On a bi-weekly basis, I am repeatedly asked the same question from my low back pain patients/clients: Is yoga good for my back?” I am sure you would agree this is a multi-factorial issue because we know back pain is not a homogenous group--which leads to the answer “it depends.”
Let me set up a scenario. A 42 y/o male arrives at the gym at 5:30 a.m. ready for a great work out. He enjoys exercise for weight control, stress relief and an overall feeling of wellness. The local gym recently purchased new “striders” and “ellipticals” ready for use by its members. This gentleman hops on one and begins to exercise vigorously. He is feeling great for the first 20 minutes, so he decides to continue, and finally stops after 45 minutes on the new machine. When walking out of the gym he notice his “back tightens up,” but no big deal. Later that day as he is sitting in a meeting and notices a sharper type of low back pain. After the meeting is completed he walks back to his office, the pain goes away and he thinks nothing of it. The next morning when he attempts to get out of bed he realizes he has a problem when he cannot stand up straight due to intense knife-like low back pain. This subset of people who have this type of acute low back pain typically would belong in the clinical pattern recognition group of primary disc pain. Specifically, a tear or rent to the outside of the annulus of the intervertebral disc known as an annular tear, brought on with repetitive cyclic movements and loading of the spine.
How does this happen? An article in the Journal of Bodywork and Movement Therapies (2012) supports this reasoning. Researchers at the University of Colorado, Division of Bioengineering studied a condition known as repetitive lumbar injury (RLI). The study looked at a series of experimental data from in-vivo feline groups and normal humans subjected to prolonged cyclic spinal movements at low loads, high and low velocities, as well as short and long in-between rest periods, while recording spinal creep. The conclusion was:
“.. when the stability of the spine is compromised (spinal creep) it had a detrimental effect on the spinal muscles leading to inflammation and over activity known has ‘spasm’.”
There is where yoga comes in. Exercises such has yoga, which hold the spine at end range along with bending and twisting activities, load the spine in cyclical fashion and stress the annulus fibrosis. Yoga routines typically are too long and produce the cyclical loading of the spine that has been shown to be damaging to the viscoelastic tissues. The result of this is deep inflammation of spinal ligaments or intervertebral disc leads to a “destabilization” effect of the spine.
People with spinal conditions such as degenerative disc disease or spinal instability spectrum should avoid yoga. These people will do better with exercise routines that provide longer rest periods while minimizing twisting and bending (i.e. Pilates or weight machines). Stationary bicycling (especially recumbent) provide a low load spinal activity and is especially favorable for patients with spinal stenosis or spinal instability.
In addition, your patients should avoid doing one exercise for a prolonged period of time (> 20 minutes) and cross train muscles including spinal muscles. Spasm of spinal muscle is usually related to a compromise of spinal stability and should be considered a “warning sign” this activity is not being tolerated well by your spinal tissues.
Practical advice like this is best given by professions who understands human movement, anatomy, spinal mechanics and spinal pathology. These topics and more are addressed in our NAIOMT Lumbopelvic Spine I and II courses. So the next time you are discharging your low back pain patient and they ask “Is it OK to return to yoga?” you will be equipped with a rationale evidence informed answer. Here's what's coming up across the country:
- Dallas, TX - August 24-25, 2019 - Advanced Lower Quadrant Integration
- New York, NY - August 25-26, 2019 - Lumbopelvic Spine II
- Berrien Springs, MI - September 8-9, 2019 -Lumbopelvic Spine I
- San Diego, CA - September 13-14, 2019 - Lumbopelvic Spine II
- San Diego, CA - September 15-16, 2019 - Lower Extremity
- New York, NY - September 21-22, 2019 - Lumbopelvic Spine II
- Berrien Springs, MI - September 21-22, 2019 - Lumbopelvic Spine II
- Denver, CO - September 22-23, 2019 - Lumbopelvic Spine I
- Boston, MA - September 28-29, 2019 - Lumbopelvic Spine I
- New York, NY - October 5-6, 2019 - Lumbopelvic Spine I
- Portland, OR - October 12-13, 2019 - Lumbopelvic Spine I
- Kansas City, MO - October 12-13, 2019 - Lumbopelvic Spine I
- Seattle, WA - October 19-20, 2019 - Lumbopelvic Spine II
- Orlando, FL - October 20-21, 2019 - Lumbopelvic Spine I
Gloria Casaroli, Tomaso Villa, Tito Bassani , Nikolaus Berger-Roscher Hans-Joachim Wilke and Fabio Galbusera . Numerical Prediction of the Mechanical Failure of the Intervertebral Disc under Complex Loading Conditions. Materials 2017, 10, 31; doi:10.3390/ma10010031
Christina A. Niosi, BSca,b, Thomas R. Oxland, PhD. Degenerative mechanics of the lumbar spine. The Spine Journal 4 (2004) 202S–208S
Moshe Solomonow, PhD, MD (Hon)*, Bing He Zhou, EE , Yun Lu, MD ,Karen B. King, PhD. Acute repetitive lumbar syndrome: A multi-component insight into the disorder. Journal of Bodywork & Movement Therapies (2012) 16, 134e147