Yoga is quite famous nowadays. Most people are doing one or the other forms of Yoga. This is because so many online and offline yoga courses are offered, and it is much more practised now than ever before. Though it originated in India, now it is much more practice in the western world with more western flavours added, like Power Yoga.

There are various types of Yoga, like Hatha Yoga, Kundalini Yoga, Bikram Yoga, Iyengar Yoga, etc.

Almost all these Yoga forms aim to bring harmony between mind and body. Because it is a movement-based practice, people extrapolated the benefits of Yoga to various movement-based ailments. For example, if someone is stiff, he will likely choose Yoga to become flexible. If someone has pain, she will enrol in some yoga program because she presumes that Yoga could cure her pain. It is a general understanding that Yoga is great for health and well-being. Different people have different goals in their minds when they do Yoga.

Why People Do Yoga:
  • To Improve flexibility
  • To manage illnesses like Diabetes, Asthma, Blood Pressure, Thyroid, PCOD, etc.
  • To get rid of their aches and pains, especially Neck and Back Pain
  • To improve their breathing capacity and Lung Health- After Covid
  • To improve Mind-Body Relationship
  • To lose weight
  • To remain healthy and to live longer
  • To Improve fitness – Power Yoga
  • To get Strength – Power Yoga

Many of us agree that Yoga is beneficial in achieving all the health benefits mentioned above. However, how exactly Yoga cures ailments like PCOD, BP, and Diabetes is still anecdotal. But as a Physiotherapist, I can argue about the benefits of Yoga in Curing Back Pain.

Back pain is damn common

Back pain affects almost everyone nowadays due to urbanization and the digitalization of our lifestyle. Due to our modern lifestyle, we have been moving less and sitting more than ever. In the past two years of COVID-related lockdowns, people’s mobility has reached a standstill. Nowadays, even the young population is not spared, and 50% of our back pain patients in our clinic are less than 30 years old. But just because it is common, it is not normal to get back pain. Normal is no back pain.

Is Back Pain a Simple Problem?

No, it isn’t simple. Back pain is complex, heterogeneous, and multifactorial. The back pain intensity, duration, and locality are hugely variable. It is only back pain for some; while some will feel it in their buttocks, some will get pain in their groin or hips, and some will feel it in their back and leg. And for a few people, it’s only leg pain originating from their back; unfortunately, they don’t know it is from their back. Even the symptoms can be either constant or intermittent. For some, it will be more in the morning when they wake up, and for some, it will be more at the end of the day. Finally, the nature of symptoms varies in that some will feel tight, some will feel pain, some will feel pulling, and some will feel spasms.

Back Pain is a Symptom, and Every Back pain must be Diagnosed

This complexity warrants a diagnosis because the structure producing Pain must be identified and treated accordingly. It needs a specific diagnosis based on detailed history taking, subjective and objective evaluation, Movement testing, and an X-ray or MRI clinical correlation. A thorough neurological examination must be done to identify nerve compromises. The pain can emanate from the Dural sheath (covering of the spinal cord), inflamed disc, bulged disc, Compressed nerve, Inflamed nerve, Muscles, Facet Joints, sacroiliac joints, etc. Rarely, it can be due to a tumour, aneurysm, infection, or fracture. It needs a solid medical background with tremendous experience to identify the source of pain. It is easy to medicate any back pain, and it is easy to prescribe general exercise. But to get a permanent cure, you need a “Medical Diagnosis” Because pain is just a symptom, not a cause.

Every patient must be diagnosed, categorized, and sub-categorized based on age and symptom presentations like locality, duration, and pain intensity.

So, the treatment for Back Pain must be specific directional exercises, with dos and don’ts, load management, and lifestyle modifications. It will work in a combination of the factors mentioned above. Unfortunately, Yoga would not consider such directional preference or classification system. Therefore, for every type of back pain, almost the same kind of Yoga will be prescribed.

Practical Difficulties of Yoga Teachers while dealing with Back Pain:
  • Yoga Teachers are not doctors to treat or manage Back Pain Patients
  • Yoga Teachers don’t understand the pain generators or Structural reasons for pain
  • They lack the clinical skills to assess neuromuscular structures
  • They will be clueless if there is an acute back pain attack or when the pain flares up
Would you go to Yoga if you get Chest pain or Abdominal Pain? Why is Back Pain dealt with differently from Chest Pain?
Facts about Yoga:
  • Yoga uses various movements and postures, which is excellent for joints and muscles
  • It is done slowly with breathing control, so you feel relaxed
  • It feels great because you have moved your body as Endorphins and other Happy Hormones are released to give you the “Aha” effect
  • Some poses need spine bending and twisting, which may or may not go well with your existing back pain
Yoga and Back Pain:

When someone already has back pain and is flexion intolerant (Forward Bending tends to worsen their pain), poses that use flexion would increase their likelihood of getting immediate back pain or the risk of future back pain. This mainly happens when one does “106” times of Surya namaskar asana. Most of the back pain population are flexion intolerant, and most Yoga postures are done in Flexion Posture. So, if you keep doing it, your risk of developing future back pain increases. Furthermore, most of our day-to-day activities are flexion or forward bending, like working from home, sitting in the car, sitting on the sofa, cooking, mopping, gardening, etc. Such everyday flexion activities will add up to further increase the vulnerability. For example, if you sit in front of the computer all day, you are already vulnerable to back pain. It will wait for a trigger. And forward bending poses of Yoga will provide that trigger.

The day-to-day workload of every person is different, so there is a varying degree of vulnerability; hence not everyone will get pain at the same point.

As Physios, we do movement testing in our clinic to identify which directional movement will cure them and which direction will worsen them. But, unfortunately, yoga teachers can’t understand this science.

Hint that your Yoga is not going to help your Back Pain:
  • If you feel back pain or soreness every time at the end of your Yoga sessions
  • Despite doing regular Yoga regularly, you wake with morning stiffness
  • Despite doing Yoga, if you still get periodic flare-ups of your back pain
  • If you experience pain while doing or after doing the below-mentioned yoga poses
If you think the Yoga way of stretching is useful, get to know this.
  • Yoga stretching will not cure back Pain or back muscle spasms
  • Just because you feel pain during stretching doesn’t mean, that stretching is good for you.
  • Flexibility will not give resiliency or immunity from developing back pain
  • Too much flexibility will compromise stability

Our Spine is like a Pillar. All our body weight must be transmitted through that pillar. Unlike the real pillar, our spine is a mobile pillar. It is flexible enough to do our activities of daily living that involve bending and twisting. But simultaneously, it must be stable enough to support the body weight without crumbling. There should always be a balance between the stability and mobility of the spine. If you look for extreme mobility (like stretching for flexibility), you will compromise strength & stability. If you are keen on stability, you will have compromise flexibility. One should not keep on trying to achieve both. A bodybuilder can’t be a yoga teacher, and a Yoga teacher can’t be a bodybuilder. A sweet spot between flexibility and stability must be identified and used. That sweet spot is different for different people. Some may get away with aggravating yoga postures, but some will get searing pain after doing those poses. So, if you have back pain, avoid doing stretching exercises. Instead, try to diagnose what is causing the pain. It is common to assume back pain is due to muscle or gastric catch. But it is far from the truth.

Dr. Rajkannan. P, PT
Chronic Pain Expert
APTER Institute, Bangalore

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