The causes of lower back pain are varied and complex. Physiotherapy texts state that in most cases it is impossible to pinpoint the exact body tissue that causes the pain and because humans have an upright posture, it is virtually guaranteed that everyone will have an episode of lower back pain in their lives. Most treatment of lower back pain is focused on relieving symptoms.
Even hi-tech imagery is not a reliable indicator of the cause of pain- people are more complex than their X-rays or MRI-scans: some have excruciating pain, and are structurally normal while others have obvious defects and feel fine. This is no comfort to those who are physically active and fit and have no injury to their spines and yet suffer from chronic lower back pain.
The lower back is inseparable from the hips and legs and it is the complex interplay between them that we need to pay attention to: the hip area is the body’s centre of gravity and imbalances in this area affect all parts of the body.
A thorough professional assessment and treatment is always necessary in cases of lower back pain, but there are ways in which Yoga practice causes or contributes to these problems: I am going to break these up into separate posts to keep them shorter. These are:
- Overall posture or Pelvic Tilt
- The Lumbar Spine
- The Legs (see below)
- The Hips (see below)
- The Sacroiliac joint (see below)
- The Pelvic Floor
Lower back pain is a very complex problem and can be very difficult to resolve. When you begin to suffer from lower back pain, Yoga can help, or make pain worse – and sometimes – is the primary cause of pain, due to the muscle imbalances that an unsuitable practice creates.
Which yoga practice is suitable for a person depends entirely on their activities. Some Yogis play sports, whereas others only practise yoga and each of us responds differently to various elements of a yoga practice, according to our individual strengths and weaknesses.
Those who begin to suffer lower back pain from their practice need to have their bodies assessed and treated, and find the correct balance within themselves, bearing in mind that the muscular system is dynamic and constantly changing.
Setting your practice in stone will ensure that your body becomes just as rigid and painful, because there is no one yoga style or practice that works the same for everyone. Applying an open, listening mind to the body is a crucial aspect of yoga, one that extends beyond the purely physical.
Reading Sources: Kendall, McCreary, Provance, 1993, Muscles, Testing and Function
Lower Back Pain and the Legs
The body’s natural centre of gravity is located in the pelvis in the area of the upper Sacrum, or, roughly 4 finger-widths below the navel. Above this point, the Erector Spinae, Quadratus Lumborum at the back and abdominal muscles in the front exert an upward pulling force on the pelvis. Balancing downward forces are exerted by the Iliopsoas, Rectus Femoris and other hip flexors in the front, and Gluteus Maximus and Hamstrings at the back.
An imbalance between these forces generally causes pain in whichever group of muscles is weakest. Runners and dancers commonly experience lower back pain if they don’t do enough core strengthening to create a balance between leg strength and core strength. So do yogis, if their practise centres on leg strengthening postures.
Some people think that core body strength is created by doing abdominal flexion and extension exercises, but this is only part of the picture, the body ‘core’ is a cylinder and needs to be strengthened front, back and sides. Yoga classes that focus almost exclusively on leg strengthening will cause pain and stiffness in the lower-back in the long term, because flexibility requires a balance of forces acting on any given joint.
Lower Back Pain and Hips
Hips can affect the lower back in two ways: one is when there is an imbalance between the left and right hips, as mentioned in Lower back pain and Alignment and the other is when both hips are weak and tight, and the pelvis is not stabilised correctly, or pelvic movement over the head of the femur (the Coxo-Femoral joint) is limited, causing the lower back to be over-used in extension movements. Yogis, and athletes in general will wonder how this is possible, especially if they do exercise to strengthen the hips, but their problem never improves.
Weakness and tightness in the hips can be created by injury, but also occurs in any athletic activity, if there is a focus on the legs, with not enough core body strength to balance. If the postural muscles in the legs, namely the Hamstrings and Hip Flexor muscles become strong and tight, they inhibit the stabilising muscles in the hips by Reciprocal Inhibition. Please refer to Reciprocal Inhibition and the Hips for an explanation.
Tight Adductor muscles inhibit the Gluteus Medius, which can lead to knee instability as well as pain in the hip and an inability to stabilise the pelvis in a horizontal plane. It is not simply a matter of stretching the stronger leg muscles, people with weak hips cannot stretch their leg muscles adequately, and is one reason why some people can’t get into Hanumanasana, Kurmasana, or Samankonasana, or some are able to do Hanumanasana, but find Kurmasana painful or impossible. If they force these postures, lower back pain is inevitable. Hip strength must be adequate for leg muscles to lengthen without injuring the lower back.
Professional assessment and treatment is usually necessary, because hip weakness can be limited to a specific side, or set of muscles and the body learns to compensate, for example: it is quite possible for the hamstrings and spinal extensors to extend the hip and leg without using the Gluteus Maximus and these motor patterns become fixed and persist, meaning that correct muscle use has to be relearned.
Sports professionals like Biokineticists are best equipped to deal with these problems. Standing balancing Asanas like Utthita Hasta Padangustasana and Vrksasana maintain a balance of hips and legs, but care must be taken not to overdo lunging postures of all kinds, these tend to strengthen the legs, at the expense of the hips, especially if they are held for long periods of time.
Reading sources: De Franca, 1996, Pelvic Locomotor Dysfunction Cook, 2003, Athletic Body in Balance Sports Injury Bulletin
Lower Back Pain and the Sacroiliac joint
There is some controversy amongst various branches of the health profession about the relevance of the Sacroiliac joint in lower back pain – Chiropractors consider it to be a major cause of lower back pain, although many other branches of the health professions do not, because none of the body’s muscles are capable of creating movement at this joint, and its movements are very small and difficult to assess. Please refer also to Sacroiliac Joints and Yoga.
However that may be, the Sacroiliac joint is supported by very strong ligaments which are connected to the spinal muscles, Gluteus Maximus and Biceps Femoris. These muscles all play a role in stabilising the joint and tension in the ligaments has been linked to lower back pain. The Piriformis attaches to the Sacrum and if there is a difference between the strength of the left and right sides, a twisting force is applied to the Sacrum, causing misalignment and pain.
A pain-free alignment of the Sacroiliac joint depends on a balance between all of the many muscles attached to the hipbones. If you only strengthen your legs, and in particular the hamstrings, and don’t pay much attention to the stabiliser muscles of the hips and abdominal wall, Sacroiliac problems are inevitable.
Reading sources: Ellenbecker, De Carlo, DeRosa, 2009, Effective Functional Progressions in Sport Rehabilitation De Franca, 1996, Pelvic Locomotor Dysfunction Franklin, 2004, Conditioning for Dance