BACK PAIN

Prevention is better than Cure.

Preventive measures include –

1. Awareness and correction of postures while standing, sitting and lying down,
2. Regular exercises and
3. Stress management .

Yoga techniques involving slow body movements followed by practices of deep relaxation are useful in maintaining the strength and flexibility of the spine. In persons who have had a minor acute episode of back pain, regular practice of a basic set of yoga practices of 45 to 50 minutes including Suryanamaskar, loosening practices, 8 – 10 asanas followed by deep relaxation, pranayama and meditation as recommended in our programme for promotion of positive health can be practised safely.

During acute episodes

Rest in bed is necessary which could vary from a few days up to about 4-6 weeks until the severity of pain comes down. Pain killers, muscle relaxants, cold or hot fomentation during this period of total bed rest and immobilization will help you to get relief from the acute pain.

Folded Legs Lumbar Stretch

STAGE -I (with one leg)

PRACTICE

Sthiti: Supine Posture

l Lie down on your back with legs together and hands spread sideways at shoulder level. l Palms are placed firmly pressed on the ground. l Fold the right leg at the knee, placing the right ankle by the side of the left knee. l Inhale. l While exhaling slowly move the right knee to the right side towards the floor, as far as comfortable andsimultaneously turn the head to the left as far as you can. l Then inhaling ,raise the right knee up and turn the head back to the centre. l Now, while exhaling move the right knee to the left towards the floor and simultaneously turn the head to the right. l While inhaling bring back the right knee and the head to the starting position (i.e to the centre). l This is one round, Repeat five rounds. l Repeat the same on the left side i.e., with the left leg folded and right leg straight on the floor. Note: l The leg that is stright should remain undisturbed and the feet should remain perpendicular to the ground. l If necessary, use the hand to place the knee on the floor. The aims in the management of an acute episode of lumbar pain are

1. Rest the painful part so that the acute injuries to the disc and soft tissues or the bone can heal faster.
2. Provide deep relaxation to the long thick para-spinal muscles that would be in protective spasm.
3. Immobilise the part so that the sharp pain that gets triggered by every small movement would increase the protective muscle spasm and would increase the protective muscle spasm and prevent them from relaxing.
4. Rest the mind; when you have much pain the mind cannot rest and sleep will be disturbed. Once you cannot sleep, you start worrying about the pain, its future consequences, the business problems, office problems, family problems, nations problems etc, etc,. which adds to the aggravation of pain. Hence it is very important to rest the mind. Conventional management techniques include a combination of immobilization, local heat or cold packs, nerve blocks, anti-inflammatory medicines, muscle relaxants, pain killers, tranquilizers to give rest and comfort.

Folded Legs Lumbar Stretch STAGE-II (with both legs) Sthiti (initial) for SupinePostures PRACTICE

Same as in Stage-I, except that here both legs are folded at the knees and the heels are placed on the floor and as close to the buttocks as possible, Inhale. l While exhaling lower both the knees together to the right towards the floor as far as is comfortable and simultaneously turn the head to the left. l Then, while inhaling raise the knees up and bring the head to the centre. l Now while exhaling, lower both knees to the left towards the floor and turn the head to the right. l While inhaling, bring the knees and the head back to the starting position. l This is one round. l Repeat five rounds. Note (For both Stages) l Synchronize knee movement with breathing. l Let the shoulders be firm on the ground; do not lift them during the practice. l Be aware and concentrate on the lumbar region throughout the practice. l While lowering the knee or knees towards right or left, feel the stretch in the lumbar region. l You may feel the stretch in the lumbar region much more in Stage-II than Stage I. l With continued practice, you will be able to perceive the stretch better and better.

Yoga during acute episodes

During this acute phase of bed rest yoga has an important complementary role to achieve quick results. Yoga, basically is a trick to give very deep rest to the mind body complex and hence can be used even during the acute phase of the back pain. As yoga emphasizes working mainly from the mind, once you start working with yourself to develop deep internal awareness and conscious relaxation and rest, you become confident to move on and on to manage yourself at later stages too.Lying down in bed has given you an opportunity and time to go within, and analyse your own life, understand the problems of your lifestyle, plan out a future time table for better management of the entire body mind complex. To be able to help yourself through these techniques you need to work with a positive attitude as a participant in this holistic complementary Management regime rather than lying in bed subjecting yourself to only the doctor’s complementary Management with scepticism and fear. The eight step yogic relaxation for low back pain is the recommended yoga during this phase .This has tobe practiced once in two to three hours through out your waking hours.

Crossed Legs Lumbar Stretch STAGE-I (Right over left) Sthiti:as for Supine Postures

PRACTICE

l Lie down on your back with legs together and arms spread sideways at shoulder level, palms facing and firmly resting on the floor. l Cross the right leg over the left by bending the legs at the knees and, wraping the right foot around the left ankle joint. l Inhale. While exhaling lower the knees to the right towards the floor, simultaneously turning the head to the left. l While inhaling bring the knees and the head back to the centre. l Repeat the same on the left side. l This is one round Repeat five rounds. Note: l If you cannot wrap one foot around the other ankle joint, just keep one leg crossed over the other. l You should be able to feel more stretch here, than in the case of Stage-II of item 1.

Why is Back pain becoming more and more common in modern man?

There are four major factors that go with the modern life style that are responsible for this increasing problem of back pain.

1. Muscles are weaker than our ancestors.

Modern technological advances has made life easy with tools, aids, gadgets and ever renewed transport facilities (cars and airoplanes) that have drastically reduced the need for physical activity. Today’s life style can be managed most efficiently without using our muscles. Every thing can happen by pressing a button on a P.C. or a Palm top. This is responsible for lesser stamina in the muscles all over the body in general and the strong thick postural muscles of the spine in particular. We know that it is regular activity that keeps any skeletal muscle strong and sturdy. The muscle power and stamina goes on increasing with increasing movement done in a systematically graded manner with enough rest in between. This is the principle used in any body building programme. Once the physical activity level reduces the muscles start becoming weaker and weaker.

Pavanamuktásana Lumbar Stretch

Sthiti: Supine Posture. PRACTICE

l While inhaling slowly raise the right leg up to 900 without bending the knee. l While exhaling bend the knee, pull it towards the chest with the hands (fingers interlocked) and simultaneously raise the head trying to touch the knee with the forehead. l Maintain for a while feeling the stretch of the back muscles. l Then, inhale stretch up the right leg to 900. l while exhaling lower the right leg to the floor. l Repeat the same with the left leg. l This is one round Repeat 5 rounds. Note: l Do not bend the knee while raising and lowering the leg, . l Synchronize perfectly your breathing with the movement. l While touching the knee with the forehead you should be able to feel the stretch at the lumbar region. l Do it with closed eyes and maintain awareness in the lumbar region. l You can do this practice with both legs together too.

2. Wrong muscles are overworked.

Bad postures during standing or sitting (sloppy chairs) or sleeping (cushiony beds) arel responsible for allowing the spine to go crooked as the supporting muscles are already weak. Wrong postures and curvatures of spine alter the line of weight transmission. This poses greater demands on some muscles that fall in this wrong line of weight transmission. These muscles are now subjected to long durations of activity in that they are made to remain in a state of partial contraction which they are not trained for. A muscle when held in a state of contraction for unused duration of time gets tired and when pushed beyond its capacity triggers off pain sensors resulting in back pain.

3. Repeated injuries due to unused exercise

After working hard all round the year in your office, you are looking forward to your long holiday away from hometown. where you would love to do your favourite sporting activity. The strain on the back starts even during your preparation for the holiday. The packing, loading, winding up the back log of office and house work , carrying travel kits are a bit too much for your untrained muscles. After reaching the holiday site you want to enjoy your sports. You are now prone to multiple sprains and strains, muscle pulls and small injuries. These soft tissue injures are most common in the neck and the lumbar spine. Whenever there is an underlying soft tissue or bony injury in the spine, the nature’s way is to protect the part by not allowing that part to move, by spasm of the long para spinal muscles. Thus any pain in the spine due to underlying injuries has almost a 50% contribution by the super-added postural muscle spasm. Acute injuries with even severe degree of pain would vanish with rest, local heat, painkillers etc. within one to four weeks. But the problem of recurrent and chronic pain is the major concern. This happens when you return to the same life style of sedentary working in wrong postures full of psychological tensions.

SEÛU BANDHÁSANA LUMBAR STRETCH STAGE-I (Seûubandha-sana breathing) Sthiti(initial) Supine Posture PRACTICE

l Lie supine with your legs together and hands by the side of the body. l Fold both the legs placing the heels on the ground near to the buttocks l While inhaling raise the buttocks and the trunk up as far as you can. l While exhaling slowly lower them down to the floor. l This is one round repeat five rounds. Note: l Keep the hands on the ground all the time. l Feel the stretch in the lumbar region while going up and release of the stretch while coming down l Synchronize the breathing with the movement.

STAGE-II (Seûubandhásana Stretch)

Sthiti(initial) Supine Posture l Same as in Stage-I PRACTICE l While inhaling slowly raise the buttocks and trunk up and place the hands under the waist to support the body well. l Then as you exhale, slowly stretch the legs forward by sliding the feet inch by inch. l Next, while inhaling slowly bend the knees again moving the feet backward inch by inch. l Finally, while exhaling slowly lower the buttocks and the trunk on the floor. l This is one round. l Repeat 5 times. Note: l You must have firm support of your waist in order to be able to maintain the balance. l Initially you may feel the pain in the elbows because of the weight of the body but gradually you will get used to it. l If you find it difficult to practice “Seûubandhâsana stretch” practice Seûubandhâsana breathing only.

4. Psychological stress.

The role of stress in chronic low back pain In a survey conducted amongst sufferers of chronic low back pain of greater than three months, it was observed that the contribution to the degree of disability in low back pain by the psychological distress with abnormal illness behavior was about 43% and the contribution by the actual physical problem was only 67%. Sikorski et al., in 1996 published their studies on the role of psyche in 131 subjects with chronic low back pain in which they concluded that the demonstrable bone or soft tissue structural problems accounted for only 38% of the pain and the rest of it was all due to the psychological stress, as assessed by a Psychiatrist. How does yoga understand the relation between life style and back ? According to yoga the causes of back pain can be classified as Adhija or Anadhija, i.e., functional or organic. The organic causes include Trauma, Tumour, infection which contribute to a small percentage of the cases of chronic back pain. The Adhija causes (functional causes) begin at the mind (Manas) level. Majority of the chronic low back pain are due to functional causes ( related to modern life style -adhija vyadhis).

DORSAL STRETCH Sthiti: for Supine Posture. PRACTICE

l While inhaling, slowly raise the head, shoulders and body up to the dorsal part of the back, raise the arms up to shoulder level (parallel to the ground). l Hold this position for a while. l While exhaling come down to the floor and relax. l Repeat the same movements five times.

Yogic definition of stress

The erratic life style of excesses either in eating and drinking habits, excessive indulgences in any form of pleasures of life, work, sleep etc., begins in manomaya koùa and this is at the base of the majority of the cases of non organic causes of low back pain.Thus the seed of stress is in the manomaya kosa.The distressful experience that we all experience as stress is an emotionalstate which could be triggered by different factors in different persons. The sages say that it is less useful to discuss what caused the stress than to know what is the state of your mind when you are stressed. Thus they go on define stress as ‘ a speeded up state of the mind.

Mechanism of adhija vyadhi

The problem of long standing stresses begins in the manomaya koùa and manifests initially only as psychological problems such as irritability, emotional lability, excessive smoking or alcohol, sleep disturbances, difficulty in making decisions etc. Over the years this starts disturbing the práïámáya koùa and shows up as any one of the digestive problems such as poor appetite, dyspepsia, constipation, flatulence, gastritis etc., which are common precursors of most stress induced ailments. As this goes on for a few more years it shows up at the annamaya koùa as unexplained musculo-skeletal pains either as muscle spasms, soft tissue pains, sprains, cramps, or inflammations. A combination of some of these imbalances settles down in one perticular part of the body showing up as recurrent episodes of acute or chronic musculoskeletal pains with no organically detectable cause.

Ardha SALABHSANA BREATHING Sthiti: for Prone Posture PRACTICE

l Lie down on your abdomen, legs together, hands stretched out over the head and chin on the floor. l Make fists of your palms with the thumb tucked inside and place them underneath the thighs.

STAGE-II (Ùalabhásana Repeat breathing)

l While inhaling, this time raise both legs together as far as you can. l While exhaling bring them back on to the floor slowly. l This is one round. l Practice ten rounds. c) Note: l Take firm support of your fists while raising one leg or both legs. Accordingly, place the fists so that you can take maximum support. ll Do not bend the knees at all. l In case of Ardha Úalabhâsana, the leg on the floor should be relaxed and straight. l Do not strain or exert yourself. l Synchronize the movement and breathing , closed eyes and breath awareness. l Be aware of your breath. l Keep your eye closed through out the practice etc. How does the prana imbalance select the target organ? We have seen that chronic back ache is a manifestation of long study stress of, if you go through major stressfully demaning life sit situations. Let us take the typical example of the pain in the neck and the back of a modern computer professional. A computer professional has all the three problems we have discussed earliernamely the sedentary life, wrong posture and the pressure of targets. The rapid pace of life demands the long hours work. An young energetic enthusiastic engineer in his twenties who is attracted by the big money that his job offers enters the company and sees that the others are smarter than him and are getting a big jump in their earnings once every three months. He is now faced with the challenge and decides to pushes himself up. The expectations both from his company and inner self push him into working long hours ignoring his sleep, food, and entertainment leave alone his own emotional needs. In this rush and joy of his achievements he moves on and on draining out his energies much beyond his capacity. Being young and proud of his own achievements his ego starts getting boosted up. He starts feeling oppressed and suppressed by the seniors. The supressed reactions along with the speed of competitiveness persist as uncontrollable speed in the manomaya kosa. Not well trained in handling this speed he drains out his energies just to manage the demands of the situation. This results in increased irritability,frustration ,indecisiveness etc. Over the next few months or years he starts getting low back pains which may pass off with rest in b ed for a few days. But this may come back and lead to chronic back pain.

Side Leg Raising Sthithi:

l Lie down on the left side, with the head resting on the folded left arm.. l Support the back of the neck with the left hand. l Place the right hand on the right thigh or in front of your chest. l Keep the whole body as straight as possible. l While inhaling slowly raise the right leg without bending the knee. Raise the leg as high as possible. Stretch out the toes. l While exhaling, slowly lower the right leg. l This is one round. l Repeat 5 times. l Repeat the same practice 5 times on the left side. NOTE: l While raising the leg you can maintain the balance, by pressing the palm on the ground. l Feel the strong stimulation of the lateral stretch at the lumbar region. l In one round of practice, one provides a good stretch to the lumbar region l To balance the body is a little difficult in this practice try to get the balance by adjusting the position of the arm below the head. l For better effect, synchronize body movements with inhalation and exhalation. How does the prana imbalance select the target organ? Amongst all the emotions, it is the negative emotions such as anxiety, suppressed anger and frustration that drain out the maximum amount of pranic energy. This speed at the manomaya koùa leads to increased nervous activity in the emotional (limbic) cortical pathways. Repeated activation of the same pathways leaves him habituated to that track to such an extent that a small stimulus is enough to trigger off this loop of excessive activity in the nervous pathways almost like an involuntary reflex response. This speed now starts showing up at the physical level as excessive activity in many nervous pathways such as the sympathetic, parasympathetic, or voluntary nervous system. Also the fast pace of life promotes early aging changes. These are probably the physical manifestations of the prana imbalances. It may take a few years before the ongoing imbalances start showing up in the annamaya koùa. Speeded up relentless activation of the skeletal muscles is the speed manifesting in the annamaya koùa as persistent muscle spasm. This in turn sets off large number of pain sensory nerve fibres to carry messages of persistent pain to the brain. Similarly the early aging change due to rapid pace of life manifesting as lumbar and cervical spondylosis is yet another manifestation of that speed.

Side Lumber stretch Sthiti: Supine Posture PRACTICE

l Lie down on the left side of the body. l Hold the back of the neck with the left hand. l Bend the right leg at the knee and hold the right ankle with the right hand behind the buttocks. l While inhaling move the right thigh backwards as for as possible by pulling therigt foot with the right hand and at the same time, bnd the head backwards arching the spine, keep the hand straight. l Then while exhaling bring the right thigh forward on the chest with the knee bent and right hand holding the right ankle. l Bend the head forward in the Pavanamuktásana style trying to touch the forehead to knee. This is one round. Repeat five rounds. l Repeat the same practice with the left leg while lying on the right side of the body five times.