“. . . 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

Thursday, August 23, 2012

Degenerative Disc Disease, The Sushumna Nadi and Yoga

“A sword by itself rules nothing. It only comes alive in skilled hands.”
Sir Te to Governor Yu in the martial arts classic, Crouching Tiger, Hidden Dragon.

Many myths, legends, and historians hold that human beings in the ancient past were much more connected to their higher selves and power. These sources maintain that, at some point in our distant past, we suffered a primal trauma—an injury that affected us to our core, both biologically and psychically. Some theorize this event affected us on the very level of our DNA. The theory is that this trauma disconnected us from our higher powers and we have been suffering, causing suffering, and trying to heal ever since. Some postulate that yoga—specifically, hatha yoga—evolved in response to this trauma to re-establish this connection, hence, the name “yoga,” which means “to unite” (or re-unite).

Sushumna Nadi



First, let’s look at the channel that connects the energy centers, according to yoga physiology. The Sushumna Nadi is said to run through the center of the spinal cord, connecting the seven chakras or subtle energy centers of the body. To understand exactly what this means, turn from yoga physiology and consider the spinal column itself. It is made up of vertebral bodies, the discs between them, and the ligaments that link the vertebral bodies to one another. The spinal cord runs in the spinal canal, entering the skull through an aperture called the foramen magnum.

spinal cord and vertebral bodies

With this in mind, let’s look at a condition that affects the spinal column and, thus, has the potential to affect the Sushumna Nadi. Degenerative disc disease (DDD) is a condition, or medical malady.  It has been shown to affect as much as 90% of the population. This condition was previously believed to have arisen primarily from “wear and tear” on the intervertebral discs. Recent groundbreaking research, however, has shown that DDD is primarily hereditary, or genetic, in origin. The authors of "The Twin Spine Study: Contributions to a changing view of disc degeneration," state:

“The once commonly held view that disc degeneration is primarily a result of aging and 'wear and tear' from mechanical insults and injuries was not supported by this series of studies. Instead, disc degeneration appears to be determined in great part by genetic influences.”1

Ok. So we have, within our DNA, something that determines a degenerative process affecting us at our core--the intervertebral discs. Further, it appears that most of us have this affliction to some degree or another. Interesting.1,2,3,4,5,6,7,8 

Furthermore, yoga does not cause degenerative disc disease; it may have been developed to circumvent it.

Now, we know that DDD is associated with clinically relevant low back pain, but it can also be present asymptomatically, with no pain at all. With this in mind, it becomes interesting to consider how this genetically determined condition affects us beneath our conscious awareness.  Does this genetically encoded defect also affect us on the energetic level? For example, does it create blockages to the flow of energy within the Sushumna Nadi? If so, the next question becomes, “does practicing Hatha yoga have the capacity to over-ride this defect?”

It is said that Hatha yoga re-connects us to the Sushumna Nadi, thus developing higher potentials in the mind and the body. Just as myths and legends say that we lost our connection to our higher selves at some point in time, so many esoteric practices have also become “lost" arts. The re-emergence of Hatha yoga is a relatively recent phenomenon, and it remains in the developmental stage. Because Hatha yoga uses the physical body to reinvigorate our connection to the subtle body, combining accurate Western scientific knowledge of the body has the capacity to truly refine the practice. Considering that the practice of Hatha yoga has now reached a critical mass in the population, what could a true “re-connection” to our higher powers mean? 

Unsurprisingly, there is an element that has attached itself to yoga that is working diligently to derail this awakening process. They are attempting to do this by employing a manipulative methodology known as “Problem, Reaction, Solution." This process involves manufacturing a perceived problem that is designed to evoke a reaction (always anxiety or fear) and then offering a solution to the “problem” created. Since the problem was based on deception, so is the solution, which always involves disempowment. This scenario is typically presented under the guise of "protecting" you. Examples of how this is being used to manipulate fears in yoga are included below. 

Enter the Couch Potato…

As background for the first example, let’s look at herniated discs (a separate, though related pathology to DDD). Did you know that 40-75% of the population has some type of asymptomatic (painless) herniated disc? Put another way, the majority of people have some type of asymptomatic disc herniation before ever walking into a yoga class. Scientific references regarding this are included below. Like DDD, practiced properly, yoga doesn’t cause the disc herniation; it works with and around it.

Keeping this in mind, let’s look at some widely circulated information on forward bends that seems to imply that forward bends in yoga cause disc herniations. It begins with a graphic description of lumbar disc herniations; however, absent from this description is any mention of the fact that most of us have asymptomatic disc herniations anyway. Also absent is any real evidence that yoga forward bends cause disc herniations. (My preliminary analysis of the data on ER visits for injuries from yoga did not reveal one herniation caused by yoga). Nevertheless, those circulating this information know that they can cause anxiety by implying that forward bends harm the discs. So far so good: a problem is presented, and a reaction (anxiety) is caused. All that’s left is the solution. The solution that has been circulated is to perform forward bends while sitting on a stack of blankets with the knees bent over a bolster, using the weight of the body to slump into the pose. While this is excellent preparation for sitting in a chair (or on a couch), it is almost unrecognizable from a yoga forward bend. Furthermore, the “slumped” posture has been shown to increase the pressures in the lumbar intervertebral discs, potentially harming them. 15,16,17

Practising (and teaching) in this manner also establishes a “fear-avoidance” behavioral pattern, whereby the practitioner becomes habituated to doing the pose this way.18 The “solution” to the fear based “problem” thus creates a vicious cycle that disempowers the practitioner on both psychological and physical levels. This pattern of graphic descriptions of herniated discs and forward bends has been circulated several times in the media, (including with instructions to avoid using the protective and empowering mechanisms described in our previous post on the thoracolumbar complex).

So, to recap, we have all of the elements of “Problem, Reaction, Solution,” but all of them are based on a false premise: the implication that yoga causes a core problem (herniated discs). This is a well-known disinformation technique: imply that the problem was caused by the potential solution.

Deceptions of this nature are multilayered in that they also disempower yoga teachers, who naturally do not want to cause herniated discs in their students and, thus, find themselves in a “fear-avoidance” pattern of behavior in their teaching. Further compounding this disservice to teachers is that these types of articles open the door for a student to claim that the teacher caused a herniated disc that was already present prior to the student attending class.

A passive aggressive variation of this theme is the manufacturing of a “dilemma” around a valuable and beneficial pose, implying the risk of injury. This technique also manipulates a fear of injury, so that the solution to the dilemma is for a practitioner to avoid the pose.

Part of this process involves the “invoking of authority.” This can take the form of falsely attributing conclusions to a medical journal, as with the statement people with strong quads and misaligned kneecaps experience rapid progression of arthritis. A variation of this disinformation technique is to characterize something as a “fact supported by substantial evidence” without providing any such evidence (usually because none exists).  Another way to “invoke authority" is via “experts” who insert their opinions; however, upon careful examination, these individuals often are not actual experts. A variation of this concept is executed when a deception is being exposed; the calling of a “summit” or “panel” of “experts.” These events, often peopled by “stuffed shirts” and controlled by the few are designed to reach a disempowering “consensus opinion” that has been scripted beforehand. We’ve seen this happening many times in government and in the media. 

Fear and anxiety are two of our most powerful emotional responses; they form in infancy and are very easy to manipulate. The same pattern of manipulation can be found in the situations we are discussing; create a problem to evoke anxiety, couple it with yoga, disempower the practice. Should persons engaging in this be creating “standards” for the practice?

Friends we are living in an exciting time. Scientific discoveries like the genetic basis of degenerative disc disease may uncover many new understandings about our past, present, and future. More to follow...

Check back again for our next blog post where we will go into greater detail on the stabilizing mechanisms of the spine with another strategy to aid in preventing lower back strains in yoga. Also, be sure to "like" us on Facebook and download your copy of our free E-book.

References:

1) Battie MC, Videman T, Kaprio J, Gibbons LE, Gill K, Manninen H, Saarela J, Peltonen L. "The Twin Spine Study: Contributions to a changing view of disc degeneration." The Spine Journal. Jan-Feb 2009; 9(1): 47-59.

2) Livshits G, Popham M, Malkin I, Sambrook PN, Macgregor AJ, Spector T, Williams FM. "Lumbar disc degeneration and genetic factors are the main risk factors for low back pain in women: The UK Twin Spine Study." Annals of Rheumatic Diseases. Oct 2011; 70(10): 1740-5. Epub 2011 Jun.

3) Hancock MJ, Battie MC, Videman T, Gibbons L. "The role of back injury or trauma in lumbar disc degeneration: an exposure-discordant twin study." Spine (1976). Oct 2010; 35(21): 1925-9.

4) Videman T, Gibbons LE, Kaprio J, Battié MC. "Challenging the cumulative injury model: Positive effects of greater body mass on disc degeneration." The Spine Journal. Jan 2010; 10(1): 26-31. Epub 2009 Nov.

5) Battié MC, Videman T, Parent E. "Lumbar disc degeneration: Epidemiology and genetic influences." Spine (1976). Dec 2004; 29(23): 2679-90.

6) Battié MC, Videman T. "Lumbar disc degeneration: epidemiology and genetics." The Journal of Bone and Joint Surgery. Apr 2006; 88 Suppl 2: 3-9.

7) Battié MC, Videman T, Levalahti E, Gill K, Kaprio J. "Heritability of low back pain and the role of disc degeneration." Pain. Oct 2007; 131(3): 272-80. Epub 2007 Mar.

8) Paajanen H, Erkintalo M, Kuusela T, Dahlstrom S, Kormano M. "Magnetic resonance study of disc degeneration in young low-back pain patients." Spine (1976). Sep 1989; 14(9): 982-5.

9) Boos N, Rieder R, Schade V, Spratt KF, Semmer N, Aebi M. "1995 Volvo Award in clinical sciences. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations." Spine (1976). Dec 1995; 20(24): 2613-25.

10) Jensen MC, Brant Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. "Magnetic resonance imaging of the lumbar spine in people without back pain." New England Journal of Medicine. Jul 1994; 331(2): 69-73.

11) Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. "Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects: A prospective investigation." The Journal of Bone and Joint Surgery. Mar 1990; 72(3): 403-8.

12) Powell MC, Wilson M, Szypryt P, Symonds EM, Worthington BS. "Prevalence of lumbar disc degeneration observed by magnetic resonance in symptomless women." Lancet. Dec 1986; 2(8520): 1366-7.

13) Masui T, Yukawa Y, Nakamura S, Kajino G, Matsubara Y, Kato F, Ishiguro N. "Natural history of patients with lumbar disc herniation observed by magnetic resonance imaging for minimum seven years." Journal of Spinal Disorders and Techniques. Apr 2005; 18(2):121-6.

14) Jarvik JJ, Hollingworth W, Heagerty P, Haynor DR, Deyo RA. "The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study: baseline data." Spine (1976). May 2001; 26(10): 1158-66.

15) Watanabe S, Kobara K, Ishida H, Eguchi A. "Influence of trunk muscle co-contraction on spinal curvature during sitting cross-legged." Electromyography and Clinical Neurophysiology. Apr-Jun 2010; 50(3-4): 187-92.

16) Watanabe S, Eguchi A, Kobara K, Ishida H. "Influence of trunk muscle co-contraction on spinal curvature during sitting for desk work." Electromyography and Clinical Neurophysiology. Sep 2007; 47(6): 273-8.

17) Claus AP, Hides JA, Moseley GL, Hodges PW. "Different ways to balance the spine: Subtle changes in sagittal spinal curves affect regional muscle activity." Spine (1976). Mar 2009; 34(6): E208-14.

18) Kell RT, Risi Ad, Barden Jm. "The response of persons with chronic nonspecific low back pain to three different volumes of periodized musculoskeletal rehabilitation." Journal of Strength and Conditioning Research. Apr 2011; 25(4):1052-64.

21 comments:

  1. We choose not to be participants in the ubiquitous Facebook presence, but we do "like" you and are saying so here and now. Thank you for this very interesting work you are doing.

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    1. I, too, choose not to forfeit my personal integrity to Facebook. But I do read this blog and in a sincere way like and appreciate the information and the effort you put into this.

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    2. Thank you for circumventing Facebook~Ray

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    3. Cheers Ray for this amazing blog and also for the newsletters. I particularly like to refer my students to your facebook page. In this time of yoga comeback where it is currently "flavour of the month" (I've seen it come and go in my 40+ years of practice)along with all other kinds of fitness frenzy that is helping people to find connection with their bodies and give meaning to their lives. You make a lot of sense and being on facebook gives many newcomers to the yoga scene another route to be safe in their practice. Your high tech presentations are also appealing and being present on facebook is definitely a plus. Facebook is what it is. Yoga teaches community-global and individual -union. Facebook could be something like that. The internet gives us that access-Facebook networks this. Thank you again for your work.

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    4. Hi Mary,

      I apologize for the delayed reply; was traveling the last two days. Agree with your comments about Facebook; well said. Glad to see your thoughts on various flavours of yoga. I think those things come and go, but Hatha in the true sense of the term, is intrinsic to the body. The high technology, as well as advancements in the understanding of the body make the practice more accessible. So I was quite happy to see your comment, since I've watched this evolution of yoga myself. I'm glad to see your comment on this particular post especially! Best~Ray

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  2. What Yoga and all other metaphysical activities promote is the connection to one's higher self/ intuition/ own authority.
    And this is what one should listen to,your own self guidance is what is needed and that also is a muscle that with practiced use becomes more powerful, reliable and is the best support structure you can have.
    There are many negatives out there who will try to derail the "re-connection" but this is all part of "The Journey" to become our own wise, all knowing, connected self, we have to learn and trust to become our own authority and not keep giving our power away to authority figures.

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  3. Thanks for writing this. I'm 57, and have a daily, often vigorous yoga practice that began 2 1/2 years ago after two episodes of disc ruptures, extrusion, and nerve impingement in 2003 and 2010 ended my 30+ years as a runner. In both episodes, there was a period of significant weakness followed by gradual recovery of function over a period of months. I still have residual numbness/paresthesia in parts of the L4 dermatome of my left leg (from 2003) and parts of the L5 dermatome of my right leg, particularly the foot (from 2010).

    I mention this injury history not to bore you with my medical 'woes' but as context for my experience as a yoga practitioner. I have found that - far from further damaging my discs - asana practice has been an important factor in understanding the extent of my injuries and recovery from them.

    For example, by working with a yoga teacher who is also a physical therapist, I learned that the residual effects of my injuries (such as weakness in the gluteus medius) are likely a factor in the instability I experience in one-legged balances, such as Vrksasana, Virabhadrasana 3, and Utthita Hasta Padangustasana. By practicing supported (and attempting unsupported) versions of these asanas and other standing poses regularly, I have made slow gains in balance and stability. I've also found that the attention required to activate the legs and feet in asana practice has led to some symptomatic improvement in the numbness/parasthesia affecting my right foot.

    Deep forward bends are among my favorite asanas and present no problem for me, despite my history. Backbends are also a regular part of my practice, now that I've learned the importance of distributing the backbend throughout the spine, rather than taking it primarily in the highly mobile lumbar region. Since starting asana practice, I rarely experience back aches or pain, and when I do, they're transient.

    An important nonphysical effect of my asana practice has been a change in the way I view injuries and injured parts of my body: I now often see them as partners pointing me in the direction of greater wellness, rather than as enemies of my well-being. It is so much better to feel unified and at peace with the body, rather than at war with it - appreciating its amazing capabilities, even in injury, rather than focusing on supposed shortcomings and failures.

    - Eric B.

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    1. Thanks for sharing your personal experience, Eric. Well said, and reflective of my own.~Ray

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    2. Eric, thank you so much for sharing your journey and your insightful perspective on injuries. I very much appreciated what you had to say.

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    3. So do I. Thanks very much. Reading this really helped me to see my own disc ruptures last year with different eyes.

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    4. Hi Eric, That's great! I have re-started my yoga practice after a 5 year gap, after being prompted by a mild disc lesion occurring this year. It is indeed an 'invitation' by my body to understand it further, and it has been very interesting. To approach an injury in this way is very productive, and enlightening! Like you I've found that yoga has decreased my symptoms, but I am lucky as in the past I've had some very good teachers who've taught the correct activation of muscles in asanas - vital information! And thank you Ray for further vital information and for putting it 'out there' for everyone to access! Namaste, Nina xx

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  4. Regarding "Scientific discoveries like the genetic basis of degenerative disc disease" in the second to last paragraph. The science of Epigenetics (understanding how perception of the World creates the biology of our bodies) will overrule any genetic basis. How you see the World selects which genes are going to be activated. Therefore Yoga is a powerful influence in so many ways. When we practice well-aligned yoga on the breath we are literally creating powerfully positive perceptions running through the bodymind complex which is re-connecting us physically, mentally, emotionally and spiritually. We are creating cohesive energy patterns and we are literally changing our DNA. Your generous webposts are reminding us of this power we have to reclaim our health.

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    1. Thank you for posting this essential information, Anon. ~ Ray

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  5. Great information. A lot of food for thought for me about my languaging while teaching. Thank you.

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    1. Thanks Gina--appreciate your pointing that out (languaging while teaching). All the Best~Ray

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  6. I want to second the comment on epigenetics. Perception is the rule. If we believe we will degenerate and fall apart "so it goes". As a yoga practitioner of 34 years and a teacher of 20 I have to hand it to the practice when people guess my age at 45 (I am 59). The practice includes seeing through Maya and believing in the infinite. We can also believe in the regenerative capacities of life. As a healer/body therapist I am to educate my clientele of their power to care for their body/self.
    www.abtherapeutics.net

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  7. Dear Ray and Chris, I cannot thank you guys enough for supplying this priceless information. I am a yoga teacher who feels knowing the anatomy of ones body is so valuable when teaching. Teacher training should include more in depth information on these topics of anatomy and how it relates to yoga. I absorb the e-mails and lessons and feel so much better about what I have learned and am much more confidant when I teach. I went to your workshop at Kripalu a few years ago, I must say one of the most informative on this topic. I use many of the techniques learned that weekend, as well as always referring to your books. I would love to attend another workshop and I do hope to receive emails on that soon! Namaste’

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  8. Dear Ray,
    Thank you so much for integrating Western science and Eastern wisdom. As a rehabilitation practitioner and academic, your posts are extremely valuable in raising my understanding about the body and how yoga fits with adaptation to chronic health conditions such as DDD.

    I do find it curious that DDD can be defined as a medical "problem" when 90% of people experience it. For me, it smacks of the creeping "abnormalization" of many different aspects (physical and psychological) of human function and well-being. I haven't read the full paper yet. Basically, it seems to say that among the 90% of the population that will be afflicted with DDD that genetics are a significant contributor. This is not surprising considering previous work that has found no relationship between the primary onset of low back pain and either fitness level or anthropometrics.

    My question is given that some among us have a propensity to develop DDD (which may or may not be symptomatic) and given that once developed, back pain is more likely to recur than not, how do people stay out of trouble in the long term. As a chronic back pain sufferer, yoga has been my biggest support over the past 3 years.

    I likewise have concerns with those who would spread a more serious condition than DDD among the population - the idea that they are damaged or may be at risk of damage given particular yoga movements. As I once heard an enlightened Cardiologist say "Don't wait to see your doctor before you exercise - get moving".

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