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).

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.

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.

Lengthening the Torso in Forward Bends

In “Preventative Strategies for Lower Back Strains Part I,” we discussed femoral-pelvic and lumbar-pelvic rhythm, muscles that influence these rhythms, and the effects of these muscles on the lumbar spine. Here, our discussion progresses as we cover the trunk, the thoraco-lumbar fascia (TLF), Uddiyana Bandha and how accurate knowledge of this can be used to enhance the benefits of yoga and decrease the risk of lower back strains.

The thoraco-lumbar complex (TLC) is a multilayered structure comprised of the thoracolumbar fascia and the muscles that connect to it. This composition of passive fascial tissues and active muscular structures acts as a corset-like structure that encircles the torso. It plays a key role in maintaining the integrity and stability of the lumbar spine and the sacroiliac joint and is also important for load transfer from the upper limbs to the lower limbs. Engaging the muscles that connect to the thoracolumbar fascia acts to stabilize the spine and trunk. We give an example of this in a previous blog post on using the latissimus dorsi to lift the lumbar and expand the thorax. Figure 1 illustrates the thoraco-lumbar composite in cross section at the mid-lumbar. 

Cross section of the thoracolumbar fascia with its connections to the abdominal core and erector spinae (at L3).

To further illustrate, consider a cylindrical container of a fixed volume. Decreasing the circumference of the cylinder results in an increase of  its' length (to maintain the total volume). The torso, with the abdominal cavity, can be viewed in the same manner: tensioning the abdominals acts in combination with the TLF to lengthen the torso and lift and stabilize the lumbar. Think of this concept in conjunction with the Sanskrit term “Uddiyana,” which means lifting or flying up. Figure 2 illustrates this.

The mechanism for lengthening the trunk with the thoracolumbar complex. The pelvic diaphragm is below and the thoracic diaphragm above.

This lengthening of the torso takes place through several mechanisms that work in concert to variable degrees depending on the position of the trunk. The first action relates to intra-abdominal pressure (IAP). Engaging the abdominals increases IAP, which numerous scientific studies have indicated stabilizes the lumbar spine. The second mechanism relates to tensioning the TLF. Activating the transversus abdominis muscle tensions the TLF, thereby providing resistance to flexion at the lumbar spine. Furthermore, the transversus abdominis muscle has attachments to the thorax; engaging it transfers stresses from the lumbar region to the thorax and shoulders. Tensioning the TLF also improves the efficiency of the back muscles (surrounded by this fascia) through a mechanism known as the hydraulic amplifier.  Because the erector spinae are surrounded by the TLF, its various layers resist muscle expansion during contraction. This tends to straighten the spine (think of how a bicycle tire straightens when you fill it with air). Finally, the erector spinae muscles have fibers that insert onto the interior surface of the TLF so that as they lengthen into a stretch, they can exert a passive pull on the fascia. These various mechanisms contribute to lengthening the torso and stabilizing the lumbar spine. I provide a number of scientific references on this subject below.

Clinical studies have demonstrated an association between low back pain and inefficient engagement of the abdominals. All of this has implications for the use of Uddiyana Bandha, both for protecting against low back strains and for potentially improving the treatment of low back pain through yoga. Below, we illustrate the sequence I use to access this mechanism.

Ease in to awareness of the thoracolumbar composite by using a progression of poses. This leads to understanding of the action of Uddiyana Bandha in lifting and lengthening the trunk and stabilizing the spine. Begin with a pose like simple crossed legs (Sukhasana) or Dandasana. The cue for co-activating the abdominal core and erector spinae is to draw the navel towards the lumbar and lift the lower back. Visualizing the trunk as an hourglass and the anatomy of the thoracolumbar composite as a corset helps to access this lifting and lengthening action. Fixing the hands on the mat and attempting to drag them backwards accentuates this lift by including the latissimus dorsi. Incorporating the accessory muscles of breathing, including the pectoralis minor and serratus anterior, in this pose lifts the lumbar from the thorax. You can experience this lengthening effect by initiating these cues even as you sit reading this post.

Co-activating the erector spinae and abdominal core to lift the lumbar.

After warming up, incorporate these same principles into Downward Facing Dog Pose. Engage the thoracolumbar composite by co-activating Uddiyana Bandha and the erector spinae (and quadratus lumborum) to lengthen the trunk and to lift the tailbone, respectively. (Figure 4)

Lifting the coccyx and lengthening the lumbar in Downward Dog Pose.

These same protective mechanisms can be accessed in forward bends such as Paschimottanasana by using the abdominals to lengthen the trunk, as with the hour-glass visualization described above. Additionally, engaging the abdominal core aids in accessing the function of these poses, which is reflected by their form. Part of this function is to lengthen the muscles of the back. Engaging the abdominal core helps to relax the erector spinae through reciprocal inhibition. Peripheral fibers of the erector spinae attach to the TLF; as these muscles lengthen, their fibers exert a pull on the TLF, thus distributing the forces through the length of the spine. Accordingly, although I may use brief periods of contraction to release the muscle (through PNF), I do not recommend maintaining eccentric contraction of the erector spinae throughout the pose (I will explain why in the next blog post).

I combine the actions of the thoracolumbar complex with lumbar-pelvic rhythm by engaging the muscles that contribute to tilting the pelvis forward. Figure 5 illustrates the connection between the tensor fascia lata, the pelvis, and the thoracolumbar composite. See “Preventative Strategies for Lower Back Strains, Part II” for the cues on engaging the synergists of hip flexion and forward pelvic tilt. Also see our post on co-activating the gluts and abs in Chaturanga Dandasana.

Engaging the TLC with the abdominal core and connecting this to lumbar pelvic rhythm with the tensor fascia lata.

The anatomy and protective mechanisms of the human body have evolved for eons. These same mechanisms have been researched and documented in the scientific literature. Anatomic and biomechanical principles that govern our bodies when we perform simple actions, such as walking, also apply when we are on the mat. Keeping this in mind, we must dispose of some incorrect concepts permeating the yoga world concerning anatomy and how the body works. The first of these implies that engaging the abdominals and Uddiyana Bandha harms the intervertebral discs. This misinformation, often circulated with graphic descriptions of lumbar disc herniations, discourages engaging the protective and stabilizing mechanisms of the thoraco-lumbar complex in yoga poses under the misguided premise that avoiding these essential mechanisms somehow protects an individual. Other disinformation discourages engaging the abdominal core in forward bends under the odd premise that contracting these muscles causes “congestion”. Finally, there is the breathtaking statement that the spine does not depend on muscles for stability. This widely circulated misconception is contradicted by basic anatomy and yoga itself. In this regard, I quote Jiddu Krishnamurti: "Until the false is seen as the false, truth is not."

Good to see you again. Practice under the guidance of a qualified instructor; use their assistance to determine modifications or suitability of a given pose for your individual practice. Always consult your healthcare provider and obtain medical clearance before practicing yoga or any other exercise program.

Check back again for our next blog post where we will go into greater detail on the stabilizing mechanisms of the spine with another protective 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) Hodges PW. “Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis.” Spine. Nov 1996; 21(22):2640-60.

2) Crow J, Pizzari T, Buttifant D. “Muscle onset can be improved by therapeutic exercise: a systematic review.” Physical Therapy in Sport. Nov 2011; 12(4):199-209. Epub 2011 Feb 26.

3) Critchley D. “Instructing pelvic floor contraction facilitates transversus abdominis thickness increase during low-abdominal hollowing.” Physiotherapy Research International. 2002; 7(2):65-75.

4) 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.

5) Essendrop M, Andersen TB, Schibye B. “Increase in spinal stability obtained at levels of intra-abdominal pressure and back muscle activity realistic to work situations.” Applied Ergonomics. Sep 2002; 33(5):471-6.

6) Cholewicki J, Panjabi MM, Khachatryan "A Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture." Spine. Oct 1997; 22(19):2207-12.

7) Unsgaard-Tøndel M, Lund Nilsen TI, Magnussen J, Vasseljen O. “Is activation of transversus abdominis and obliquus internus abdominis associated with long-term changes in chronic low back pain?" A prospective study with one-year follow-up. British Journal of Sports Medicine. Jul 2011; 26. [Epub ahead of print]

8) Hodges PW, Richardson CA. “Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb.” Journal of Spinal Disorders and Techniques. Feb 1998; 11(1):46-56.

9) Bjerkefors A, Ekblom MM, Josefsson K, Thorstensson A. “Deep and superficial abdominal muscle activation during trunk stabilization exercises with and without instruction to hollow.” Manual Therapy. Oct 2010; 15(5):502-7. Epub 2010 Jun 8.

10) Hodges PW, Cresswell AG, Daggfeldt K, Thorstensson A. “In vivo measurement of the effect of intra-abdominal pressure on the human spine.” Journal of Biomechanics. Mar 2001; 34(3):347-53.

11) Hodges PW, Eriksson AE, Shirley D, Gandevia SC. “Intra-abdominal pressure increases stiffness of the lumbar spine.” Journal of Biomechanics. Sep 2005; 38(9):1873-80.

12) Barker PJ, Guggenheimer KT, Grkovic I, Briggs CA, Jones DC, Thomas CD, Hodges PW. “Effects of tensioning the lumbar fasciae on segmental stiffness during flexion and extension: Young Investigator Award winner.” Spine. Feb 2006; 31(4):397-405.