“. . . according to the Yoga Sutra (3.1), the term [Bandha] refers to the ‘binding’ of consciousness to a particular object or locus (desha), which is the very essence of concentration.”
Georg Feuerstein

Tuesday, January 24, 2012

Preventative Strategies for Lower Back Strains in Yoga: Part One

In this post we take a look at one of the leading causes for emergency room visits from yoga—lower back strains—and examine preventative strategies that may help in reducing the risk of this injury while enhancing the benefits of Hatha yoga practice. This series begins with info on joint rhythms and how understanding them can help in preventing injury.

Also, I would like to recommend reading Dana Santas interview in Men’s Health magazine entitled “Will Yoga Really Wreck Your Body?”1 Dana is an experienced yoga practitioner and teacher who works with elite athletes from a number of professional sports. She is a great resource for information on integrating yoga into sports training regimens. You might also check out Jason Amis’ counterpoint to a recent article published in the New York Times, which includes a clear and in-depth analysis of much of the data that was referenced. 

Jason provided me with the NEISS data relating to emergency rooms visits for yoga injuries in 2010 and I’ve done some preliminary analysis, which I will share with you. Data like this is extremely valuable, because it allows us to find ways to identify risks and then reflect on how to prevent them – a variation for the yoga community on the Sanskrit term “Atma Vichara,” or self inquiry. Here are my impressions: first, I was impressed by the relative safety of the practice compared to other activities. Second, it was clear to me that many of the injuries resulting in ER visits were potentially preventable. Think of it this way: there are injuries that are unpredictable, like stubbing your toe (also reported as an ER visit related to yoga), and there are those that are potentially preventable through application of common sense and knowledge of the body. Analysis of data like this provides an opportunity to identify preventable injuries and eliminate unsound practices that may have caused them in the first instance.

For example, lower back strains were the most common single diagnosis reported in the data for ER visits relating to yoga for 2010 (from the NEISS report). In fact, back strains are also a common workplace injury and much research is focused on the prevention thereof. Nevertheless, people still often strain their back at work, especially during situations in which they forget or are unable to implement preventative measures.

There is never any reason to rush or force oneself into a yoga pose, so it is possible that many of the back strains that occurred were preventable through working with proper technique, using modified poses where indicated and not rushing. Then, the practice becomes potentially therapeutic for the lower back, as has been demonstrated, rather than injurious.

Since I suspect that a percentage of these lower back strains may have arisen during forward bending poses, let’s begin by looking at the concept of lumbar-pelvic and pelvic-femoral rhythm in the forward bend Paschimottanasana.  


lumbar-pelvic and pelvic-femoral rhythym - paschimottanasana
Pashimottanasana illustrating lumbar-pelvic and pelvic-femoral rhythm.

Lumbar-pelvic rhythm refers to a type of joint coupling whereby tilting the pelvis in one direction produces a corresponding movement in the lumbar. Tilting the pelvis back (tucking the tailbone) produces flexion of the lumbar vertebrae. Tilting the pelvis forward produces extension. (I give a practical example of the former in a previous post on engaging the abs and gluts in Chaturanga.)

Pelvic-femoral rhythm refers to joint coupling at the hip whereby flexing the femur produces a corresponding forward tilt of the pelvis – and vice versa for extending the femur.

I access these rhythms when I work with yoga poses – especially forward bends – by gently engaging muscles that improve hip flexion and anterior tilt of the pelvis (joint coupling between the pelvis and the hip) and releasing the muscles that can limit hip flexion. In this manner, the forward bend comes more from the hip than the lumbar spine.

The hamstrings, for example, are hip extensors. They can limit hip flexion. Contracting the quadriceps contributes to releasing them through reciprocal inhibition. One head of the quadriceps, the rectus femoris, is also a synergist of hip flexion (and anterior tilt of the pelvis). Thus, engaging the quadriceps helps to produce forward bending from the hips rather than the lumbar. In general, when practicing forward bends, movement of the pelvis on the hips should be equal to or greater than movement of the lumbar spine in relation to the pelvis, otherwise flexion is concentrated in the lower back.

joint rhythym in paschimottanasana
Pashimottanasana illustrating joint rhythm with quadriceps engaged. 

As an aside, I also use periodic gentle muscular engagement of the quads when I am practicing a longer duration relaxed forward bend that is directed towards lengthening myofascial sheaths. Periodically engaging the agonists – or yang side of a stretch – does not diminish the lengthening on the antagonist (yin) side. In fact, it can enhance it both biomechanically and physiologically. This engagement also re-establishes alignment and mental focus. The Mat Companion Series provides a step wise approach to understanding the various muscles in the poses from this perspective as well.

Now, let’s look at what happens when we eliminate engaging the quads, for example, out of fear that the rectus femoris will cause “congestion”. We lose reciprocal inhibition of the hamstrings, which remain tight through the action of the muscle spindle in a stretch. This limits hip flexion. We also lose the contribution of the rectus femoris to hip flexion and forward tilt of the pelvis. The result is that the forward bend is produced more from the lumbar than the hips, which may contribute to lower back strain. Thus, avoiding an imaginary problem potentially causes a real one. For more info on the rectus femoris not causing “congestion”, see our blog post on how misguided cautions decrease benefits and increase risks.

joint rhythym with tight hamstrings - paschimottanasana
Pashimottanasana illustrating joint rhythm without engaging the quadriceps. Note the increased lumbar flexion.

Unsound theory is like a fly in the ointment. These things become “memes” that get circulated as if they were based on truth. And although such theories are often not based in reality, they can have manifestations in the real world, including a potentially increased incidence of back strains and other injuries. These problems then get sensationalized in the media and so on. Ironically, such media coverage can lead to well considered analysis – like Jason’s – which then helps to identify and eliminate potentially harmful disinformation and implement an affirmative strategy of prevention.

If you suffer from back pain, be sure to consult your physician to determine the cause; work under the guidance of a physician to manage your pain (see our full disclaimer here).

Great seeing you all again! Check in next week for Part Two of this series on preventative strategies for lower back strains in yoga. Also, be sure to visit us on Facebook for your free Chakra poster and e-book.

Namaste’ 

Ray and Chris


1. Greenfield, Paige. "Will Yoga Actually Wreck Your Body? | Men's Health News." Men's Health Magazine. 20 Jan. 2012. Web. 24 Jan. 2012. <http://news.menshealth.com/yoga-men-injuries/2012/01/20/>.

37 comments:

  1. Thank you so much for this post and all of your wonderful posts. Your illustrations with the arrows and your precise explanations and instructions are so useful. I can hardly wait for "Part 2 of preventative strategies for lower back strains in yoga" next week. Thank you for sending out all of your posts. I look forward to seeing you at the 2012 Toronto Yoga Show this spring. Catherine P.

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  2. Thank you, Catherine! I look forward to seeing you at the Yoga Show as well.
    Namaste'

    Ray

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  3. Once again an excellent post! Clear and concise. I would love to read the next post. Also, this might be a great idea to address certain areas regarding safety during practice. Maybe, culminate in a new book...Practicing Safe Yoga!

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  4. This is excellent information, thanks Ray and Chris! I often have issues with Pashimottanasana, and engaging the quads really helps!

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  5. Many Thanks, Nikos! I'm working on that subject as well--have a blog post coming up with some general thoughts. Namaste'~Ray

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  6. Thank you, Cinnaster! Definitely helps! Ray

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  7. I immensely appreciate informative biomechanical explanation. I hope you plan to send it as a Letter to the Editor of the New York Times!

    Sandy

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  8. i appreciate very much your very goods illustrations even if i don't understand all the texte ! It would be fine to have a possibility of translation in french !
    thank you ! it is really nice and helpfull !

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  9. as always, your articles are tremendously helpful. thank you!

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  10. I greatly enjoy your posts and appreciate the thorough explanation. My practice is deeper and my students are safer because of it. ~ Liz

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  11. thank's, I knew the action of the rectus femoris to hip flexion but never considered it in that position. I am an avid reader of your explanation and I have all your books. I used your tips all the time in my practice. I try to apply those to other field, like dance. It's based on science and I love it. we need more of that.

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  12. As an almost new yoga teacher I appreciate these blogs extensively and will definitely keep reading and learning from them. Thank you YTT mentor for signing me up. Yvonne W

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  13. Hey Ray, Monique here from the Yoga Loft in MN. Man, that muscle memory is truly something mind-blowing. Stablizing that pelvis is truly an injury preventive with my yogi & yogini students. Graci! Merci! This is some great karma you're making. Mary Beth has been using your techniques in her Monday eve Astanga class too. So happy you are doing what you do, please stop back to the Loft!

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  14. Thank You Ray. Your pictures and guidelines have helped me work slowly and carefully, without injury. My right knee turns in,2ndary to an old skiing injury, causing weakness in my rt groin,hamstrings are tight, and my hips unstsble because of the pulling. Very slowly, my knee is moving towards the center and my hamstrings are relaxing. My hips are opening and are more stable. I would not have thought it possible. Jan 25, 2012

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  15. As always, Thank You for your clear, concise and helpful posting. I find them an invaluable tool of understanding for both my private client performance specific and my everyday yoga class teachings. Many Thanks....
    Gerry Lishin
    South West Orlando Yoga and author - Yoga Teachers and Yoga Students Notebooks.

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  16. Nice informations. Thanks it's helpful.

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  17. Thank u Bandhayoga u hav given a good demo the need of asana adopt

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  18. A post said something about a Yoga show...Where is it and when? Thanks

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  19. Hi Anon,
    Toronto Yoga Show:
    http://www.theyogaconference.com/toronto/

    We'll be presenting two full day workshops on combining anatomy and physiology with yoga--hope to see you there!

    namaste'

    Ray

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  20. Hello Gerry,

    Thank you for commenting! Great to have your support-Namaste' Ray

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  21. Hello Monique,

    Delighted to hear the muscle memory is working for you guys! More on that in this series on preventative strategies next week. All the Best to everyone up in Minnesota! namaste'
    Ray

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  22. Thanks for commenting Ischa! We hope to have the blog translated at some point to French--are working on Spanish at the moment. Delighted to hear that you enjoy it! Namaste' ~ Ray

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  23. Hello Yvonne--All the Best with your YTT! Keep me posted on your progress. Namaste' ~ Ray

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  24. Thanks Sandy--glad to hear you're benefiting from the biomechanical illustrations. On the NYT, they know about me already! Namaste'~Ray

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  25. Thanks Yogini! Namaste' ~ Ray

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  26. Good to hear Liz--nothing is perfect but I have found that to be true in both my practice and teaching. I'll have some more pointers soon on safety soon! Namaste' ~ Ray

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  27. This is a great post. LBP (Low Back Pain) is one of the most common chronic conditions we see in Physical therapy (I am a current PTA student and yoga instructor). There are many ways people injure this area. Yoga can help immensely, if body awareness and satya (truth) are practiced. Be well, Namaste!

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  28. Great article I would also like to add that low back pain/ injury is best assessed and managed by Physician and Physical Therapist. Here in Canada you can self refer directly with a Physiotherapist who can provide expert and timely treatment as it can often take some time to get an appointment with a Physician. Acute healing phases last about 2 weeks. This is a key window for soft tissue healing during which we can maintain and improve the integrity of the tissues for optimal recovery. Then modified Asana practice can be resumed and reintroduced.
    Prevention is best though so listen to your body.
    Stay well

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    1. Thanks Billy, definitely true. Best~Ray

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  29. Ray!

    This was awesome and as always based in science unlike a lot of "so-called facts" that are out there! We appreciate your work because it's REAL! Namaste!

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  30. Hi Kelli! Thanks for stopping by. Great fun at the workshop at Zen Spot today. You guys have a solid program, very good to see.

    Namaste'~Ray

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  32. I'm a new yoga teacher and recent graduate from Kashi Atlanta - thank you so much for this post!!! One of our required reading materials was "The Key Muscles of Hatha Yoga". Your insight is INVALUABLE. Thank you so much!!!

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    Replies
    1. Great to hear, Adrianne. All the Best in your teaching! Ray

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    2. hi Ray,
      it really very Excellent Information got from your website. I am also Yoga student. I recently i took admission for 1 year course. and i got very important info from ur website.
      Thanks a lot
      Reshma
      From India

      Delete