What Yoga Poses Are Helpful for Low Back Pain?
What yoga poses are helpful for low back pain? We get this question a lot as yoga teachers, and the answer is that it depends. It depends on what is causing the low back pain. The two biggest misconceptions about lower back pain are that (1) we need to stretch the low back more and (2) we need to strengthen the core. It's true that at times stretching the low back may be the solution, but this is only the case if the low back is compressed. It can also be true that a weak core can cause pain in the lower back, but that is rarely the case despite popular belief.
What is Causing Your Low Back Pain?
Your first step when you are experiencing pain in the lower back is to find out what is causing the low back pain. There are questions you can ask yourself to help you get to the bottom of your low back pain mystery. Questions that I recommend you ask yourself include:
What are you doing with your body when your low back hurts? Are you typically standing or sitting when you feel the pain? Does it hurt when you fold forward or when you backbend? Does it hurt when you're lying down?
- Is the pain constant or intermittent?
- Does the pain come in random waves or is it always present? Does it hurt when you engage in a particular movement or activity?
- What kind of pain is it? Does it feel sharp or dull? Is it a shooting pain or a constant ache? Are you feeling something else?
- Does the pain come in different places in your body or is it always in the same spot?
- Is there anything that always makes the pain worse?
- Is there anything that always eases the pain?
Low Back Anatomy
The low back is made up of the lumbar spine and sacral region. There are many muscles and tissues that are in the low back area that could also be involved in low back pain.
Muscles that are in the low back area or that could have an effect on the area include:
- Quadratus lumborum
- Psoas major
- Transverse abdominis
- Internal obliques
- External obliques
- Rectus abdominis
- Erector spinae muscles
- Thoracolumbar aponeurosis
- Gluteal muscles
There are three main structures that can be found in the low back. They include the pelvis, the SI joint and the lumbar spine. The lumbar spine has a generous curve in that leads up to the thoracic spine, where the spine begins to curve in the opposite way. The lumbar spine is intended to mostly move in flexion and extension (forward bending and backbending). The curve is within these movements. Sometimes if this curve is not there, this can cause a lot of back pain and we start to see hyperextension.
Postural Issues Causing Low Back Pain
One of the primary causes of low back pain can be postural issues. In our 200 hour yoga teacher training online and 300 hour yoga teacher training online, Alecia teaches in our anatomy section about adaptive shortening which is when our muscles shorten as a result of our movement patterns and habits. For example, when my children were younger, I used to hold them on my left hip because I'm right handed. So my left hip was always slightly higher than the right and my left side would be engaged, my left hip and left shoulder moving towards one another and shortening the left side body. Then my right hand would be free for use. Over time, I realized my right side was longer and my left side was stronger.
Muscular Low Back Pain From Sitting for Long Time Periods
Adaptive shortening takes place when we do ordinary things with our bodies, like sitting for long periods of time. In our world, there's no way to escape sitting. We all sit. The postural issues come in when we sit for long periods of time and we don't counter that with standing and movement. When we sit, the lumbar curve goes away much of the time. After awhile, this leads to tightened abdominal muscles, shortened hip flexors and an overall imbalance in our muscles. This can lead to low back pain that is muscular.
Structural Low Back Issues From Sitting for Long Time Periods
In addition to muscular pain in the low back that comes from prolonged sitting, we can also find ourselves developing structural problems from sitting for long periods of time. The diminishing lumbar curve that we get when we sit can also start to compress the front of the spinal column which then compresses the discs we find between our vertebrae. This can eventually cause herniated discs or bulging discs, which causes pain in the low back.
If you picture the front of the spine being compressed, you can imagine that backbends would feel good because spinal extension lengthens the front of the spine. In this scenario, forward folds would not be helpful because they would further compress the front of the spine and cause additional pain.
Identifying Your Low Back Pain
Sometimes the part of the body that is hurting is the victim and another part of the body is the culprit. We can't assume that because we feel low back pain, there are issues in the back that are causing the pain. It could be that another part of our body, such as hip flexors, quadriceps or shoulders are tugging on our body causing pain. Sometimes, it really is the part of the body that hurts that is the source of the pain.
Common Muscular Low Back Pain Issues
The Erector Spinae muscle group includes 3 muscles that run medially to laterally along the spine. They are very thick and can become tired and overworked in the lumbar region pretty easily. In yoga, when we are focusing on strengthening the back or we have a heavy backbending practice, we tend to see pain from this muscle group. This muscle group can also become tight and may have trigger points that lead to pain in the SI Joint.
Tight Abdominal Muscles
When the front body is shortened from sitting or from any other practice, the abdominal muscles can become tight. This doesn't mean that they are stronger, only they are shortened and tighter. In this case, we would want to gently lengthen the front body, including the tight abdominal muscles. One thing that can be helpful is to get a bolster and spend 5-10 minutes daily in a supported backbend.
It is possible that weak core muscles contribute to low back pain, but that isn't always the cause. I've had students who spend a lot of time in boat pose and working their core to counter low back pain and it usually isn't the source of the problem. However, there are times when a weak core leads to an overworked back and in these cases, strengthening the core can help with low back pain.
Tight Hip Flexors
When the hip flexors are tight, this can contribute to low back pain. Specifically, the psoas major, the adductors and the rectus femoris can have a lot of impact on the low back. What happens is that tight hip flexors sometimes keep the pelvis in an anterior tilt. This creates excessive curvature of the low back and shortens the muscles in the lumbar spine area like the erector spinae muscles and the quadratus lumborum.
Common Structural Low Back Pain Issues
SI Joint (Sacroiliac Joint)
We often hear the Sacroiliac Joint being connected to low back pain. The Sacroiliac Joint, SI Joint, is the joint that links the pelvis and lower spine. Specifically, it connects the iliac bone (pelvis) to the sacrum (lowest part of the spine above the tailbone). The SI Joint is located at the very bottom of the low back. Pain from the SI Joint shoots upwards into the low back. Muscles in the low back area may have trigger points that send pain down into the SI Joint.
Joint Connecting Mid-Back to Lower Back
There is also a joint that connects the lumbar spine to the thoracic spine that can be associated with low back pain. From vertebrae T12 upwards, the joints that link the vertebrae together are facet joints that facilitate twisting and side bending but don't as much facilitate backbending and forward folding. From L1 down, we have facet joints that facilitate side bending, backbending and forward bending but not really twisting.
Because the spine functions differently in the mid-back region than it does in the lower back region, this area where the mid-back and low back connect often feels more tension. There's more force coming from both directions to this one space of the spine. When the force hits, it's stuck right here and can create low back problems and pain.
Disc Issues in the Lower Back
Low back pain may also be a result of issues with the discs in the lumbar spine. Disc dysfunction in the low back area is often very painful. There are so many reasons why discs can have dysfunction. Common reasons for disc dysfunction in the lumbar spine include postural, genetic, injury, repetitive movement or a lack of movement. Many people experience disc degeration, bulging discs, herniated discs or thinning discs.
Yoga and Low Back Pain
You can probably agree that low back pain and yoga is a complicated topic. Yoga can help some low back pain and worsen other low back pain. Whether or not yoga is helpful for low back pain depends on what causes the low back pain. It also depends on what style of yoga you are referring to.
Normally when students have low back pain, they want to know whether they need to stretch the low back or strengthen the low back. The answer is that it depends. There may be times they need to refrain from yoga altogether for awhile. Other times, strengthening helps while it could be that stretching would be the most helpful. It takes a level of awareness and personal investigation to figure out where the back pain is coming from.
I often ask my students to go see a medical professional. Healthcare providers can use their expertise and their equipment to rule out structural issues. They can help to find out what the source of the back pain is in most instances. While yoga can be helpful, it is not a substitute for healthcare and it's important that as yoga teachers, we stick to our scope of practice. We don't want to try to diagnose anyone or guess the cause of back pain. We simply want to support our students as they make good decisions for themselves. If they can't determine the cause of the low back pain themselves, they should see a healthcare provider. Once they've done this, they can provide us with much needed information to design a yoga practice that will be helpful.
There are times that we overstretch in yoga. Sometimes we force ourselves to go too deeply into a posture and our supporting muscle groups aren't ready for that movement. It can cause pain from overstretching, especially with spinal extension and flexion. We sometimes forward bend for too long or we go too deeply and this overstretches the low back. We can also move too quickly or too deeply into a backbend, which can compress and hurt the low back while overstretching the front of the spine. Remember that extension and flexion are easy for the low back, which increases the likelihood that we go too far and overstretch this area.
Forward Bending and Low Back Pain
When we forward bend, it should be about 65-70% hip joint movement and 30-35% spinal movement. When the hamstrings or the rest of the back body is tight, it can make it more difficult for the hip joint to find this range of motion. As the pelvis shifts forward and down around the femur heads, we reach a space where hip joint movement stops. If we lack the awareness to realize that the movement has stopped and we've reached our edge, we are more likely to overcompensate with movement from the spine. This can cause low back pain.
What might be helpful is to sit on a block or a stack of blankets. This lifts the pelvis and helps us to achieve more of an anterior tilt which can help to bring the pelvis back to a neutral place. We will then feel the forward bend more in the hamstrings that in the low back.
Some people are super flexible in the hamstrings in which case overstretching is more likely. In this instance, you would want to refrain from going as deeply as you possibly can into the forward bend. Holding back a little can keep the pelvis neutral. My pelvic floor teacher, Leslie Howard, emphasizes that we always want the pelvis in a neutral space. A neutral pelvis is a health pelvis.
Back Bending and Low Back Pain
As we've discussed, backbending can either help or cause low back pain, depending on the source of the pain. I always like to open the hip flexors before backbending. When the hip flexors are open, the pelvis is more liberated and can move without as much resistance. This alone will decrease the likelihood of low back compression. When backbending, we want the backbend to happen evenly throughout the spine. We wouldn't want the entire backbend to take place in only the lumbar spine. Rather than focus on going as deeply as possible in the low back area, you may want to try to shift focus to the mid-back where backbending is more challenging.
Join Us In Our 200 Hour or 300 Hour YTT to Learn More About Yoga Anatomy and Low Back Pain
If you'd like to learn more about yoga and low back pain, we'd love to have you join us in our 200 hour yoga teacher training and 300 hour yoga teacher training. Our anatomy sections help you to explore adaptive shortening and other anatomical issues.