Yoga & Low Back Pain. A Physical Therapist’s Perspective.

Take Home Point #1: Yoga is Not Good for All Types of Low Back Pain.

Yoga as the Image of Health & Wellness

Somewhere along the way, yoga became the image of health and wellness. If someone does yoga, they seem to be healthy. Therefore, If I feel I am unhealthy or out of shape, I should do yoga to be healthy, right?

Not necessarily.

What is Yoga and Where Did it Come From?

Yoga is rooted in ancient Indian philosophy. Through the practice of breathing, meditation, and the physical practice of certain postures and poses (called “asanas”), the practice of yoga is meant to unite your spirit with a universal spirit (depending on the person this may be the Earth, God, or something similar).

Is Yoga Good in General?

Yes. I love yoga and practice it myself from time to time. I do not deter patients from practicing yoga in general either. We just want to be sure that yoga is good for YOUR body RIGHT NOW.

3 Greatest Physical Benefits of Yoga

1. Improves Muscle Flexibility. With the prolonged stretches/ poses, your flexibility does improve.
2. Improves Muscle Strength and Tone. Holding positions for prolonged periods works your muscles isometrically (strengthening when the muscle does not change in length). This is especially true if you “keep strong” while you hold your poses, rather than relaxing completely to try and increase your range of motion.
3. Improves Your Balance. Some of these poses are quite challenging to maintain for multiple breath counts. Continued practice of these poses will improve your balance ability.

So What’s the Problem with Yoga & Low Back Pain?

Many yoga poses challenge the limits of normal flexibility. Then, once you have achieved the apparent “end” of your limits, you are invited to stay there and breathe for multiple counts, inviting you to extend those limits even further.

All of our joints have a natural stopping point. The purpose of these natural end points include:

1. Protection of Essential Life Structures. Example: The Neck. The reason why we cannot turn our heads around 360 degrees like owls is to protect the arteries that are supplying blood to our brain.
2. Impact of a Bone on a Bone. Example: When you reach the end of elbow extension, the stop of the motion is because the ulna (one of the forearm bones) has reached the humerus (the upper arm bone). We don’t want to make an elbow that has normal straight range of motion even straighter as you would simply be impacting the bones on each other. In the long run, this would degrade the bone. Over time (typically years), this would cause significant arthritis.
3. End of Ligament (Passive Structure) Length. Ligaments are supportive structures that connect a bone to a bone. They are never meant to stretch. If you over-stretch a ligament you will sprain it or if taken too far, you will tear it. The ligaments typically make their complaints heard by achy pain. For example: When you sit with bad posture for too long and your low back starts to ache, this is typically the ligaments indicating they’ve been asked to support you for long enough and they would like a break from the stress.

This is the Fundamental Reason Why Yoga Can Actually Increase Low Back Pain.

If you are suffering from a type of low back pain that is due to structures being stressed due to TOO MUCH MOVEMENT, practicing yoga that INCREASES MOVEMENT FURTHER can only lead to INCREASED PAIN.

Take Home Point #2. Full Range of Motion is Good. Additional Range of Motion is Not Necessarily Better. Especially When Dealing with Types of Low Back Pain that Come from Too Much Movement to Begin With.

But My Back Feels So Stiff! Shouldn’t Yoga Help Decrease that Stiffness & Pain?!

People are so smart! This is an extremely logical thought process.

But the body’s symptoms can be deceiving.

When the body perceives that a body part (e.g. the low back or the sacroiliac joint) is moving too much, the body starts to protect itself. It does this by making the muscles in the region tighter. It’s as if the body is saying, “I have been telling you that this body part is hurting by giving you some pain. You didn’t listen. You’re still allowing that body part to move too much. If you won’t listen, I’ll just make everything super tight in that area and force you to not move it as much.”

So the real solution is to actually stabilize the body part that is hurting through strengthening exercises. ANY stretching will actually make you feel worse.

So What Should I Do Instead?

You should strengthen and stabilize. Especially gluteal strengthening and core stabilization.

Breaking Down If Yoga is Good or NOT Good for YOUR Low Back Pain

1. Is Your Pain Severe?

If your pain is severe and you would rate it as an 8/10, 9/10, or 10/10 pain on a scale from 0-10, yoga is not a good place to start. See an MD or a Physical Therapist first.

2. Does Your Low Back Pain Come with Pain in Your Buttock or Leg?

Yoga is not a good place for you to start. See a Physical Therapist first.

This type of pain suggests Sacroiliac Joint Pain and Dysfunction that is typically caused by too much movement at this joint. Yoga will typically make this pain feel worse.

3. Does Your Low Back Pain Come with Numbness/ Tingling that Travels into Your Leg?

Yoga is not a good place for you to start. See a Physical Therapist first.

Numbness/ tingling suggests nerve and/ or disc irritation. Aggressive stretching is not a good idea at this time.

4. Did Your Low Back Pain Start with a Bending, Lifting, and/ or Twisting Injury? AND Does it Hurt to Bend Forward? (NOTE: You must answer YES, to both of these questions for this to apply to you.)

Yoga is not a good place for you to start. See a Physical Therapist first.

This suggests possible disc irritation. Aggressive stretching that involves twisting and bending is not a good idea at this time.

5. Are You Newly Pregnant? Did You Recently Have a Baby?

Congratulations on your bundle of joy! Yoga is not a good place for you to start. See a Physical Therapist First. Due to the hormones in the body while pregnant, during childbirth, and while breastfeeding, the body is at its most loose and mobile. Yoga will typically loosen things further and increase pain.

6. So What Types of Low Back Pain Can Start with Yoga?

Yoga is a good place to start for individuals with:

• Gradual onset of low back pain over months or years.
• If the low back feels mildly tight rather than severely stiff.
• You feel tight in general and wanted to improve your mobility/ flexibility, but your actual pain levels are low.

5 Physical Therapist’s Tips for Practicing Yoga
In Relation to Low Back Pain

1. Seek Full Range of Motion with Lack of Tightness, Rather than As Much Range of Motion As Possible

I already made this point above, but it is worth repeating. To me, yoga should be about having range of motion with the absence of tightness. This will help keep your joints, muscles, tendons, and ligaments happy and without excessive stress.

2. “Stay Active” During Your Poses

True or long-term yogis typically do not like this suggestion. Much of the teachings surrounding yoga is about letting go of tension and relaxing into your poses and stretches. This is great for your stress and your energy, but not great for you orthopedically. My suggestion to “stay active” during your practices opposes this thought. When you’re in an aggressive pose, I would prefer for people to keep their muscles subtly activated to make sure your joints and ligaments still feel supported. Muscles simply need to be on to be supportive, no aggressive tension or contraction is required.

3. Beware of Deep Lunging Poses

If you have history of sacroiliac joint (SIJ) pain, I highly suggest you limit or eliminate Deep Lunging Poses completely.

By having your thighs in a split position close to the pelvis, it is like you are taking one half of the pelvis and pulling it one way, while the other half of the pelvis goes the other way. This is very stressful to the joints that connect the pelvis into a stable ring (these are the sacroiliac joints).

I typically approve of Warrior I and II and Triangle Poses as long as your legs are not in an extremely long stride.

I request that people keep the following poses to a minimum:

• Crescent
• Pigeon
• High Lunge
• Low Lunge
• Side Angle Pose
• Half Moon
• Or Any Other Pose that Resembles These

4. Beware of Deep Squatting Poses

Anytime you are in a deep squat (your buttocks is close to your heels) you are increasing pressure on the pelvis and the pelvic floor. Be cautious with these positions if you have a history of sacroiliac joint pain or pelvic floor dysfunction.

5. You Should Have Control of Every Degree of Flexibility You Have

If you pursue exaggerated flexibility, working on having strength, stability, and neuromuscular control into that range is essential to keeping your body pain-free.

Bringing It All Together

Yoga is not good for all types of low back pain. If you have low back pain, you will likely benefit from being evaluated and treated by a physical therapist first.

Tell your PT that your goal is to practice yoga and they can help guide you into a safe and healthy practice!