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Yoga for Low Back Pain


Is getting through your day a real pain in the back? Low back pain is a common issue for many Americans—it is estimated that 70% of adults experience low back pain at some point in their lives and approximately 50% have chronic pain (França, et al. 2012). With such a high prevalence in people, it is somewhat difficult to pinpoint the cause of low back pain. Those who live more sedentary lives, active and constantly moving, or everything in between, can be affected by low back pain. No matter the lifestyle you live, if you suffer from low back pain, it can truly affect your day.


While there can be various causes of low back pain, it is often a result of tight hip flexors and extensors (Parka and Jungb, 2020), as well as weakened abdominal and glute muscles. Tight hip flexor and extensor muscles become shortened over time, resulting in decreased flexibility. Our hip flexors attach to our low back and frequent sitting causes these muscles to shorten and become much less flexible. When we do stand or move, these shortened muscles pull more on the low back, leading to pain (Figure 1).


In addition to hip flexors, our hip extensors are often tightened through sitting leading to low back pain. These muscles include the hamstrings on the back of the leg; and while it seems strange that tight leg muscles result in low back pain, it does! The hamstring muscles attach at the pelvis, and when these are tightened, they pull on the pelvis, resulting in a tilt of the pelvis, causing tension on the low back and ultimately leading to pain!

Weakened abdominal muscles and glute muscles can also result in low back pain. Both of these muscle groups work to support the low back, and if they are not strong enough to hold up the weight of a person’s torso, the work has to be made up by the low back! In addition to neglecting training for these areas, frequent sitting can cause these muscles to become weakened over time.

So, what can we do to stretch and strengthen these muscles and alleviate our pain? Yoga could be one answer; by incorporating exercises that focus on stretching and strengthening muscles that support the back, yoga can ultimately lead to reduction in pain levels. In a study (Sherman, et al., 2019), it was found that yoga resulted in reduction in low back pain levels for the participants, with this effect lasting for several weeks after the study concluded. In addition to being an effective option for pain relief, yoga is free and can be performed nearly anywhere.

During the pandemic, there are some great options for practicing full length yoga sessions (whether it’s a 30 minute routine or a full 90 minutes) that are available online through a paid (and sometimes free) subscription or through free videos on YouTube or other platforms. Not every type of yoga is appropriate for every person, as advanced poses can be difficult for some. So be sure to clear it with your doctor if you are concerned, and make sure to avoid poses that cause more than slight discomfort. If you are looking into practicing yoga more regularly, Hatha, Iyengar and Yin are all great options as they focus mostly on restorative and gentle poses.

However, if you are not able to incorporate regular yoga practice into your routine, there are some poses that can be easily integrated into your day (doing 3-4 poses will only take as little as 5 minutes!)


Try these yoga poses to alleviate pain in your low back:

1) Cat-cow

This pose allows you to relax your back as well as warm you up for any additional poses you might perform.

Get into a tabletop position: hands and knees on the ground, with your hands directly below your shoulders and your knees directly below your hips. Make sure your spine is neutral and your abdominal muscles are engaged. Take a big inhale.

Next, while exhaling, begin cat pose: round your spine to the ceiling while tucking your chin toward your chest, allowing your neck to relax. Focus on engaging your abs by drawing your navel toward your spine.

Then move into cow pose: while inhaling, bring your spine toward the floor, allowing your back to arch and your ab muscles to relax, while also allowing your head and tailbone up toward the ceiling.

This is one cycle of cat-cow. Perform at least 10 times.

cat pose of cat-cow
Cat pose with exhalation
cow pose of cat-cow
cow pose with inhalation


2) Standing forward fold

This pose stretches the hamstrings and calves, as well as allows tension release from the neck and shoulders.


Start this pose by standing tall, with your feet several inches apart. Take a deep inhale. Next, while slowly exhaling, bend forward from the hips, not the waist! Allow your head to drop down and relax, while your fingertips or palms reach the floor. Be sure to not allow your back to round too much. (If you are not able to fully reach the floor, see modifications listed below.)

Remain in this position for 30 seconds, trying to make sure to breathe deeply and evenly. Repeat twice more.

To come out of this position, place your hands on your hips and slowly inhale while you come up. Keep your back flat and torso long while you come up, and push your tailbone toward the ground. (do not roll your back as you come up!)

Modifications:

If you are unable to touch the floor, there are several modifications you can make:

1) bend your knees so that your abdomen rests on top of your thighs (be certain your back doesn’t round, and if so, bend your knees more)

2) Use a block to allow the forward fold while keeping your knees more straight

Tips:

-Make sure to keep hips aligned over your ankles

-Keep your weight on the balls of your feet (avoid too much weight on the heels or toes)

-Do not lock your knees (slight micro-bends are perfectly acceptable!)

-Do not try to stretch too deep; a mild discomfort is okay, but make your fold less deep if

it’s very uncomfortable or painful.

forward fold for hamstring stretch
Standing forward fold
this modification allows you to get closer to the ground
Modification: Forward fold with knee bend
this allows you to keep your knees straighter so gain more stretch in hamstrings
Modification: forward fold with yoga block

3) Downward dog

This pose allows for stretching of shoulder, back and calf muscles.

Start in a tabletop position (kneeling with hands on ground, wrists under shoulders and knees under hips).

While exhaling, tuck your toes under, and push your hips up and back toward the wall behind you so that your knees come off the floor. Try to bring your legs into a straight position, making heels contact with the floor (without locking your knees). It’s okay if you cannot bring your heels to the floor!

Press down through your heels and palms, while lifting your glutes toward the ceiling (don’t rise on your toes to do this). Make sure to engage your arm muscles to prevent your shoulders from touching your ears. Also make sure to engage your core and legs (this pose is fairly active)

Hold this position for 30 seconds, while maintaining even breathing.

Return to tabletop position to come out of this pose.

Tips:

-Keep your middle fingers pointed forward to prevent shoulders from rolling inward too much, and make sure they are spread wide to hold your weight more evenly

-Don’t walk your hands and feet together—keep your body open and extended

-Draw your chest toward your thighs to keep lengthening and stretching your back

-Allow your head to relax but don’t let it hang.


while the aim is to have your heels touch the floor, it is perfectly acceptable to have them lift if you are unable to do so!
Downward dog


4) Low lunge

This pose helps to both stretch the hip flexors and back, as well as strengthen your quads and glutes.

Start by getting into a lunge position. You can do this from downward dog pose or from standing if that is easier. Start with your right foot forward and your left foot back.

Keeping the toes of your forward foot facing straight, lower the back knee to the ground, so that your leg and top of the foot make contact with the floor.

While keeping your hips level, inhale while sweeping your arms up over your head, making sure to lift the chest up and using your lower ab muscles. Have your palms face each other and your biceps near your ears.

You can either stay looking straight ahead or perform a slight back bend so that your gaze is at your thumbs. Stay in this pose for at least 5 full breaths.

To get out of this position, bring your hands down to either side of you, lift your knee up and step back into downward dog.

Repeat on the other side.

Tips:

-Place a mat or folded blanket under your knee to provide cushion.

-Don’t let your front knee stick out too far past your foot (think knee over ankle)


you can also perform low lunge with your arms at your side and no back bend
Low lunge with slight back bend

5) Bridge pose

In addition to stretching the back, shoulders, chest and hip flexors, this pose allows for strengthening of the glutes and hamstrings.

Start this pose by lying on your back with your knees bent, feet on the ground and about hip distance apart. Make sure your ankles are right under the knees.

Place your arms at your side. While pressing your elbows, shoulders and heels into the floor, lift your glutes up toward the ceiling, and lengthening through the tailbone toward your feet. Make sure not to arch your back too much in this pose.

Straighten your arms and grasp each hand together under your raised hips. Make sure to keep your shoulders away from your ears. Slightly press your head into the floor and broaden your chest while maintaining the upward lift of your glutes. Remain here for at least 5 breaths.

To come out of this pose, unclasp your hands and slowly lower your hips to the floor.

Tips:

-Make sure you do not let your knees flare out past your hips. Keep them in line with each other.

-To avoid strain on the low back, do not clench your glutes or push too high to the ceiling.

the bridge pose engages the glutes and hamstrings
Bridge pose


6) Supine twist pose

This pose allows for release of your lower back tension as well as stretching of the glutes.

Start this pose by lying on your back, with your legs straight out.

Starting with your right leg, bend your knee and cross it over the left leg. Use your left hand to gently press your knee into the floor. Make sure that both of your shoulder blades are in contact with the floor.

Extend your right arm out at shoulder level and rotate your head so that your gaze is at your right hand. Hold this position for 30 seconds or 5-10 breaths.

Repeat on the other side.

Tips:

-Make sure to keep hips stacked on top of one another when performing this pose.


supine twist pose to stretch the glutes
Supine twist


7) Child’s pose

This pose can be especially relieving for the back, as it removes low back pressure and lengthens the entire back. This pose is meant to be relaxing and soothing, but for some it can be quite uncomfortable—if it is, try some of the modifications listed below. If you are still in pain or greatly uncomfortable, avoid this pose.

Start this pose by kneeling. Have your knees about hip distance apart and your big toes touching each other behind you.

Take a deep inhale, then on the exhale, slowly fold forward so that your abdomen touches your thighs.

Rest your forehead on the ground and have your arms stretched out in front of you with your palms on the ground. Try to lengthen your spine by drawing your head away from your shoulders.

Hold this pose for 1-3 minutes.

Tips:

-If your forehead cannot make contact with floor, place a yoga block or folded up blanket under your forehead.

-Place a block or folded blanket under your hips if they are not able to come close to the floor.

-You may also perform this pose with your arms at your sides, fingertips pointing behind you.

child's pose is a restorative pose that stretches the entire back
Child's Pose
use a yoga block in child's pose to make it more comfortable if needed
Modification: Child's pose with block

You can perform one, three or all of these poses to give your back some relief. Whether you choose to perform them at the end of the day or incorporate them into breaks in your workday, these poses can make a big difference for your low back pain!




References:

França MSc, PT Thomaz Nogueira Burke MSc, PT Renê Rogieri Caffaro MSc, PT

Effects of Muscular Stretching and Segmental Stabilization on Functional Disability and Pain in Patients with Chronic Low Back Pain: A Randomized, Controlled Trial. 2012.

doi: 10.1016/j.jmpt.2012.04.012


Karen J. Sherman, PhD, MPH; Daniel C. Cherkin, PhD; Robert D. Wellman, MS; Andrea J.

Cook, PhD; Rene J. Hawkes, BS; Kristin Delaney, MPH; Richard A. Deyo, MD, MPH

A Randomized Trial Comparing Yoga, Stretching, and a Self-care Book for Chronic Low Back Pain. American Medical Association. 2019. doi: 10.1001/archinternmed.2011.524

Dae-sung Parka , Seung-hwa Jungb. Effects of hamstring self-stretches on pelvic mobility in

persons with low back pain. 2020. https://doi.org/10.14474/ptrs.2020.9.3.140 pISSN

2287-7576


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