Understand the difference between general back pain and herniated discs
Practicing yoga with back pain is one thing. Practicing yoga with a herniated disc is something completely different! Differentiating between the two is a big guessing game for most yoga teachers. It’s difficult because the symptoms of back pain and herniated discs overlap.
General symptoms of generalized back pain:
- Muscle ache
- Limited movement
- Pain traveling and moving to various areas
- Inability to stand up straight
General symptoms of herniated disc:
- Pain shooting down the back of one or both legs
- Inability to lift leg if laying on the floor
- Limited movement
- Inability to stand up straight or at all
Two things that can appear to be herniations and contribute to back pain:
- Trigger points
- Kidney stones
Where to start
If there is any doubt about whether you have a serious problem such as a herniated disc, go see a doctor and if possible have an MRI. Having more information is always better than having less information. At the very least you are then able to make better informed decisions about how you want to work with what you have.
You can read further about what happens in the body when you have a herniated disc on pages 184-187 (1st ed.) of my book: Functional Anatomy of Yoga.
What to do if a diagnosis of a herniated disc has been confirmed
For the remainder of this article I want to focus on practicing with back pain if you know (meaning diagnosed by a doctor) that what you’re dealing with is a large bulge or a herniated disc. What I am suggesting here is not meant to be taken as the only thing you should do. This protocol could change as symptoms change.
WarningPlease note that none of this should be attempted if you are in an acute stage of disc herniation. My suggestions are for only after things have calmed down and you have been checked by a professional!”
My suggestions are particularly pertinent to those that are doing a practice that contains a number of forward bends. Ashtangis take note! If you don’t know already, I teach Ashtanga vinyasa yoga. The majority of practitioners that I work with are working within the primary series which contains a number of forward bends. For those that want to practice yoga with herniated discs, the primary series of ashtanga seems ridiculous because the most common (there are always exceptions) movement that should NOT be done when you have a herniated disc is to flex the spine. Flexing the spine means shortening the front of it. Since the majority of herniations head backward and off to one side, when you flex the spine the disc gets compressed and could further herniate. Not a good idea!
So what to do?
What we need to do is redefine how to approach the forward bending yoga posture in this situation. Where does that forward bend happen from anyway? A forward bend is made up of about 2/3rd hip joint movement and 1/3rd spinal movement if your hamstrings are flexible. If the hamstrings won’t allow that much movement, then the most typical compensation your body will do is to flex the spine more than the remaining 1/3rd needed for a forward bend.
In an effort to minimize the amount of spinal flexion and potential disc compression, we want to emphasize the amount of movement at the hip joint.
How do we set up the forward bend?
The way we do this is rather simple. The difficult part is letting go of how you think the forward bend is supposed to be or what it’s supposed to look like. What we do is arch the back and maintain the lumbar curve from the beginning. From that point you only fold forward as far as your hip joint will let you. The moment your lumbar curve starts to flatten out, just stop. In addition, re-emphasize the lumbar curve by trying to create an anterior tilt in your pelvis. Send your pubic bone down toward the floor while lifting the chest. If you’re grabbing your ankles, feet, or using a strap, you can use the leverage created by holding them to help draw your ribcage up and forward and accentuate the lumbar curve.
The rest is simple, just hold it there and breath.
This is particularly written for those who are practicing and having symptoms. If you’ve had a herniated disc in the past and it has receded, this may not be necessary any more. It’s up to you test it!
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David answers the question: How do I self-treat sit bone pain and obturator internus? He explains that sit bone pain can originate from many different sources.