Hot Yoga and Back Pain

This testimonial is the story of my personal recovery from debilitating pain from herniated discs through the practice of the therapeutic Bikram Method Yoga.  This yoga gave me back my life. In the depths of my pain, I remember sitting in the car with my husband outside one of our favorite restaurants crying. I couldn’t even imagine enduring the suffering of a nice, romantic dinner. The thought of sitting for 45-minutes was pure torture.

The following is my story and experience. I have included a posture-by-posture list of my personal approach to the practice for back pain-sufferers. I offer the information to help you on your way. People write me daily asking if Bikram Yoga will work for them. I am not a doctor. It worked for me. It has worked for hundreds of my students. The principles work.

My story

I injured my back in the fall of 2001, shortly after starting yoga. I had spent my youth playing sports: rugby, field hockey, snowboarding, running and weight-lifting. A lifetime of aggressive contact sports culminated in two herniated discs in my low back at S1/L5 and L5/L4. They caused acute low back and sciatic pain radiating down to my left knee.

I was in pain constantly, even in my sleep. I couldn’t roll over in bed. The pain was so acute some days that my husband had to put my shoes on my feet before work. I was unable to carry a bag of groceries. It was excruciating to go to work, to rest, to sleep, to walk, to drive.

I dreaded the shaking pain from brushing my teeth.

My doctor offered three options: drugs, discectomy, or cortisone shots for life.  At this point, I had begun my yoga practice and something about it just felt right. Like the stubborn Pole that I am, I decided to try yoga first.

It was no miracle cure from the start. Classes were hard and uncomfortable  I was new to yoga, so I had limited body awareness and poor abdominal control. I had set backs regularly. At the time, my job only allowed me to attend 3 to 4 times a week. Some days I didn’t think I could handle the pain and challenge of a class, but I always felt better after attending. I had increased range of motion, better sleep, less pain and an ability to participate in more. Class was hard, but I always felt worse when I skipped class.

Somedays, I would turn my head to the side after Cobra and pour tears from the pain.

Over eighteen months, I saw slow progress. The miracle happened when I started practicing two times a day at teacher training. It took me ten days of doubles to be pain-free. PAIN. FREE. As in, no pain. I could sit without a back support. I could roll over at night. I could put my pants on standing up.

I kept it up for two months, resting on Sundays. I had a few set-backs in the first year. Under extreme stress or after moving or shoveling snow for hours in the Vermont winter, I had times where I got sore again. I found that the quicker I got back to yoga and the more frequently I practiced, the faster I recovered.

Now, seventeen years out from the initial bad spell, I live a free, active life. I hike, snowboard, shovel, stand on my head. I competed last year in the Tough Mudder. There are no yoga poses that I skip or avoid. I haven’t thrown out my back since 2004.

I had two babies and never experienced back pain. I continue to practice 4-7 times a week, every week. I practiced regularly throughout both pregnancies. In fact, I took the nooner and had my son that same night.

I recognize that double classes are not possible for all of us. With less frequent practice, the healing will simply take more time. Be patient with yourself and your students. Be strong and work hard. All you need is your body and this yoga to heal yourself.

Anatomy of Back Pain

Once a herniation, always a herniation. Intervertebral discs function to cushion the spine and absorb shock.  A herniated disc is essentially a disc with a hole in it. In a herniation, the annulus fibrosis (the tough outer membrane of the disc) is breached, and the softer, inner membrane (nucleus pulposis) extrudes. In general, pain occurs when the extrusion comes into contact with a nerve.

It is interesting to note that contact with a nerve causes pain, but long-term contact with a nerve causes numbness. Since most people with herniated discs experience pain for months or years, this doesn’t fit with the anatomical expression of pain. This leads us to believe the connection between pain and structural deformity are not necessarily causative. Specialists like John Sarno speculate that it is our pain response that causes chronic pain, and not the herniated disc.

A traumatic accident or years of accumulated abuse and degeneration of the tough outer walls most commonly cause herniated discs. Studies report that by the age of 25, 80% of Americans have experienced back pain. A vast majority of the population shows herniated discs on an MRI, but there has been no proven correlation between herniated discs and pain.

It is common for people with painful, herniated discs to have tight hamstrings (creating downward pressure on the pelvis) and/or weak abdominal muscles. Both cause a state of nearly constant forward bending in the low spine and unsupported movement of the lower back.

The spinal nerves are located on the back side of the spine. When a person bends forward, the front of the vertebrae move closer together. This forces the disc toward the back of the spine and the spinal nerves. Persistent, unsupported forward bending will cause or aggravate back pain from herniated discs. It is essential, especially in the beginning of healing for the student to be very cautious with forward bending. Remember that bad posture, driving, working on the computer, slumping on the couch, gardening and sitting are all forward bends.

In a culture where we spend most of the day seated, it is no wonder back pain is endemic.

For most people, when their low back hurts, they lean forward and touch their toes. This will exacerbate the back pain. You just spent all day forward-bending. More of the same will get you more of the same.

It will sound counter-intuitive to most people to backward bend when they are sore, but it is essential to make that philosophy shift. Instead of leaning forward, a back pain-sufferer should try a supported standing back bend throughout the day as needed. It will be hard and sometimes painful in the beginning because of the trauma-like protective tension in the muscles and inflammation. You cannot approach your healing from a place of fear.

That has been the hardest point for me to get my students to understand. I have watched students yank on their toes in the final stretching, skip camel, drop into child’s pose between postures and do the whole class with their gut hanging out. After years, they cannot understand why they are not healing. When they finally understand and embrace the anatomy of their back pain and try the postures the right way, they begin to live without pain.

Back bending heals the spine.

Back pain sufferers need backward bending to strengthen and relieve pain.  In a back bend, the backside of the vertebrae come together, moving the discs and their extruded nuclei away from the spinal nerves, thus relieving pain. Pain relief may not be instantaneous because there is often a good deal of swelling in the area and tension in the muscles from experiencing pain. Time will help.

Step one in back bending is traction. Imagine lifting your vertebra off the offended disc. Create length in the spine first so you can flex and extend without pain. You don’t need a $5,000 anti-gravity table for that. Simple yoga poses like Half Moon Pose or Pranayama Breathing are simple and safe ways to relieve pressure and tension in the spine. These exercises also serve to make your back muscles stronger to support the compromised joints in your spine.

Second, it is important for those with herniated discs to begin strengthening their abdominal and back muscles. One can never heal or repair a herniated disc. The hole will always be there. The student must develop enough muscle strength to support the back and prevent aggravation. That means: SUCK YOUR GUT IN. Throughout the class, draw the abdominal muscles in during all postures, even backward bending. When you are walking, lifting, bending, pay attention to your abdominal muscles and engage them.

Third, spine twists are a healing movement for herniated inter-vertebral discs. The rotation of the vertebrae serves to draw the extruded material back into the disc. Any time the low back has been compacted or strained, a spinal twist (like the reclined abdominal twist) will help undo the damage. Initially, the degree of rotation will be limited because of the compression and pain. This is why your physical therapist says it is contraindicated. They are primarily interested in helping you with pain management. Over time, as the pain decreases and your alignment and strength increase, your range of motion will follow.

What to do in class: There are four main concepts to work on during class.

 Easy does it in forward bending

Traction first

Back bend like crazy

Activate your abdominals and all of the core-stabilizing muscles

The following is a list of modifications that may need to be made in the beginning of a student’s healing process while there is a lot of inflammation in the lumbar spine and trauma in the muscles.

Expect your limitations to change.These modifications are temporary changes to help you get through the tough times. As you are able, you will move back to the regular execution of all postures. Really. You.

Pranayama: Beginning breathing is a tremendously-powerful traction exercise for the spine. It causes decompression of the intervertebral discs and through this action, the cartilage uptakes moisture and nutrients to improve function and health of these tissues.

Pranayama is also a chance to build the muscles that support the lumbar spine. Take this opportunity to engage your abdominal muscles as much as possible.  Remember that a strong belly means a strong back.

Half Moon: The side-bending is helpful in relieving the tension in the muscles around the lumbar spine.  Use it to help you feel less uncomfortable. Remember, traction first. Draw the belly muscles in and lift up out of the waist as you bend to the side. Keep the abdominal muscles in to prevent hanging from or hinging at the lower spine.

Backward bend, backward bend, backward bend. Traction first: stretch UP before a back bend. Remember to keep your arms straight and reach back so you don’t sink into your lower back. Concentrate on lifting your chest as you arch back. Feel the back bend begin in your neck, travel down the rib cage through your thoracic spine and down into your lower back one vertebra at a time. Use 100% of your back strength.

Many people with back pain tend to bend only at the top of the neck and the lower spine. A therapeutic backward bend involves every vertebra in the spine to the best of it’s ability with no excess pressure on one or two joints to take you deeper.

Hands to Feet: Take it very easy. Walk your hands down your thighs instead of keeping your arms with your ears. Try to touch the floor. If putting your hands on the floor is too much, bring your hands to your thighs, chin up, suck in your belly and flatten your back. No rounding when the pain is acute. You should look like an upside-down letter L from the side.

Awkward: Work the backbend in part one like it is your job. Oh wait, it is. Work your abdominals throughout. Imagine you are drawing the lowest points of your ribcage together.

Eagle: No problems. Remember this pose is a back bend. Work it. Again, stomach in.

Standing Head to Knee: This one is a major challenge in the beginning. If you can reach your foot, try standing up a little higher with it and sucking your abdominals in when you feel sore. If you cannot reach your foot due to pain, stand up straight and lift your thigh as high as it will go. DO NOT GRAB YOUR KNEE OR YOUR THIGH. This will put more pressure on your low back. As you are ready, contract the abdominals and begin to round forward vertebra by vertebra and reach toward your foot until you can grab it. This pose will be a long time coming for most people in acute pain. Take your time and have patience. Pushing beyond what you are capable of today will not speed your healing process.

Standing Bow: Work it as strongly as you can; it’s good for you! This is a unique opportunity to stretch your tight hamstrings while in a backward bend. If tight iliopsoas muscles causes pain in your tender back, drag your abdominals in as strongly as you can and then add the kick. Pull in the transversus abdominus can feel like pulling the hip crests toward each other or sucking in your belly to zip up a tight pair of jeans.

Balancing Stick: You may not be able to come down to parallel because your arms and torso drag on your lower back fairly intensely. If not, set it up. Step forward and stand rock solid like a statue and stretch your body apart from your toes to your fingertips. Belly in, of course. Over time, start to take it down inch by inch. Patience, grasshopper.

Standing Separate Leg Stretching: This posture may strain the low back in the beginning, but it is important to get a stretch to those tight hamstrings. The goal is to find a happy medium. Try hands to the thighs or hands to the floor in between your feet, depending on your flexibility, with a flat back, stomach in just like suggested in Hands to Feet. No rounding of the spine. Go down only as far as you can from hip flexion, not spinal flexion.

Triangle: Another good one to open your hips and reduce back pain. This pose is also a great spine strengthener and gentle twist. Do your best with lots of abdominal control and without fear.

Standing Separate Leg Head to Knee: Similar to balancing stick, you may only be able to set it up. Step out, arms strong, belly in and turn to the side. Build the strength in your abdominal muscles, create traction in your spine and in time you will be rounding down with the best of them. As you begin to round down, move with your spine as far as it will go. When it stops, you stop. Don’t let yourself start creating compensation patterns because you really want to touch the floor or get your head to your knee. This is a process of healing, not “getting” postures.

Tree: Great hip opener. Work those abs.

Toe Stand: Test it out. Sometimes the bend forward hurts in the beginning. It is a great opportunity to loosen your hips and that can be a great relief to your back, so return to it as soon as bending forward no longer causes you pain.

Savasana: When the pain is acute, you may need to bend your knees up in Savasana. Straightening the legs is a mild psoas stretch and you may not be ready for it. As soon as you can, return to the regular execution of savasana as tight psoas are a major cause of back pain. It may help to dribble your knees up and down like they were basketballs when you stretch them out to shake out some of the tension out of your lower back muscles and relieve the cramping.

Wind-removing: The only reported problem is picking up the foot. Sometimes the pull on the front of the spine by the psoas muscles doesn’t feel good. Do what you need to do to get your leg up. Sometimes it helps to bend the opposite leg, sole of the foot on the floor, while you are lifting the target leg into position. Enjoy how the floor is supporting your whole spine.

Sit up: None in the beginning. Log roll over and push yourself up. Over time you will return to them. When you are healthy enough to try them again, remember they are a curl-up, not a heave-up. Concentrate on bending your spine consecutively from the neck to the pelvis. This takes a lot of strength.

Cobra: Work your hardest even though it may be sore in the beginning. It is good for you. Think of lengthening forward as you lift up and bending every vertebra in your spine from bottom to top.

In times of acute pain, substitute Sphynx pose here with the forearms on the floor and elbows directly under the shoulders. If you’ve been in a lot of pain, this will help you to find a supported backward bend and release some of the protective tension in the lower back that’s making you so uncomfortable.

Locust: Just do your best. It will help to strengthen your back, but your legs may feel too heavy in the beginning. Lock your leg muscles tightly. Work them off the floor as you can.

Full Locust: Go for it! Length and strength. Remember, extension of the spine helps to move the bones back to their proper alignment. BEND your SPINE.

Bow: Another good one that may feel like cramping in your low back. Work through it while respecting your limitations and don’t baby yourself. Remember, you are bending your spine as much as possible. Use the glutes to keep the hip in extension and prevent the psoas from pulling on your lower spine.

Fixed Firm: Tight hip flexors can pull acutely on the low back in this one. That may be uncomfortable, but it is important to get them a good stretch. Do the best you can. Concentrate on lifting your chest once you can get to the floor. That should take some of the pressure and acute bend out of the lumbar spine. If your lower back is really crampy, try squeezing and then releasing your gluteus muscles.

Half-Tortoise: Walk your hands down your thighs to come to the floor, contracting the abdominal muscles. Take this opportunity to relax and gently stretch the over-tired muscles at are trying to protect you from pain all day long.In some acute cases, you may need to open your knees up to 24 inches and drape the belly down in between. In this way, you stretch the back muscles, but the lumbar spine is actually in a backward bend. Imagine your spine like a hammock, hanging between two trees.

Camel: Sore or not, Camel is your friend. Don’t be scared. Camel is here to help. Traction first, then extension. Do your best. Inhale, fill you lungs as if with helium. Lift up so much you start to backward bend, little-by-little. And remember, friends don’t let friends skip Camel.

Rabbit: Go easy or skip in the beginning. You can also modify like Half-Tortoise above. I mean EASY. You may just put your hands on the floor and lower your forehead. Also acceptable to replace with Cat/Cow to get a little movement into the spine.

Head to Knee: Try it, but go easy. No strain, no pain.

Final Stretching: Bend your knees if you need to, to get your feet.  Chest up, flat back, stomach in.  As you develop strength and flexibility, you will be able to bend forward with the rest of the class.  ALWAYS SUPPORT YOUR LOWER BACK WITH YOUR ABDOMINALS IN ALL FORWARD BENDS. If you are Type A and have a hard time not struggling to “achieve” a posture, bend your knees and glue your chest to your thighs so the forward bend is isolated to hip flexion.

Half Spine Twist: So good for you over time. This rotation will actually help to draw the extruded disc material back inside. Your degree of rotation will and should be limited in the beginning. Pull in on your abdominals, lift up out of your waist and rotate.

Kapalbhati: This is a great opportunity for you to develop strength in your abdomen without doing sit-ups or Pilates classes. Work it.  

Sara Curry is a Certified Yoga instructor and owner of Blaze Yoga and Pilates in Portsmouth, New Hampshire. She lives in Southern Maine with her husband and two children.

Sara receives lots of emails from around the globe.  Before you write, please consider these frequently asked questions:

Why Bikram Yoga? I recommend the Bikram Yoga method because it is a therapeutic series and it works. It was scientifically-designed to work the entire body and you don’t have to worry if the flow your teacher designed today will be right for you. That’s why I recommend it to my students, my friends and my family.  It has an even balance of back bending and forward bending. Look for a Bikram Yoga, Original Hot Yoga or 26/2 Certified teacher with a minimum of 500 certification hours.

I have herniated discs in my neck.  Will Bikram Yoga help me? The same principles apply to cervical and lumbar discs. Individuals with neck pain may need to keep the neck neutral for the first few months. That means you won’t be able to drop the head back in Pranayama or look up at the ceiling in Cobra. That’s okay.

For beginning breathing, try interlacing your fingers behind your head instead of under your chin. As we inhale, draw your elbows toward the back wall. As we exhale drop your head back into your hands and draw your elbows toward each other. This will allow you to experience the therapy of a back bend for your cervical spine while supporting the excessive weight of your head.

You can also repeat this motion in Half Moon Back Bend and Camel to find extension in your whole spine while supporting the weight of your head.Go as far as you can with your neck today. Concentrate on bending the rest of your spine first, particularly the thoracic spine. Be patient. You can do this.

What about a spinal fusion? The important concept to remember with a fusion is that every vertebra in the spine is responsible for a small percentage of the range of motion in any direction for your spine. Each bone does a few degrees pf motion and that can add up to a total spinal movement of more than 90 degrees. Once two or more bones are fused together, that percentage of the motion is lost forever. Don’t try to make the joints above and below the fusion make up the slack. This will only result in injury to that cartilage.

I live too far to study with you.  Where else can I find Bikram Yoga?
You can find certified teachers and studios offering the method all over the world by Googling: Hot Yoga, Original Hot Yoga, Bikram Yoga, 26/2, or Core 26 in your area. If you can’t find this particular method, look for the teachers in your area with the greatest amount of training and experience. Write to them and ask about their experience working with your condition. If they recommend you avoid back bends, run away.

My doctor told me not to backbend and not to twist.  Will Bikram Yoga hurt me? Remember that Sara is not a doctor and does not know you as a student. If you have questions about the series, bring the Bikram Yoga book to your physical therapist to ask about the individual postures. With that in mind, remember your doc and PT are in the business of responding to your symptoms. They want to get you pain free today. Rehabilitating from back pain is not a pain-free process. There are no solutions in the medical field other than drugs, steroids or surgery and none of them work to eliminate the problem.

Can you prescribe a series of postures for me? The 26-posture series above is a beginner-accessible series of therapeutic postures suitable for all ages and levels of abilities. It is the series of postures that I used and worked for me, so I’d recommend them. I am not a doctor. I know this is a scary time, but you are unique like everyone else. You CAN heal yourself.

There is no Bikram near me, but I want to practice under a teacher at least in the beginning.  What should I look for?  I highly recommend practicing under a trained instructor. You may be an expert electrician, but if you have less than 10,000 hours under your belt in yoga, this is not your field of expertise. Don’t try to go it alone with a DVD when you have a serious injury like this.

Look for a teacher with a minimum of 500 hours of training. Remember that Registered Yoga Teachers, RYT, need only 200 hours of training before they can buy that title. Find out about their training in yoga therapy or anatomy and physiology. Talk with your teachers about their experience in working with back injuries. If they send you into a series of forward bends, hit the road.

In the beginning of your healing process, be cautious of practices based on vinyasa, Power, or “flow” yoga, as they include a lot of forward bending. Upward and Downward Facing Dogs are not suitable for the beginning phases of rehabilitation. Examples are classes called Flow, Vinyasa, Jivamukti, Power, Ashtanga, Baptiste, or any other discipline with a lot of sun salutations or “vinyasas”.  These practices will be available to you later when you are through the acute stage of your pain. Yoga is great fun. Heal up so you can enjoy the all-you-can-eat buffet in your area!

For those of you suffering chronic pain, I also recommend reading Healing Back Pain: The Mind-Body Connection by John Sarno.