing our range of motion.

Is it safe for my spine?

When done correctly, back bends help increase extension of the spine, a normal movement that is available to us based on the anatomical structure of the lumbar vertebrae.  There are approximately 55 degrees of extension available in the lumbar spine in most humans.  As we move up the spine, extension is more limited due to the shape of the thoracic vertebrae.  In optimal alignment, the lumbar spine should rest in a slight arch (lumbar lordosis), to properly carry the body weight and prevent low back issues.  When we lose the normal curve due to poor posture or frequent forward bending, there is an increased risk of low back pain, disc injuries and muscle spasm.

With all this in mind, it is important to increase the extension in our spine in order to maintain back health and mobility  and combat the constant effects of gravity that pull us forward.  In addition, back bends help increase lung capacity, prevent arthritis, alleviate depression, build stamina and energy as well as improve circulation, digestion and immune function. Backbends are said to help us move from the past into the present, and to help us open our hearts and let go of fear.

Backbends are safe for most individuals (contraindicated for those with spinal stenosis or spondylolisthesis) as long as the body is warmed up appropriately and there is close attention paid to proper alignment and actions in each pose.  The beauty of Yoga is that detailed instructions can be given to help one attain ideal alignment so a greater sense of opening is experienced.  When we have pain in backbends, it is because something is breaking down in our execution of the pose.  Discomfort is an opportunity for us to practice more awareness and find a new, pain free way to work in the posture.

Common limitations

Individuals who have difficulty in backbends can be categorized into two main groups: those with tight muscles and ligaments and those who are naturally loose and highly flexible.  In every body, there is a dance between the qualities of stability and flexibility in the musculoskeletal system.  There is a myth that being more flexible is a sign of better physical health, however, the more flexible a person is, the more prone their ligaments are to injury in Yoga because they lack stability.  Conversely, those who are stiff are less likely to suffer an injury due to overstretching however, these individuals need to increase their flexibility so the pelvis and spine can move freely and avoid compression during activities of daily living.

Common restrictions for tight individuals include decreased range of motion in the chest, shoulders and hips (primarily in the hip flexors and external rotators).  These areas become restricted from prolonged sitting at a desk, driving, frequent forward bending and lifting and can even occur from overtraining the anterior chest musculature.  Runners, cyclists and avid athletes are prone to tightness in the hip flexors and external rotators as well.  These individuals need to focus on increasing flexibility in the chest and hips to prepare for backbends.

Hyper flexible people experience different difficulties in back bending postures. They often have tight hip flexors but compensate with overextension in the low back.  Core strength is usually lacking in these individuals, so they tend to ‘hinge’ at one segment in their spine over and over again instead of dividing the extension throughout the length of the spine.  In this case, the hyper mobile segment becomes more mobile while the tighter segments in the spine stay tight.  Years of ‘dumping’ into the low back without awareness can lead to injury as the segment bears all the work.  These individuals need to focus on stability and strength in their backbends, which may mean backing off a little to maintain the integrity of the pose and length throughout the entire spine.

How to practice correctly

Here are some important tips to help you achieve success in your back bending poses:

• Warm up! In order to be ready for back bends, you must practice poses that open the chest, hip flexors, quadriceps and external rotators of the hip. It is also important to practice a couple of poses that encourage strength in the arms and legs to prepare for certain backbends.
• Keep the front body long. “Back bends should really be called front body lengtheners,” says Jo Zukovich, a well known Iyengar Yoga teacher from San Diego.  While we are extending our lumbar spine, it is important to maintain length at the same time so there is more space and equal movement between each spinal segment.  The common mistake that leads to pain and injury is collapsing in the spine at one segment while in the backbend.
• Internally rotate your hips. Internal rotation in the hips is essential in all backbends to avoid compression in the spine.  If we allow our hips to externally rotate (which will cause the knees to splay out), our stronger muscles, namely the gluteus maximus and external hip rotators, will contract.  By internally rotating the thighs, we turn off those stronger hip muscles and activate the deeper gluteal muscles which help to create more space.
• Avoid gripping! The tendency in backbends is to contract the buttocks strongly which creates more compression and less freedom in the spine.  In addition, ‘tucking of the tailbone’ creates shortening instead of increased length in the spine.  Instead, think about lifting the lower belly to help the tailbone descend. This creates length while maintaining the integrity of the spine and core strength in back bends.
• Don’t fight the backbend, GO FOR IT. Most people try to resist the back bend while they are doing it. It is safest to work on helping your lumbar spine move into extension at every level.  Focus on moving the spine into the body as if it were sinking into quicksand in order to safely increase extension in the lumbar spine.

Instructions for common backbends (hold each pose for 5-6 breaths):

1. Setu Bandha Sarvangasana (Bridge Pose): Begin by lying on your back with your knees bent and feet in line with the hips.  Make sure the toes point straight ahead and that the knees are directly above the ankles when you lift your buttocks.  Press all four corners of the feet firmly into the ground and lift the outer hips up. Internally rotate the thighs so that the knees stay in line with the hips.  Roll the shoulders under and clasp the hands or hold a strap.  Press the outer shoulders and forearms into the ground to open the chest. Press the feet into the ground to lift the hips up. Relax the buttock muscles and use the thigh muscles (quads) to lift more.

2. Bhujangasana – ( Cobra Pose): Lie on your belly with the feet in line with the hips.(The classical version of this pose has the feet together, however taking the feet apart provides more space for the sacroiliac joint and is easier on the low back).  Place the hands directly under the armpits and keep the elbows close to your waist.  Press all 5 toes firmly into the ground, especially the pinky toe, which will help you maintain internal rotation in the thighs.  Inhaling, pull the floor towards you with your palms and extend the spine as you lift up.  Keep the shoulders away from the ears and squeeze the elbows into the waist tightly.  Focus on lengthening the spine as you come up and absorbing the vertebrae into the body one level at a time.

Modifications:

If there is discomfort in the low back:

• Only come up a few inches off the ground.
• Keep the forehead on the ground and practice the actions of the pose in a neutral position.

3.  Ustrasana – (Camel Pose) Start in a kneeling position with the feet hips distance wide.  Press all five toes equally into the ground and take the inner thighs back (internal rotation).  Place your hands on your sacrum and pull the sacrum down as you roll your shoulders back and lift the sternum.  Keep the thighs active and in line with the hips throughout the entire pose.  Lift your lower belly to protect the spine and slowly arch backwards, maintaining length in the lumbar spine as you extend.  Keep length in the front body.  Reach back for the heels.  Lift the chest away from the sacrum and let the neck extend back maintaining as much length in the cervical spine as possible.

Modifications:

• If you have a neck injury, keep the chin tucked in towards the chest
• Practice with your hands on blocks or on your sacrum instead of reaching for the heels.

4. Danurasana –  (Bow pose) –  This back bend is the safest because you are using the back muscles as you lift up against gravity.  Lie on your belly and reach for the ankles with your hands.  Roll the shoulders back and press the legs into the hands as you lift your legs and chest off the ground.  Keep your knees in line with your hips as you continue to lift up.

5.  Urdvah Danurasana – (Wheel Pose). This is an intermediate back bend and is best performed under the observation of an instructor.  Lie on your back with your feet in line with the hips. Make sure the feet are pointing straight ahead to prevent the knees from splaying out to the sides.  Press the hands and feet into the ground to lift your body off the ground into a back bend.  Spread the shoulder blades wide on your back as you move the sternum away from the hips. Roll the inner thighs down towards the floor as you move your hips away from your head, maintaining length in the lumbar spine. Lift the lower belly for the duration of the pose.

Modifications:

• To decrease the arch in the lower back you can place your feet on a chair or your hands on blocks in this pose.
• Place a belt around the center of your thighs and press out into the strap to help relieve low back discomfort.

Every pose in Yoga leaves us with a certain residue.  When practiced with safety and mindfulness, your experience after backbends should be one of exhilaration, clarity and serenity.

Floralynn Einesman

Aparna Bharati

Mike S.

Principal, MSJ Associates

Shauna MacKay, B.P.E., RYT-500

~ Sue Perisi 

Assistant Vice President Commercial Loan Administrator

Yoga Therapist in Training

This was the second in an ongoing series on the therapeutic applications of yoga to appear in LA YOGA Ayurveda and Health magazine. A copy of the article can be viewed at: www.layogamagazine.com

I clearly remember the moment when shooting pain in my back sent me down on my knees, unable to breathe. I remember the numbness and tingling in my right foot – no matter how much I commanded, my foot would not obey. As a physical therapist, I knew exactly what was happening, I just couldn’t believe it was happening to me. I was young, healthy, active and a dedicated yoga practitioner. How could it be that I had herniated a disc in my lower back? The fear surrounding any significant injury began to surface. My main question was, “Would I be able to stay active and do the things I love, the activities that fulfill my soul and inspire me daily?”

The doctor took one look at my MRI (revealing a significant disc herniation at L5-S1 with nerve root impingement) and told me I would have to modify my activities for the rest of my life. Knowing better, I began to heal my injury with what I loved most – yoga. Six years later, I am pain-free, enjoy a full practice with no limitations and help others overcome their injuries with therapeutic yoga.

What went wrong?

The injury and my subsequent self-inquiry forced me to look closely and honestly at the way I was practicing yoga and living my life. I became aware that I was performing asana (postures) the way I thought they should look. I was missing an inner awareness of how each pose could serve me and my body. I would repeatedly overextend my lumbar spine while avoiding opening up tight areas in my body, namely my hip flexors and external hip rotators. I also have a mild scoliosis, which creates some restriction in my thoracic spine. In backbends, I continuously used the flexibility in my lower back to push into what I perceived was a deeper pose, instead of backing off to create more movement in my chest and upper back. In addition, I was not engaging my lower abdomen correctly, which contributed to constant compression in the lumbar spine. I was able to practice, even with this imbalance, for a number of years until the straw broke the camel’s back. I herniated a disc after performing a deep forward bend.

My experience led me to develop a growing awareness that injuries are not necessarily caused by a specific pose or even the yoga; rather it is the way one consistently practices over time that creates the problem.

When I examined how I approached my life, I was forced to recognize the competitiveness I had with myself both on and off the mat. I have been a perfectionist for as long as I can remember and although competition can be healthy, it can be accompanied by self-directed violence and aggression when motivated by a feeling of not being good enough. In this case, I was never fully present in the moment because of constant striving for my perception of a ‘better’ version of the pose, and ultimately myself.

In Healing Back Pain, Dr. John Sarno states the personality type who most often suffers from back pain is one who appears calm on the outside but tends to internalize stress, putting a lot of pressure on themselves to succeed. This stems from a lack of trust in life and a lack of awareness that the universe supports us. Since the lower back is the support for the torso, it is no surprise my pain manifested there.

Finding Purna Yoga

After the opening Om of a daylong workshop on Yoga for Low Back Pain with Aadil Palkhivala, I knew I wanted to study with him. Purna Yoga, founded by Aadil and his wife, Mirra, offers many advanced and innovative therapeutic techniques. Aadil studied with BKS Iyengar from the age of seven and developed a system based on his work with Iyengar emphasizing awareness and alignment accompanied by applied philosophy, nutrition and transformative spirituality. Purna Yoga encourages the student to look deeper into the causes of injury and disease and to work with lifestyle modification and meditation in addition to asana to ensure complete and true healing.

Therapeutic Asana for Low Back Pain

When working with any injury, it is important to look at the cause by identifying areas of tightness, weakness and misalignment. In my case, the root cause was tightness in the hips, thoracic spine and chest as well as weakness in the core. I also needed to learn to be more present in my body, to feel what was happening instead of forcing into a pose.

The first and most important action to tearn to protect your back in all asana is the engagement of the pit of the abdomen, what Aadil calls the POA, the region between the belly button and the pubic bone. To protect the lower back, lift the POA toward your head, enabling the navel to move into the body and upward, helping the sacrum descend. This action creates length in the spine, relieves compression in the low back and protects the back during backbends and twists.

Although each individual is unique in her or his therapeutic needs, the following asana are generally safe and effective for individuals with sub-acute or chronic conditions. These are suggestions for back health, but remember that it is important to work with a yoga therapist who can evaluate you and design an appropriate program for your specific condition.

Tadasana (mountain pose) [pictured, above] is a wonderful place to start at any stage in the healing process. Placing a block between the legs facilitates opening the outer hips, strengthens the adductors and core, and relieves pressure in the spine. Place the block between the upper thighs and ground all four corners of the feet into the earth. Engage the thigh muscles and roll the thighs in toward one another, squeezing the block and moving it backwards. As you maintain the internal rotation in the thighs, lift the POA. Draw the shoulder blades away from the ears and keep the chest lifted. When working in harmony, this action helps the descent of the sacrum, places the pelvis in a neutral position and creates space between the lower lumbar vertebrae.

Most individuals with back pain and disc herniations have tightness in one or more areas in the hips. The hip muscles attach to the pelvis and the sacrum attaches to the pelvis via the sacroiliac joints. When the hip muscles are tight, the alignment of the spine is directly affected, especially during the performance of yoga asana. Most injuries and disc herniations occur in the lumbosacral area between L4-L5 and L5-S1. The Purna Yoga Hip Opening Series is a wonderful sequence of postures that increases range of motion in the hips in every possible direction along with traction. I have observed students and clients finding relief from years of back pain after practicing the sequence regularly. The Hip Opening Series is comprised of six postures that open the hip in flexion, adduction, abduction, internal and external rotation and extension. The following excerpts from the series are safe for most back conditions.

1) Supta Padangusthasana:

(Lengthens the hamstrings.) Lie on your back and place a strap in the arch of the left foot. Bring the left leg up and extend the right leg out. Engage both thigh muscles and press out through the right inner heel. Make sure the bottom thigh does not roll out to the side. Instead move the inner knee towards the floor so that the knee and toes point directly upward. If the top knee is bent, move the leg further away from the head and engage the thigh muscles. Keep both hip bones level. You should feel the stretch in the hamstrings, behind the left knee or thigh. If you feel the stretch in the buttock area, back off a little bit until the stretch moves out of the buttock and into the posterior thigh. Repeat on the other side and hold for six deep breaths.

2) Parvritta Supta Padangusthasana:

[pictured, above] (Lengthens the external rotators of the hip.) Begin this in the same way as the previous asana but hold the strap in the right hand. Take the leg across the body so that the heel of the left leg lines up with the right shoulder, but no further. Press up through the left heel as you bring the left buttock down toward the floor. Hold for three breaths and repeat on the right.

3) Hip Internal Rotation:

[pictured, above] (Increases internal rotation of the hip and stretches the psoas major, one of the hip flexors.) Lie on your back with knees bent and feet together. Step the right leg out to the side and let the knee fall toward the floor. Make sure the thighbone and shinbone are perpendicular to one another. Cross the left ankle over the right knee and allow the hip to come up off the floor. Strongly lift the POA toward the head and move the right thighbone away from the head. If there is any pain in the right knee, support it with a block. Hold for six deep breaths and repeat on the left. For all injuries, it is important to approach the healing process in stages for a complete recovery. All too often, we jump ahead to strengthening before the structure is properly aligned.

The five stages of healing:

• Re-Align: Identify what is tight and weak and correct it.
• Create Space: Open up the tight structures and surrounding connective tissue to reduce joint and nerve compression.
• Re-educate: Identify faulty movement patterns that contribute to the imbalances and learn how to move in a different way.
• Stabilize: Once the structure is aligned, stabilize.
• Practice: Be consistent for long-term results and transformation.

It is my belief and experience that injuries happen for a reason. Although, it may not be apparent at the time, if we can step back and see our pain as a gift, we can work on it with more acceptance, patience, and clarity. If our bodies send us a clear message, it presents an opportunity to reexamine the way we have been living our life physically, emotionally and spiritually. This can point us in the direction of making changes, enabling us to new levels of health and awareness. My injury certainly guided me to cease pushing toward my concept of perfection. It helped me learn to accept myself in this moment. It brought me face to face with my ego and insecurities. While neither easy nor pleasant, I am grateful for the ability to practice compassion and acceptance for myself and others.

Rachel Krentzman is a licensed physical therapist and certified Purna Yoga instructor at the 2000-hour level. She is the co-founder and director of Embody Yoga and Physical Therapy in San Diego, where she sees private clients and teaches weekly Happy Back Yoga, Women’s Yoga and Purna Yoga classes.