Yoga and the Management

of Back Pain (Part 1)

Swami Bhaktipoornananda Saraswati

Why is it that 80% of the population suffer back pain at some time in their lives, many for a
protracted period of time? Pain is like the warning lights on the dashboard of our car. When
they light up, we investigate what is wrong and top up the oil, water, etc. Otherwise we'll
wreck the car! Similarly, with the body it's no good wishing away the pain or just taking
pain killers ad infinitum, that's like removing the bulb from the warning light. We need to
discover the reasons for the pain.

Pain and injury

To my knowledge there is one major source of back pain and that is injury, and not
necessarily the obvious injury resulting from falls, lifting, sports, etc. Even though we may
not know it, many of us have injured our backs at some time in the past; strains and
sprains can occur without our knowing that anything has happened. These small injuries
stop the spine from moving properly, which leads to pain and inflammation at the site of the
injured tissues.

Pain in the back is always associated with a part that is not moving properly. It can be very
difficult to pinpoint because a small area of inflammation can have so many sensitive areas
around it. Toxins are produced when there is inflammation. This affects surrounding tissues
and we get a wide area of pain experience.

Back pain is so common because of our lifestyle and the way we use (or don't use) our
bodies. We make very limited use of the back in our normal day to day life and also tend to
adopt poor posture habits which often begin at school (where we sit slumped at a desk) or
in the home (where we sit back in soft easy chairs with the spine in a forward curve). If we
consider a small joint of the spine (Figure 1), it consists of facet joints on each side of the
spine and a disc separating the adjacent vertebrae by sitting between the two vertebral
bodies and cushioning them. This gap between the two vertebral bodies is designed to take
weight. In a slumped posture, instead of the weight passing through these discs there is
pressure on the facet joints of the spine which are not designed to be weight bearing.
Gradually this can lead to localized pain at these joints and surrounding tissues, producing
swelling from the loss of fluids from minute tears. This clears away in the healing process
but leaves a residual area of scarring, hardened tissues and weakness.
However, not all back pain is from facet joints, it can come from soft tissues (tendons,
cartilage, ligaments) and surrounding muscles and from the nerves as they emerge from
the spinal column.

Inflexibility

A healthy spine is flexible and absorbs the impact of falling and lifting. Through bad habits
our joints become inflexible and less able to respond to sudden movement or jarring. When
we jar the back or move beyond our habitual range of movements suddenly, we damage
the soft tissue of the spine.

Discs are surrounded by a lattice of criss-crossing ligaments that pass from one vertebra to
the next. When we damage these tissues, they harden and are less able to move. Because
of the limited movement of a joint in the spine, the joints above and below have to move
more to compensate, resulting in increased wear and tear. So we then have a joint that has
lost some of its elasticity and cushioning and is more prone to injury. The joints on each
side do more work than they were designed for. The joints themselves can become quite
irritated by subsequent strains and injuries and the surrounding muscles often go into
spasm to protect the joint from movement. When we ignore this combination of irritation
and muscle spasm, the spasm will become more intense and pull the two bones together to
block movement completely.

Spasm

If the muscles around an injured joint are in severe spasm or persistently in spasm, then
this can put so much pressure on the disc that it will bulge (prolapse) (Figure 2), especially
where the ligaments across the outside of the disc have been strained and the disc has been
traumatized by poor posture or from taking extra work because of other limited joints in the
vertebral column. When we release the muscles that are in spasm, the bulging disc can
retract back into its normal space.
Disc deterioration

When a spine has been immobilized for a long time through pain, the soft tissues around
the spine shorten and disable the springing effect that a healthy spine has by virtue of its
spongy discs. When we stretch the shortened tissues out again, the discs also need their
encircling girdle of ligaments to be stretched. When a whole section of the spine becomes
stiff and solid, the discs start to shrivel and collapse or completely disintegrate, and so we
lose height. This leads to increased strain on the bony facet joints because they are closer
to each other. They can jam up, causing more pain and discomfort. Also, because the disc is
not as thick as before, the ligaments that surround it seem too long. They can no longer
hold the joint firmly. The joint is then unstable and more easily injured. The long erector
muscles on each side of the spine have no way of holding the individual vertebrae in place,
that is the job of the intrinsic muscles that link each vertebra to its adjacent vertebra. If the
long back muscles are in spasm, as they usually are when we are in pain, they paralyze
these intrinsic muscles and threaten the stability of the spine.

In my own experience of progressive injury I jarred my back when I fell onto my buttocks
whilst snow skiing and again falling downstairs. Because I was not using my spine well
(poor posture and general lack of muscle tone), there was damage to the soft tissues. About
two years later I strained it again lifting. Six years later I strained it badly pulling on a rope
(rotation) and needed a week or two of rest. Another six years passed before I strained
again pushing a wheel barrow then hoeing (3 years later) when I had excruciating pain for
many months from a prolapsed disc. Then another 8 years on I was stepping into my
trousers and the disc 'went' again.

So the last spectacular strain was from a very minor movement brought on partly by
weakness from resting for several months because I had been ill, and partly because of my
susceptibility to ligament strain just prior to menstruation. (This is a known syndrome that
involves changes to the ligaments similar to those that occur during pregnancy, but
occurring as part of the menstrual cycle.) The prolonged inactivity had led to weakened
musculature generally, but especially these intrinsic muscles. This left my previously injured
disc very vulnerable in an unstable joint, and so the simple forward bend (after a warm
shower, so it was nice and loose!) was my undoing.
Primary disc disease

There is another condition called Primary Disc Disease which is usually caused by a heavy
blow or jarring of the spine. A blow to the buttocks will affect the lower lumbar discs. A blow
to the head can affect discs in the neck. The disc itself doesn't prolapse, but the nucleus
(the softest part in the centre) degrades. This is picked up as a dark disc on an MRI scan.

Pain from nerve roots

The nerve roots that emerge from between the vertebrae have a prolific supply of pain
sensing equipment. If they are put under pressure from a bulging disc or swelling from the
tissues around the facet joint, or from changes in the bony structures, then a lot of pain is
felt.

Acute pain

If we are in an acute phase of pain, then exercise is not appropriate. At this stage we need
rest and then mobilization of the joints. Acute pain needs rest and I do mean rest – not
watching the TV or reading, but the deep healing rest of yoga nidra and prana nidra, plus
meditation practices with movement of awareness in the frontal passage or along the spine
with breath and/or mantra. Complementary therapies may be useful (osteopathy,
physiotherapy or similar bodywork). Then exercise is phased in as therapy phases out. We
can assist in this process with gentle loosening and massage of the affected areas using
practices like 'pelvic rocking' and 'rocking and rolling'. If medication is used to dull the pain,
then it is not advisable to do any body movements like these until the medication has worn
off.

Chronic pain

Chronic pain can be constant or recurring. It can seem to move around or always come
from one area. It can be hot, burning, stabbing, knife-like, or cold, aching or dragging. We
need to discover if it is referred pain (visceral pain) which can come from the liver (usually
experienced around the right shoulder blade) or menstrual (usually worse before or during
the monthly bleed). If so, add the appropriate practices for the liver and endocrine system
respectively, such as twisting and sideways bends for the liver and surya namaskara (salute
to the sun) for endocrine (see also Asana, Pranayama, Mudra, Bandha - Bihar School of
Yoga).

Whether pain is acute or chronic, we also need practices to help us to attune to the mental
and emotional stuff that always accompanies pain. When we have pain, we react on all
levels of our being.

In physical pain there is:

 mental reaction: judgement (e.g. 'good' pain when we have a massage, 'bad' pain when we
are incapacitated in some way), memory and comparison;
 emotional reaction – dislike, anger, annoyance;
 physical reaction to protect the area of 'bad' pain.
Similarly when we have emotional pain, e.g. grief or anger, we have mental and physical
reactions.

Back pain is seen mostly as a reflection of deep subconscious or unconscious beliefs and
conditioning. Writers like Louise Hay have even pinpointed how different parts of the back
reflect different issues. This came home to me loud and clear when I met a man with
multiple sclerosis which only affected his body below the 12th thoracic vertebra. His father
was super critical of his actions. Criticism is seen as affecting the joint between the 12th
thoracic and the 1st lumbar vertebra. I realized that if he was to gain any notable
remission, first he would have to deal with his reactions to the criticism he received from his
father.

Before examining the mental and emotional aspects of pain and how to deal with them
through yoga we need to examine posture and the common patterns of imbalance. Regular
practice of hatha yoga can help to correct poor patterns of posture that created the tiny
injuries which led to back pain.

(Part 2 will look at postural imbalances and practices to manage back pain.)
Yoga and the Management of Back Pain (Part 2)

Swami Bhaktipoornananda Saraswati

Postural patterns

Regular practice of hatha yoga can help to correct poor patterns of posture that have created the tiny
injuries which led to back pain. Different postural problems require a different emphasis in exercise.
Lordosis is a forward curving of the spine found in the lower back (sway back) or neck. Kyphosis is an
exaggerated forward curve of the thoracic spine. A lordosis of the lower back is often accompanied by a
kyphosis of the thoracic spine (round shoulders) and a lordosis of the neck. Scoliosis is a sideways curve,
'C' or 'S' shaped when viewed from behind. Many people have a 'short leg' or a flattened back in the
lumbar region. These too have their own patterns of wear and tear and pain.
Role of exercise in correcting posture

Exercises are done to address the structural problems in the joints and the spine as a whole. They can be
therapeutic or preventative. They keep the muscles in good tone and prevent contraction, so that the
muscles can allow complete movement and lubrication of the joints. Tone is the amount of tension in a
muscle when it is at rest. The more tone there is, the less you can extend it, so a muscle that is highly
toned becomes shorter. It may appear strong, but it can't let go and release to a full stretch. The joint
consequently cannot go through its full range of movements. Conversely, the weaker muscles become
longer. Paired muscles become of equal length and equal strength. For example, with the elbow joint, if
weight lifters do more work with the muscles that bend the elbow than with those that straighten it,
they will eventually not be able to straighten the elbow completely.

Postural correction standing

 Practise relaxing in the standing position with correctly aligned posture:

Bring the feet a few inches apart (10 cm) and parallel to each other. Then bring the awareness
into the soles of the feet and gently rock backwards and forwards coming up onto the toes and
back onto the heels. Then return to a standstill and feel the contact with the floor through both
feet. The body sways and the weight moves forwards and back and left and right quite naturally.
Be grounded through the feet and allow them to take the weight evenly.

 Make sure that the knees are unlocked and pull up the kneecaps.

If they point in towards the centre then rotate the thighs outwards and tighten the buttocks.

 (The following exercise can also be practised in your sitting posture). Now tilt the pelvis
backwards and forwards finding the balance so that the spine can grow comfortably upwards
out of the hips.

 Bring the shoulders up and back, and let them go wide with the arms hanging loosely.

 Hold the head and neck upright so that the ears are above the tops of the shoulders and the
head feels lightly balanced on top of the neck.

 Imagine that a string is attached to the top of the head and that someone is lifting the head up
and out of the shoulders. Feel how your posture alters when you 'let go' of this imaginary string.
General notes

Forward bending: Pressure within a disc is at its lowest when we are lying flat on our back. It is at its
greatest when we tip forwards and pass through 20 degrees from the vertical. After that point it
decreases again and we can curl forward comfortably. It is at this 20 degree angle that an unhealthy disc
is likely to bulge or herniate (e.g. me putting my trousers on!). As we bend the spine forwards 20% of
the bend comes from the joint between the 4th and 5th lumbar vertebrae and 60–70% from the joint
between the 5th lumbar and the sacrum. This makes this part of the body highly at risk of being
damaged.

Bending the spine forwards needs to be done with care as it is risky when discs have deteriorated or
been damaged. If we know there is an unstable joint or a whole section in the back that doesn't move
from degeneration, then it is important to take care when coming up from a forward bend (standing or
kneeling). Use the hands to 'walk' up the legs and support the body so that it does not feel like it is going
to give way or go into spasm.

Backward bending: When we bend backwards the lumbar spine takes the curve and the thoracic spine
tends to flatten. In most cases backward bends can assist in relieving pressure on a disc. The exception
comes when the lumbar spine is already curved back and any extra bend pushes the facet joints further
into each other. This can lead to pain.

Twisting the spine: When we twist the body it is the thoracic spine that twists most, not the lumbar
spine. When we have one leg shorter than the other we get a lot of wear and tear on the junction
between the 12th thoracic and the 1st lumbar vertebrae because the twist on the pelvis is imbalanced
as we walk. The lumbar spine does not turn much so this lob-sidedness increases wear and tear on the
first vertebra designed to twist (i.e. 12th thoracic).

Meru wakrasana and ardha matsyendrasana are important twisting practices which keep the whole
spine supple without straining ligaments. They should be practised initially with one hand resting close
to the sacrum and the arm straight so that it lifts the back upright and supports it.

Sideways bending: The whole spine can bend to the side. Inhibition comes from the muscles away from
the spinal column (latissimus dorsi and quadratus lumborum and muscles in the sides of the trunk).
When scoliosis occurs, the major work needed comes from sideways bending. The muscles that require
strengthening are on the outside of the curve and the muscles that require stretching are on the inside
of the curve.

The tendency in bending sideways is always to twist the pelvis or the shoulders. We can help prevent
this by flattening the lower back and tucking the tailbone under before doing postures like trikonasana
variation 3 (triangle sliding the hand down the side of the leg). Another way to fix the pelvis so that it
cannot rotate is either by squatting against the wall, or by beginning in shashankasana (child pose) and
bending to the side. Tiryaka tadasana must be practised with caution as the arms over the head provide
great leverage to each side especially in tall people.
Other practices

A combination of practices is vital in the management of back pain. Pranayama techniques help pump
lymph and remove toxins from the site of inflammation. They assist in the movement of the cerebro-
spinal fluid that bathes the nervous system and keeps it healthy. The following practices should be
learnt from a competent teacher.

Abdominal breath and full breath activate the abdominals and massage the spine from inside, especially
when done lying prone as in advasana, jyestikasana and makarasana.

Pranayama that requires forced exhalation and agnisar kriya work many of the postural muscles
especially the pectorals, back muscles (latissimus dorsi and anterior serratus) and the abdominals.
Agnisar kriya also helps activate and clear the bowel.

The practice of moola bandha is useful in decreasing pain levels (see Moola Bandha – the Master Key,
published by Bihar School of Yoga).

Yoga nidra works to release mental tensions as well as bring about a deep state of rest where healing
can take place.

Antar mouna and antar darshan (see Yoga Darshan, published by Bihar School of Yoga) are practices to
help with self-knowledge and acceptance.

Prana vidya (see Prana Pranayama Pranavidya, a Bihar Yoga Bharati publication) is used to direct prana
for healing.

Constipation and impaction of the faeces are common with chronic back pain. The removal of all faecal
matter often brings pain relief. Practice of laghoo or poorna shankhaprakshalana is important once the
body is strong enough to do the asanas.

Movements to be avoided

Anyone who is unfit or with a history of back pain should avoid the following movements as they cause
undue strain on the body:

Sit ups: When the bones of the lumbar spine are habituated to a backward curve (lordosis), there is
minute damage of the intervertebral ligaments. If we lie on the floor with the knees bent and bring the
upper body off the floor taking the weight on the buttocks in a sudden way, the shearing force across
the bones can be enough to increase the damage already done.

Pawanmuktasana part 2 practices 1 to 3 will cause strain if the back is arched. The hip flexors (if already
strong) pull the lumbar spine into more of an arch. Avoid double leg raising unless the back is flat and
abdominal muscles are strong.

Neck stretches: Avoid circling the head and dropping the head back to look at the ceiling (better to keep
the teeth together to prevent over-extension).
Halasana (plough pose) or sarvangasana (full shoulder stand) because of the pressure on the neck and
lumbar spine.

Forward bends that swing up if you have low back pain.

Gatmatyak meru wakrasana (dynamic spinal twist) and trikonasana variation 4 twisting to the opposite
foot and variation 2 with the arm stretched over the ear – if you have low back pain (too much leverage
on the spine).

Lying on the side and lifting both legs up.

Shalabhasana (full locust pose) or star pose (with arms above the head).

Dhanurasana (bow pose) can be done with knees remaining on the floor.

Vyaghrasana (tiger pose) is OK if the leg being raised does not go past 15 degrees above the horizontal –
the lumbar spine is stressed beyond this point especially when the movement is done too quickly

Paschimottanasana (back stretching pose) is not recommended to stretch hamstrings.

Squatting and vajrasana to be avoided where knee problems exist.

Note: When learning the practices of yoga the guidance of a qualified yoga teacher is recommended.
Most practices referred to are detailed in Asana Pranayama Mudra Bandha (APMB), published byBihar
School of Yoga.

(Part 3 of this series will suggest specific practices for managing back pain.)

Yoga and the Management of Back Pain (Part 3)

Swami Bhaktipoornananda Saraswati

Suggested practices

In the following practices, numbers denote the recommended sequence in which the practices are to be
done. Practices marked S are those that are sometimes indicated; ask your teacher for advice on the
number of repetitions and whether they apply to you. Refer to the practice note later in this article for
explanation of the symbols H, 1, 2, 3 and 4.

If you are on painkillers, then you will not receive the full pain warnings from your body. Tune in to pain;
use the friendly pain, but avoid anything that produces sharp or increasing pain. If in doubt, don't.

A. Lumbar lordosis (sway back)

Stretch hip flexors, adductors, lower erectors, back muscles (latissimus dorsi and quadratus lumborum).
Strengthen hip flexors (sometimes), buttocks, abdominals:

1. Pelvic rock and clock: Lying on the back with the knees bent, the pelvis is tilted forward then
backward so that the back alternately flattens and arches (see diagram). This is followed by movements
where the pelvis is rolled so that pressure against the back of the pelvis moves in a complete circle –
several times in each direction.

An alternative is jhulana lurhakanasana (rocking and rolling): Firstly rock from side to side, grasping the
legs firmly to the chest. Then roll along the length of the spine, making sure to use a thick pad to protect
the back from bruising.

2. Supta pawanmuktasana (leg lock pose)H: Bend alternate legs, with the emphasis on extending the leg
that is 'resting' straight to bring a stronger stretch into the hip flexor muscles. Then bend both legs.

3. Once this is comfortable, shashankasana (moon or hare pose) is done in stages, mastering each stage
before moving to the next: static, then bending forwards while breathing out and coming up again while
breathing in, with:

a) hands clasped behind the back

b) hands held at shoulder level
c) hands held at ear level, and
d) hands held above the head.

The hands and arms are raised higher as strength increases.

Once the back is strong enough to do these practices, then more weight bearing forward bends are
explored to gently stretch the shortened fibres around the discs. In the rag doll (pada hastasana) we
stand and, gently curving the spine, use the hands to walk down the legs and back up again until
confidence is gained. From the relaxed forward position, start by contracting the buttocks, tightening
the pelvic floor and tucking the tailbone under. Then breathe in and use the breath and the stomach
muscles as a girdle to roll the pelvis back. Straightening the lower back first, unfurl the back until
vertical, raising the head last. This combination of breathing in and contracting the abdomen into a
girdle (all around) increases the pressure in the abdomen, which in turn supports the spine, transferring
the weight from the ligaments to the back muscles. This exercises the intrinsic (joint to joint) as well as
the erector muscles, making them stronger. The pelvic floor contraction is especially important if you
have had haemorrhoids – we want the pressure to move up not down!

4. Body curls1 or naukasana (boat pose)4.

5. Kandharasana (shoulder pose).

S Utthanpadasana (raised legs pose)2, or chakra padasana (leg rotation)2, or pada sanchalanasana
(cycling)2.

S Side leg lifts: lifting the upper leg about 30 centimetres, and circling slowly.

S Shroni chakra (hip rotation)2, or ardha/poorna titali asana (half/full butterfly), holding for a count of
10 in the relaxed position.

6. Meru wakrasana (spinal twist) H, or ardha matsyendrasana (half spinal twist)H.

S Choose any side bending practice.

7. Ardha or poorna shalabhasana (half or full locust pose) H.

8. Shashankasana (moon or hare pose) – static for 3–5 minutes.

B. Flat back (lack of lumbar lordosis)

Stretch hamstrings, abdominals. Strengthen hip flexors, buttocks (sometimes), abdominals (sometimes),
lower erectors:

1. Utthanpadasana (raised legs pose)2, or chakra padasana (leg rotation)2, or pada sanchalanasana
(cycling)2, or janu naman (knee bending)H lying down: grasp back of thigh, straighten knee and extend
heel away until a pull is felt in the back of the thigh (back must stay flat).

2. Initially we explore a backward bend with asanas such as marjariasana (cat stretch pose), or
kandharasana (shoulder pose). Then sphinx and makarasana (crocodile pose) can be attempted. If these
are painless, then we can move on to stronger stretches such as utthan pristhasana (lizard pose), which
gives a wonderful feeling of lengthening in the lower back, and then bhujangasana (cobra pose) and
other backward bends.

3. Kandharasana (shoulder pose).

S Body curls1; naukasana (boat pose)4.

4. Ardha shalabhasana (half locust)H, or sarpasana (snake pose)H.

5. Side leg lifts – lifting the upper leg about 30 centimetres, and circling slowly.

6. Shashankasana series (see above).

7. Utthanasana (squat and rise pose).

C. Lordosis of the neck

Stretch neck erectors:

1. Greeva sanchalana (neck stretches) forward and back.

2. Kandharasana (shoulder pose).

D. Kyphosis (round shoulders)

Stretch abdominals, pectorals:

1. Advasana (reversed corpse pose).

2. Marjariasana (cat stretch), or kandharasana (shoulder pose). Then sphinx and makarasana (crocodile).
If these are painless, then we can move on to stronger stretches such as utthan pristhasana (lizard), or
bhujangasana (cobra).

3. Dwikonasana (double angle pose)H, or gomukhasana (cow's face pose)H.

Strengthen buttocks (sometimes), abdominals (sometimes), mid erectors:

4. Ardha shalabhasana (half locust)H (with arms raised), or sarpasana (snake)H.

5. Shashankasana series.

6. Utthanasana (squat and rise).

SVyaghrasana (tiger)3, body curls1, naukasana (boat)4, side leg lifts: lifting the upper leg about 30
centimetres, and circling slowly.

E. Protruding shoulder blades

Stretch pectorals and strengthen anterior serratus and lower trapezius:

1. Advasana (reversed corpse pose).

2. Utthan pristhasana (lizard).
3. Skanda chakra (shoulder socket rotation).
4. Ashtanga namaskara (salute with 8 limbs).
5. Dwikonasana (double angle pose)H.
6. Sarpasana (snake)H – with chin tucked in.
7. Trikonasana (triangle pose) – variations 1,2,3.

F. Scoliosis (sideways curve)

Stretch hamstrings (one will be tighter), back muscles:

1. Any twists and sideways bends especially trikonasana (triangle) variation 3.

2. Janu naman (knee bending)H – lying down, grasp back of thigh, straighten knee and extend heel away
until a pull is felt in the back of the thigh (back must stay flat).

3. Supta udarakarshanasana (sleeping abdominal stretch pose).

Strengthen abdominals, erectors, back muscles:

4. Body curls1 or naukasana (boat)4.

5. Sarpasana (snake)H or ardha shalabhasana (half locust)H (arms raised).

6. Shashankasana series.

7. Vyaghrasana (tiger)3.

8. Dwikonasana (double angle pose).

G. Unstable joints of the spine

Strengthen intrinsic muscles:

1. Rag doll with support from arms, then breath and abdominals. See Lumbar lordosis above.

Practice note

1 Body curls: Abdominal muscle exercises are always done in a curling way with the knees bent. We are
aiming to achieve a controlled movement of each vertebra of the spine up and down, not sit ups. Body
curls have to be done properly or they will cause further injury.

1. Beginners need to have the feet held down to begin with. Reach towards the knees as you slowly
come up off the floor, arms extended. Then it is done with the shoulders turned, so that the shoulder
comes towards the centre line as you lift up. Repeat with the other shoulder forwards. When 10 rounds
can be done slowly and comfortably, we progress to the next stage:

2. crossing the arms

3. hands on shoulders
4. hands on ears.

To prevent straining the back, we need good overall muscle control. Both the longitudinal and oblique
muscles need to be worked. A body curl taking the nose towards the gap between the knees
strengthens the longitudinal group. The oblique muscles are worked when we twist as we lift and take
the shoulder towards the opposite knee. It is quality not quantity that is important.

2 Pawanmuktasana part 2: These practices will only assist in building abdominal muscle strength if the
lumbar spine is flattened towards the floor (bending the non-moving leg to facilitate this flattening).

3 Vyaghrasana (tiger pose): Do not swing the leg up, instead hold it no higher than the top of the head.

4 Naukasana (boat pose): Head and heels must be less than 15 centimetres off the floor.

H Hold pose for as long as possible without pain or excessive effort to allow full stretching and
strengthening of muscles. (When stretching a minimum count of 10 is needed.)

Mind, emotions and prana in healing

In yoga, we recognize that injury or trauma on the physical level is also reflected in the levels of mind,
emotions and prana. Healing of an injury is prolonged if these aspects of ourselves (pranic flow, feeling
and emotions) are not also cleared of trauma.

Assessment of the mental state and posture

Correction of posture takes time and effort on the physical level. While effort is made towards physical
correction, there is a flow-on to improve the general well-being too. As the body's posture reflects our
attitudes and feelings, we also need to consider psychological factors. Back problems are mostly rooted
in the unconscious mind and we need to work on releasing unconscious and subconscious tensions. In
yoga, we work to release these tensions through yoga nidra. If we consider our standing posture, we will
find that an imaginary line drawn in side view from the ear through the shoulder, hip and knee will
either be vertical (perfect posture), in a forward curve (indicating a tendency to worry or run away from
things), or in a backward curve (where we would rather face things bravely and fight). These inclinations
will predispose us to certain emotions. Practices like antar mouna can help us to identify and deal with
these emotions and help us to correct our posture.

Awareness and prana

Yoga also sees pain from the pranic perspective. Pain is accompanied by lack of prana, blocks in pranic
flow and imbalanced flow. Because prana is the stuff that interconnects every layer of our being, disease
can then manifest in any of those layers, and in more than one at once. To bring about healing at any of
these levels, we can work directly on that level, e.g. asanas for physical disease, meditation for
mental/emotional disease, kriyas for disease of the psychic body. Or we can work through prana. Where
your awareness goes your energy flows, and by tuning in to any form of pain our prana is directed there
and healing can begin.

As healing starts, prana begins to flow again and its flow is vital to complete healing. Blocks to prana are
cleared by physical movement, and bodyworking types of therapy. As joints and muscles are brought
back to full mobility, more prana will flow. When we gain mobility through yoga asanas we clear the
blocks more easily, and when we experience our prana we have a chance of directing it to speed our
healing through practices like prana vidya.

We can also work on clearing blocked prana using the relaxation and meditation techniques of raja yoga,
the yoga of the mind. When we've gained insight into our thoughts and mental patterns, we can then
use our minds in a positive and constructive way. Meditations specific to pranic flow, strengthening,
healing of injured tissue and clearing away the toxins are easy to learn and powerful in speeding up and
completing the healing process.

Healing visualizations

These images worked for me, but what you need to consider are the qualities you need for improved
health and what represents those qualities to you. It's very personal to your own experience and your
own mind. So don't use an imagery that doesn't feel right. Learn as much as you can about any disease
you have and how it heals itself. On the practical level, decide whether your body needs heat or cold,
clearing away first or nourishment for starved tissues (e.g. if there is osteoporosis, then we want to
bring calcium and collagen into the bones, so we may visualize bricks and mortar to represent these two
aspects of the cure).

Some suggestion for visualization

1. Cleaning up
• Damaged parts being cleaned up (buckets mops and brooms working around the cells of bone,
ligament and muscle). At the site of injury it's a bit like a battlefield. (It's the same with viral illness or
cancer.) We need to find a way of imagining the inner scene. There are dead bodies everywhere, so we
need to clear all the dead bodies away. Clearing the rubbish of war – spent weapons (dead white blood
cells and their rubbish), old foodstuffs, excrement. At the same time we need a good supply system
bringing in supplies to the troops which are there to heal, repair and fight any invading organisms.
• Improving circulation to clear away inflammation and toxins. The images could be of a whole gang of
cleaners with their gear to clean up the rubbish. We see all the wastes dissolving and being washed
away to be excreted from the body.

2. Rebuilding
• Rebuilding bones, tendons, discs and other soft tissues (builders, ladders, cement, bricks and lots of
tender loving care).
• Massage for aches and pains to help circulation to and from the area concerned.
3. Strength
• What represents strength for you? It may be an oak tree, or a steel bar or something completely
different.

4. Flow
• Prana and blood flowing easily in blocked areas. The prana flows through the body in many different
ways. In yoga, we are concerned with distribution and circulation of prana and where your awareness
goes your prana flows. So, if we can move the awareness through the body in particular patterns, we
find that this can be very therapeutic in removing blockages and distributing prana throughout the
whole system. Here are a few ideas to try. All should be done in a comfortable position and a relaxed
state of mind, sending love and respect with your awareness. As you move through the parts of the
body, there may come an experience from time to time of vagueness, jumping, lack of clarity as you
move through a part. This can be a sign of blockage. So, we move more slowly through that area, trying
to discover how we can get a clearer pathway through rather than skipping over it. Awareness and
prana will eventually flow smoothly. These areas of blocks can be areas that are painful, that have been
injured or deformed, or are holding physical, mental or emotional tension. Do not judge yourself by the
number of blocks you have. Just work to remove them.
• Alternate leg breathing: This is similar to alternate nostril breathing, but the awareness is taken
through the legs alternately in the same pattern. Once a smooth flow is established, we can extend this
practice to bring the awareness up to the heart and chest area, or even to the eyebrow centre before
going back down the other side of the body.
• Alternate arm breathing is similar. The awareness moves from the right fingertips, through the arm
into the chest and down the left arm to the fingers. Then reverse with the next breath.
• Movement of awareness through the spinal column. This is part of meditation practice where mantra
can also be repeated as the awareness moves.

Remember, your healing is only limited by your own imagination and beliefs.

We also need to recognize the phenomenon of cellular memory. Each cell remembers everything it has
ever done! It is said that scar tissue can be dramatically reduced by clearing the trauma from our cellular
memory through the power of the mind.

When we are comfortable with expressing our feelings, they no longer have to be stored
inappropriately, creating tightness and tension and lack of pranic flow. As well as reliving the experience
as a witness, bhakti yoga can help us to learn to express emotions in a joyful way, usually through music
and singing. Never be embarrassed to break out into song!

Attitude to pain

Nobody wants pain. It wears us down, draining energy and often creating a sense of hopelessness and
depression. We can carry on as before and resist it. When it interferes with our hopes and dreams, we
become dispirited instead of seeing the opportunities it brings. Sometimes pain gives us the time and
reason to rest instead of driving on through our lives. It's worth keeping a journal and writing down all
the advantages and disadvantages of pain, and discovering how we can gain the advantages without
having the pain. We can learn to be more accepting and welcoming of the pain, which results in an
immediate decrease in the pain experienced. Resistance to pain creates more pain.

Motivation

Now, imagine for a moment that you can do anything you want to do. You have all the resources you
need – money, connections, knowledge, time, health, energy and so on. What would you do with the
rest of your life? No limits! What is important? When your list is complete, write a new list just for the
next five years. Then go for it! Let it inspire you – without inspiration we struggle. How inspired are you
about the future? Your progress will depend on this factor.

Note: When learning the practices of yoga, the guidance of a qualified yoga teacher is recommended.
Most of the asanas referred to in this article are detailed in Asana Pranayama Mudra Bandha (APMB),
published by Bihar School of Yoga.
Yoga and Back Pain

Dr. Swami Karmananda Saraswati, MB, BS [Syd]

Backache is one of the most common disorders in our communities today. Every year in the United
States alone an estimated two million new members join the ranks of the multitude of sufferers from
chronic back pain, while in the United Kingdom the syndrome is second only to bouts of respiratory
disease (colds, flu, bronchitis, etc.) as the leading cause of lost man hours in trade and industry. It is
estimated that between 50 and 60% of the population will suffer from an incident of acute or more long
term back pain at some stage of life.

In spite of the magnitude of the problem, a simple, effective cure for backache has proved elusive to
modern medical science. For this reason, most doctors lack confidence in treating backache patients
effectively with therapy often becoming a long, drawn out and frustrating affair for doctor and patient
alike. As a result, the attitude of the chronic back sufferer is commonly a fatalistic and resigned
acceptance of this painful condition - 'till death do us part'.

However, our experience is that this need not be the case, for yoga offers a simple, effective and
permanent cure for this troublesome condition. Many chronic back pain sufferers who have resigned
themselves to a life of pain after a diagnosis of incurable spinal degeneration or osteoarthritis can be
readily liberated from their problem, and from later recurrences, after a few days or weeks upon
adopting a simple daily yoga program. Furthermore, the small percentage of patients (perhaps 5%), who
are actually found upon X-ray examination to be suffering from prolapse of an intervertebral disc, prove
equally amenable to yoga therapy.

What causes backache?

This question is hotly debated in therapeutic circles. However, recent studies have shown that the vast
majority of backaches are caused simply by muscular insufficiency and inadequate flexibility of muscles
and tendons. This contradicts the popular prevailing belief that a high percentage of backache is caused
by slipped disc, arthritis and degenerative joint disease, or organic conditions such as bone cancer,
Paget's disease and rickets.

Research studies

In one study, conducted jointly by researchers from New York University and Columbia University, USA,
an unselected sample of 5000 consecutive patients presenting complaints of backache to hospital
casualty departments were followed up. It was found that in 8% of the cases, the back pain had no
connection with herniated intervertebral disc, tumours or organic conditions of any kind. For over 4000
of the patients investigated, back pain arose simply from muscular strain as well as tendinous
inflexibility.

A similar study, again of 5000 patients, conducted by Dr. W.D. Friedman of the LCD. Rehabilitation and
Research Centre, USA, obtained almost identical results, concluding that in 4 out of 5 patients, acute
back pain occurs simply because functional demand upon the back muscles exceeds their capacity.
Failure to recognise this is probably the major reason why back pain is so poorly treated at the present
time.

The mechanism of common backache

The most common site for backache is the lower back, followed by the neck and the region between the
shoulder blades. This pain arises when the muscles surrounding and supporting the spinal column are
held rigidly and uncomfortably contracted over a long period of time. This situation commonly arises
from long hours in uncomfortable car seats and office chairs. When this goes on day after day, the
muscles gradually go into a state of tight painful spasm which becomes semi-permanent, as fibroblasts
infiltrate the troublesome region, laying down fibrous tissues. These spasmed or fibrosed areas can be
readily felt as deep hardened bands and nodules within the tender back muscles.

Chronic backache tends to be worse at days end and is relieved by massage, heat, relaxation and bed
rest. It responds readily and permanently to a program of yoga asanas and relaxation aimed at
increasing the functional capacity of the weak muscles.

Acute backache

Acute backache is usually a variation upon this theme. This is back pain of sudden onset and agonising
severity, which renders the victim completely immobile and helpless. This pain can strike at any time,
especially in those leading a sedentary lifestyle characterised by lack of exercise and overweight, both of
which contribute to functional inadequacy of the back muscles. Acute back pain commonly arises after a
trivial jolt or insignificant movement such as a cough or sneeze. Agonising pain accompanies every
subsequent back movement, to such an extent that movement becomes almost impossible.

This is by no means a rare occurrence, for statistics suggest that between 50 and 60% of the population
will suffer just such an incident at some time in their life.

When one is in this predicament, the first thing to do is to get into bed as soon as possible. The muscles
surrounding the injured area quickly go into spasm to provide a protective immobilising splint,
preventing all further movement of the area. By immediately getting into bed, the body demands are
reduced and the muscles can safely relax a little.

In the acute situation this severe pain can be effectively relieved by aspirin. The bed should have a solid
wooden supporting base underneath the mattress.

Application of heat to the affected area by fomentation or hot water bottle also brings relief. Stiffness
can be avoided by gradually moving the position in bed from time to time. Alternatively, relief may be
gained by applying a cold compress (ice blocks in a cloth are ideal) and some patients obtain best relief
from alternating hot and cold compresses every few minutes. Gentle massage several times a day also
facilitates recovery.
Ninety percent of cases of acute back pain will fully recover with a week of bed rest, with vast relief after
a day or two. The problem then becomes one of preventing a recurrence and it is here that yoga proves
of great benefit.

Yoga program to eliminate simple backache

These asanas should be practised for 15 to 20 minutes each morning without fail, followed by 10 or 15
minutes in shavasana. This program is specifically designed to increase the functional efficiency of the
various muscle groups responsible for back pain, and should be learned under expert guidance:

1. For lower back muscles: ardha shalabhasana, shalabhasana (locust posture), ushtrasana (camel
posture), makarasana (crocodile posture).
2. For shoulders and upper back muscles: dwikonasana (double angle pose), sarpasana, bhujangasana
(cobra posture), majariasana (cat posture).
3. Relaxation in shavasana or advasana with visualisation of tight congested back muscles relaxing,
letting go and flushing with fresh blood, as pranic energy is visualised flowing into the back muscles in
conjunction with breath.

(Note: Full details and illustrations of these postures are contained in Asana Pranayama Mudra Bandha,
a Bihar School of Yoga publication).

Dietary recommendations

Correction of back pain is facilitated when a light vegetarian diet is consumed and excess weight is
removed. Correction of chronic constipation often brings spontaneous remission of back pain. In this
respect the optimal diet consists of whole grains, roti or wholemeal bread, pulses, vegetables (steamed,
boiled or salad), fruits, nuts and juices.

Avoid excessive sugar, milk and dairy products, oil, meat and spices.

Follow this program regularly for One month and then reassess the state of your back and general
health. You will not recognise yourself- body and mind.
Backache Dr. Swami Shankardevananda Saraswati

Backache and slipped disc are major problems in today's world, and as yet modern medicine can do very
little to alleviate them. Many people are turning to yoga for an amazingly simple, yet effective, way to
remove the intense and crippling pain of backache and sciatica, and to prevent their recurrence.

Backache

Probably the most important cause of backache is tension. In today's fast moving world most people
find that they are being threatened by their environment and job situations. This tense state of mind
causes tightness in the neck, shoulders and back muscles. When we are threatened, we clench our teeth
and raise our shoulders in a defensive manner. We close ourselves off from the environment, and this
involves hunching our back and shoulders. This unconscious reflex must be corrected by awareness and
relaxation.

Another reason for so many back problems in our modern world is the advent of furniture. Chairs and
spring mattresses promote poor posture and induce weakness of the back muscles so that slipped disc
and sciatica can occur. When you sit in a chair you cannot maintain a straight and strong back for any
period of time. This causes our neck and shoulder muscles to compensate for the poor posture by
tightening up to prevent us from slouching excessively.

A strong spine is necessary for health. Yoga postures promote a straight and relaxed spinal cord. This
allows the prana to flow freely and the nerve currents to move unhindered. Yogasanas such as
makrasana, bhujangasana and dhanurasana strengthen the spine and back. Sitting in a cross-legged
pose, such as sukhasana, siddhasna or padmasana, keeps the back straight and is of great benefit to all
those suffering from back pain and sciatica.

Cause of backache

The major causes of backache today are:

1. Injury from twisting, lifting or crushing.

2. Degeneration of the back resulting from congenital or acquired causes or to lumbar spondylosis.

3. Spinal disease in the form of inflammation, tumours or Paget's disease of the bone.

4. Fevers such as influenza or abdominal disorders of the stomach, duodenum, pancreas or

urogenital tract.

5. Idiopathic (unknown cause) such as fibrositis, myofasciitis, sacroiliac strain, etc.

Slipped disc

This common occurrence is the main cause of backache. The disc lies between the bony spinal vertebrae
and is composed of a fibrous ring of tissue called the annulus which contains a fluid called the nucleus
pulposus. The disc supports the vertebrae and allows movement of the spine to take place. Slipped disc
is caused by prolapse of the disc substance. Either the annulus or the nucleus slips out of its normal
position. It can then press on the spinal cord causing backache, or on the nerve roots causing backache
and/or sciatica (pain starting in the buttocks and shooting down into the back of the legs). Prolapse is
usually below or above the fifth lumbar vertebra, at the level of the waist. It is accompanied by swelling
which makes the symptoms worse; this generally subsides with time, allowing the disc to slip back into
place. If the swelling is severe, the disc many remain prolapsed, interfering with the functions of the
spinal cord and the mechanics of the joints of the vertebrae. This causes permanent weakening of the
disc and if it has gone back into place, it may slip again due to the slightest strain or provocation, unless
strengthened through yoga and revitalised with prana.

Slipped disc is usually due to strain caused by lifting with the back bent, thus tearing a ligament along
the vertebrae. Incorrect movement is therefore the main cause. When you lift anything, the back should
be straight with the knees bent. Use the power of the legs and hips rather than the back. Slipped disc is
also caused by an increase in pressure inside the annulus from the absorption of fluid, or the
degeneration of the ligaments due to old age or ill health.

The first symptom of slipped disc is a sudden onset of intense pain, though the pain may be slight at first
and increase with time. The patient may be fixed in the forward bending posture with backache and/or
sciatica. Subsequent attacks can also come suddenly and often follow a trivial event such as coughing or
slight straining. The pain is made worse by straining or stooping.

Medical treatment

Medical treatment consists of applying heat to the area, analgesics for the pain, and exercise to
strengthen the muscles. To treat the prolapse itself, medical science has three possibilities.

1. Rest on a hard bed, made by placing boards beneath a thin mattress. (This is the type of bed used in
the ashram.) If it is a severe attack, the patient should stay in bed for three weeks. For less severe
attacks a special corset can be made, and for minor attacks the patient is asked to avoid stooping or
lifting.

2. Reduction by traction or manipulation can be applied to open the disc space allowing the prolapse to
move back into place. This also lessens pain. Manipulation is a valuable tool in the right hands, but is
usually avoided if there is sciatica. Alternatively, to reduce pain, local anaesthetic can be injected.

3. Removal by operative techniques has an eighty per cent success rate. It is only suggested by the
doctor if the attacks are severe, recurrent, disabling and persistent despite other forms of treatment.
This may leave the patient permanently disabled, perhaps with a fused spine, and should be avoided
unless other treatment has proved ineffective.

After medical treatment, rehabilitation involves education in lifting from the hips rather than the spine,
and exercises (backward bending) to strengthen the muscles. These exercises are similar in many ways
to yoga and restore suppleness and muscle power. Patients are advised to continue sleeping on a hard
mattress.

Yoga treatment

Through the practice of yoga combined with medical expertise, the strength of your back will return,
thus preventing further trouble. This is true preventative medicine. Backward bending asanas aid in the
treatment of slipped disc and sciatica by exerting traction on the area, strengthening and loosening the
muscles, releasing muscle spasm and freeing nerves which have been constricted. At the same time they
supply prana to the affected area.

The following three postures should be practiced regularly with awareness and relaxation for the relief
and cure of all back problems: makrasanna, the crocodile pose; bhujangasana, the cobra pose; and
dhanurasana, the bow pose. There are many other backward bending asanas which can also be used to
strengthen the back, for example: sarpasana, the snake pose; shalabhasana, the locust pose; ushtrasana,
the camel pose; supta vajrasana, the sleeping thunderbolt pose; chakrasana, the wheel pose; and ardha
matsyendrasana, the half spinal twist. All these postures offer the same benefits for back problems.
However, a few poses done well and practised regularly are far better than many poses performed
quickly without awareness and relaxation. All the above-mentioned asanas can be found in Asana
Pranayama Mudra Bandha, published by the Bihar School of Yoga.

While you have back pain or sciatica do not bend forward or do any forward bending poses. These will
come later when your back is stronger and free of pain. In order to strengthen your back as quickly as
possible, use makrasana whenever you have a chance- while you are reading a book, watching TV, etc.
This pose relaxes the whole body and eliminates pain. In this position be aware of those parts where you
have felt pain and try to direct prana into that area. Imagine this prana as a golden, warm, tingling,
flowing stream of force that revitalises and removes all dis-ease.

While doing any of the backward bending asanas, remember to feel into the spinal cord. Feel the
vertebrae and discs moving, massaging the annulus and making it strong and firm. When these postures
are practised as a supplement to medical treatment, the speed of cure and removal of symptoms is
increased. In this way you will benefit from the best of both sciences- yoga and medicine.
Physical benefits of backward bending asanas

The vertebral column and the discs between the vertebrae are made strong and flexible. This ensures
that the discs are maintained in the best possible health and do not become squashed or weakened,
thus preventing slipped disc. Spinal deformities can be straightened out and posture corrected, e.g.
rounded shoulders are eliminated.

The spinal cord is massaged. The nerves which emerge from the spinal canal can pass through the
vertebrae unimpeded. If regular exercise is not done, it is possible for the vertebrae or a disc to move
out of position and impinge on a spinal nerve, thus preventing the flow of vital nerve currents. Backward
bending asanas also increase the blood flow into the spinal cord ensuring a good supply of nutrients.
This is done by squeezing the blood out during the asana, so that on relaxing the pose, new blood
washes the impurities from a usually sluggish venous system. This encourages maximal function in the
nerves and thus affects the health of the whole body.

The autonomic nervous system is rebalanced and toned up by the action of the blood supply and the
massaging effects.

The back muscles are strengthened and nourished by the increased flow of blood. Backache is quickly
and easily removed. Posture is readjusted and corrected, removing spinal deformities. Backache will be
removed by relaxing tense muscles, releasing compression of the spinal nerves and removing general
body fatigue.

Slipped disc can be eliminated by the traction created, but it is preferable to have a teacher to help you
with these asanas, at least the first few times.

Rheumatism and other causes of backache are prevented and removed by the action of these asanas on
the joints of the spine and the rest of the body. This maintains flexibility and efficiency in the whole
musculo-skeletal system.

The whole body is made healthy through these powerful asanas. The abdominal organs are massaged
and manipura chakra, the pranic centre of the body, is stimulated and rebalanced. The lungs are fully
inflated and massaged, cleaned and stretched. The heart is stimulated and cleansed. The blood is
purified more efficiently by the lungs, kidneys and liver. The brain benefits from an increased amount of
blood. Massage of the spinal cord also improves brain function. When the spinal cord and brain are
relaxed and the whole body is toned up, back problems are eliminated.
Effects on Prana

Backward bending asanas increase prana by acting on the spinal cord and the solar plexus. These
physical manifestations of the most important areas of prana are revitalised, unclogged and cleaned out.
The spinal cord is the vehicle for sushumna, the central nadi of the body. It is the vehicle for the
autonomic nervous system, the physical manifestation of the ida and pingala nadis. The solar plexus is
the physical manifestation of the manipura chakra where prana is generated, stored and distributed.
When prana is generated from the solar plexus, the back remains naturally straight as the flow of energy
in the spine is like a rod, supporting the vertebrae and flowing into all parts of the body, maintaining
good health and preventing disease. Thus it can be seen how valuable a tool yoga is in co-operation with
modern medicine and healing systems in general.

The spiritual side

When you are crippled by back pain or slipped disc, how can you help your fellow man? Instead you
must be helped to regain your health and vitality. When the body and mind function as a harmonious
unit and prana flows freely, psychic centres open up. These are the chakras located in the spinal cord.
But if you have spinal trouble or back pain, it is not possible to open these centres in a healthy manner.
First the spine must become strong and straight, and the mind healthy. Only then can you reach the
higher levels of awareness that are the birthright of everyone.

Yogic Management of Slipped Disc and Sciatica

Dr. Swami Karmananda Saraswati MB, BS (Syd)

Slipped disc and sciatica are two closely related conditions occurring in the lumbosacral spine. The
human spinal column consists of more than 33 individual bones called vertebrae, stacked one on top of
the other and surrounded by the thick spinal muscles, the strongest muscles in the body. Lying between
the vertebral bodies are cushion-like fibrous pads which act as shock absorbers, protecting the brain,
spinal cord and internal organs from damage as we walk, just as the shock absorbers of a car protect the
passengers from the shock of a rough, bumpy road. These are the spinal discs. They are filled with a
thick jelly-like fluid and are held in position by strong ligaments attached to the bones above and below.
Slipped disc occurs when excessive strain is brought to bear upon the lower back region, causing one of
these discs to rupture so that the fluid inside herniates and escapes backwards. This injury usually occurs
while bending forward with the knees straight to shift a weight from the floor or while shoveling or
weeding in the garden. It has also occurred simply when releasing the clutch pedal while driving a car.

This painful experience usually occurs when a person with weak spinal muscles and ligaments applies an
excessive strain to the back. It seldom occurs in seasoned labourers or manual workers, but is frequently
seen in sedentary workers who are unused to regular exercise. Its incidence would be greatly reduced
by daily practice of a few yogic asanas to preserve the strength and flexibility of the spinal muscles and
ligaments, and with more widespread knowledge of the correct way to lift a heavy weight from the
floor. The crouching position with knees bent protects the vulnerable lower back from excessive strain.
The onset of slipped disc is sudden and immediate. Something is felt to 'go' or 'tear' in the lower back,
followed by a sharp, well localized pain which may be agonizing. The individual is left incapacitated-
either unable to straighten up at all, or else unable to bend the spine forward again, even slightly, as this
gives rise to immediate severe pain. He or she is usually brought to bed or for X-ray examination soon
after.

In the next few hours the back pain continues to worsen until it is constant and unremitting. This occurs
as the ligaments and tissues around the injured disc become engorged with blood and tissue fluids. The
protective covering of the spinal muscles rapidly goes into tight spasm to prevent further painful
movement of the area, and the delicate pain fibres supplying the torn disc ligaments become
increasingly irritated. The whole area becomes inflamed, hot and swollen and is very tender to touch.

Sciatica refers to a sharp, lightning-like pain which shoots down the back of the leg. It occurs if the
herniated material from a ruptured spinal disc in the lower back presses upon the delicate nerve roots
emerging from the spinal cord at that level. These nerve roots pass from the spinal column and converge
to form the sciatic nerves, which run down the back of each leg. These nerves run right down to the
feet, supplying the skin and muscles of the back of the legs. This is why sciatic pain may be experienced
in the buttock, in the back of the thigh or in the calf, even though the root problem lies in the lower back
region. In response to this pain, the muscles of the back of the leg go into a tight spasm, especially if the
sufferer continues to walk, because every step further stretches and irritates the injured nerve roots.

Initial recovery from slipped disc and sciatica

Slipped disc with accompanying sciatica is a painful, incapacitating experience which demands
immediate immobilization on a hard bed. Absolute bed rest is necessary while the ruptured disc heals
and inflammation subsides. In the acute situation of the first few days, pain relief can be provided by
applying alternating hot/cold fomentations over the inflamed area, and adopting a suitable yogic
posture such as makarasana which minimizes strain on the lower back region. Aspirin also proves useful
in this period. It is important that the spine be kept immobilized as far as possible. No attempt should be
made to leave the bed for any reason. For toilet purposes, a bed pan should be available. The patient
should rest in a quiet room with minimal disturbance until healing is complete. This commonly requires
10 days or even longer, if the injury is a severe one.

Long term complications and problems

Many slipped disc and sciatica sufferers have a long history of recurrent bouts of crippling incapacity
stretching back for many years. Any slight sudden strain, twisting or bending movement is often enough
to initiate the whole process once again. As a result they are no longer able to enjoy a full, active life.
They often become dependent on analgesic drugs for relief and are frequently forced to take time off
from work or household duties in order to rest in bed. Often their employers, family and friends begin to
regard their problem as a psychological one, for they are unable to comprehend a life punctuated by
continual incapacitating bouts of back pain. Sufferers often develop personality disorders as well -
becoming depressed, niggardly and irritable. They are often labeled as 'whiners' or 'complainers' and
others avoid their company. Marital, family and social relationships commonly deteriorate as the
problem continues to recur.

Surgical procedures

Long term slipped disc sufferers frequently come to surgery for removal of the troublesome disc and
permanent fusion of the vertebral joint. Whenever two bone surfaces are permanently opposed to one
another they quickly fuse together so that all movement ceases. The surgeon induces this process
wilfully by removing the damaged disc and obliterating the intervening joint contents. This procedure
which renders the spine permanently stiff and unable to bend, nevertheless provides welcome relief
after many years of suffering. Yoga, however offers an effective and far simpler way out of this painful
predicament.

Yogic management of slipped disc and sciatica

The following yoga program, when followed diligently, has been found to restore disc health and
prevent recurrences of both slipped disc and sciatica. The program is based on the backward bending
asanas, which strengthen the posterior ligaments and muscles that hold the damaged disc in place, and
promote the circulation of pranic energy to the whole region. They should be practised each day so that
spinal stability and function can be restored and a full range of activities can be re-adopted. In this way
surgical intervention usually proves unnecessary.

1. In the acute stage of immobilizing pain, a prone (face down) posture on a hard bed should be
adopted. Resting in makarasana (crocodile pose) for long periods reduces tension on the disc and nerve
roots, providing relief from pain and promoting healing. Sleeping in advasana (reversed corpse posture)
or jyestikasana (best posture) is recommended. In sciatica, matsyakridasana (flapping fish posture), with
the affected leg drawn up to the chest, to relieve pressure on the damaged nerve roots, will bring relief.
These postures should be adopted for relief of pain in the acute situation, so that as much rest as
possible can be gained.

2. The following backward bending asanas should be adopted, according to capacity, as healing
proceeds and pain diminishes. The first asana attempted should be the simple version of bhujangasana
(cobra posture) known as the sphinx posture. Do not strain, and stop if pain develops. Once sphinx is
mastered, the following asanas should be adopted gradually, in this order: bhujangasana, ardha
shalabhasana, saral dhanurasana, poorna shalabhasana, dhanurasana. Ultimately this program should
be practised in full each morning, before any food has been taken. Each asana should be practised a
maximum of 5 times, followed by complete relaxation in advasana. The session should conclude with
deep relaxation for 15 or 20 minutes, initially in advasana and later shavasana can be adopted. Daily
practice should continue indefinitely to avoid recurrence.

3. All forward bending asanas should be absolutely avoided for 4-6 months, as they can precipitate a
recurrence of the original condition. They may then be re-introduced gradually, under guidance, after
recovery is complete, beginning with shakti bandha series, shashankasana, majariasana and shashank-
bhujangasana.
4. During the recovery period, cross-legged sitting postures should not be adopted, as they increase
nerve root tension in the lower back. They can be resumed after a few months. Pranayama and
meditation in vajrasana are highly recommended.

5. Ajapa japa, movement of breath awareness in the spinal passage from mooladhara chakra in the
perineum up to ajna chakra at the top of the spinal column, is very effective in all spinal disorders,
including slipped disc and sciatica. Awareness of So-ham should be practised in conjunction with the
psychic breath, drawing the breath up from mooladhara to sahasrara with inspiration and the mantra
So, and taking the awareness down from ajna to mooladhara with expiration and the mantra Ham. This
can be practised in any prone relaxation posture with the spine straight. In the beginning, advasana can
be used, followed by shavasana once the supine resting pose can be comfortably adopted. Awareness of
the natural abdominal breath can also be added in shavasana. Ajapa japa can be practised as frequently
and for as long as desired. It promotes the flow of pranic energy in the spinal column, facilitates healing
and brings deep mental and physical relaxation. Finally, the practice should be continued in vajrasana,
then in a cross legged posture.
The effects of ajapa japa can be intensified if ujjayi pranayama is practised in the meditative postures
with an upright spinal column. The tongue is turned back onto the upper palate (khechari mudra) and
the throat region is contracted to produce a gentle snoring sound. This automatically increases the
depth and duration of respiration and concentration.

6. Dietary recommendations. In the beginning, a light, semi-solid diet should be taken, commencing with
vegetable soup. This will preserve digestive energy which can then be redirected towards the healing
process, and also prevents constipation, a major problem for patients confined to bed. As the condition
improves, vegetables and rice can be taken and later pulses and whole bread should be added. Avoid
heavy and constipating foods such as meat and oily preparations indefinitely. Dairy products and eggs
should be reduced during this period, as extra protein is not required. Highly processed and richly spiced
foods are best avoided indefinitely as well.