Can Yoga Help Low Back Pain?
The lumbar spine with discs.
Herniated disc. Slipped disc. Bulging disc. Ruptured disc. Sciatica. All of these terms can be used to describe low back pain. But what do they mean? And if you have been told you have one of these things, what should you do or not do? Do you need expensive imaging? Surgery? Injection? Can you keep doing yoga?
The answer to the first question, what should you do or not do, is quite simple. Movement is going to help you heal faster than rest, and yoga has been shown to have a positive effect on low back pain, when taught by a highly qualified teacher. The positive effect of movement for low back symptoms has been shown over and over again, and the negative effects of waiting for things to get better have also been proven time and again. But does it hurt to move? Often times, yes, at least a little. The movement hurts, but that does not mean you are making the situation worse. What is needed is an evaluation of what movements are likely going to help you heal the fastest, make sure you how to do those exercises, and figure out what you what to specifically avoid. Yoga asana, the poses, are a form of exercise that can be modified into a low back program, making it a safe practice that promotes healing and relieves pain. Add in the other beneficial aspects of a full yoga practice, pranayama and meditation, and you really have some powerful healing tools.
What is a herniated disc ? Is this different from a bulging disc? Both types of disc injury mean that the outer layer of one of your spinal discs has weakened. When the disc wall has completely weakened to the point where the insides of the disc are pushing outward, it is considered herniated. Imagine an onion, with many outer layers, with a jelly-donut like filling pushing outward. As the disc weakens, the layers and sometimes the middle substance, push outward and onto the sensitive spinal nerves as they leave the spinal cord. The disc is considered bulging if it is pushing outward but the inner contents remain intact. Strangely enough, the amount of irritation of the nerves is rarely correlated to the amount of disc pushing on the nerves. This can prove a distressing situation for you if you have been told you have minimal bulging, but your pain seems intense. Conversely, there are many people walking around with significant bulging and no symptoms.
Side view of lumbar disc where spinal nerve exits through the foramen.
“But what if the disc is really herniated?” A good number of people are walking around right now with herniated discs. Most herniated discs have developed slowly over time, and may be occasionally symptomatic, but overall stable. A long car ride may aggravate the symptoms, causing an increase in discomfort for a few weeks, then it resolves. An acute herniated disc comes on suddenly and is associated with unrelenting low back pain which often radiates to the foot and can result in true muscle weakness, such as drop-foot, or inability to control bowel or bladder function. This is the type of back pain that is appropriate for a visit to the physician if symptoms don’t improve in a few days or weeks. But most cases of low back pain are limited to the low back and buttocks, and there is no related muscle weakness. The pain may be sharp, but without other symptoms, exercise, such as yoga and cardiovascular movement, is the best way to move through the episode and start the road to recovery.
Sciatica is the term that is used to refer to the pain that results from pressure put on the sciatic nerve. The sciatic nerve is a combination of spinal cord nerve roots that combine to form a large nerve found most easily in the center of the buttocks. This nerve can be irritated anywhere along its path, and therefore the diagnosis is somewhat vague. It can be caused by a herniated or bulging disc further up in the lumbar spine; it can be caused by compression of the nerve in the buttocks, as can happen with a long car trip where you sit on the nerve; it can happen with shortening of the muscles in the buttocks, often the piriformis muscle is identified as the culprit. Again, exercise is the most beneficial intervention, with directed exercise being even more helpful. Although the pigeon pose is often used to stretch out the symptoms of sciatica, this deep stretch can often increase the compression of the nerve and keep it irritated. It is important to have the root problem identified in order to do the right poses along with your breathing.
Extended side angle pose with the yoga wall assisting
Finally, slipped disc. There is just no such thing. It is a slang term to describe back pain, possibly of disc origin. Discs do not slip in and out. You cannot get adjusted and have a disc put back in place. Once your disc has bulged, it is bulged. It does, however, become less hydrated over time, and repeated MRIs done several years apart can show a decrease in bulging as the body reabsorbs the tissue. Your body is capable of healing with the right movement, good posture, healthy eating, and avoidance of the motions most likely to cause further injury.
Yoga, as done here in the United States can be a great way to help heal low back pain. The emphasis on posture, balance, breath awareness and alignment, all are known ways to help overcome pain and restore strength. If you are experiencing low back pain and think yoga might be a good way to treat your back, you can get started with an individual evaluation and an individualized home practice, then move into group classes as you master the poses and become educated on what poses you need to modify.
References
Cramer, H., Lauche, R., Haller, H., & Dobos, G. (2013). A systematic review and meta-analysis of yoga for low back pain. The Clinical Journal Of Pain, 29(5), 450-460.
Williams, K., Abildso, C., Steinberg, L., Doyle, E., Epstein, B., Smith, D., & ... Cooper, L. (2009). Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain. Spine, 34(19), 2066-2076.