You got into yoga to relax and get some exercise. But, as you lie in corpse pose at the end of the class you find yourself wondering, “how the heck am I supposed to relax when my back is killing me?” You intended to be doing something good for your body, not hurting it!

This was me for a long time. Yoga has many wonderful health benefits, but it is also a common culprit in creating back pain. When I first started doing yoga, and actually many years into my practice, I loved the way it made me feel but couldn’t help noticing that my back pain was getting worse, not better. Many of my patients have been told by their doctors to try yoga for back pain, and end up with no change or even worse pain! In this article I’ll share with you the most common reason why yoga causes back pain and how to get rid of it. I’ve worked with many patients to get them back to yoga without back pain, and you can do it, too.

Breathe Better to Relieve Your Lower Back Pain

Modern yoga tends to have a lot more extension based postures (i.e. backward bends) compared with traditional yoga practices.

Yoga Postures that commonly cause back pain:

Upward facing dog pose
Bow pose
Camel pose
Basically any pose where your spine is arched back.

I am not sure why backward bends have taken a forefront in today’s yoga, maybe it’s because they look pretty? However, they can be very problematic to our backs for several reasons.

It’s not that backward bends are inherently bad, but rather they require a certain amount of stability and skill before they can be performed correctly. I was always very flexible, so it was easy for me to contort myself into all kinds of crazy postures. However, when you do back bends without the right stability, they create a lot of compression in you lower back which causes back pain and sometimes sciatica. Improper backward bending can also force us into bad breathing patterns.

Let’s maybe not go for this until we’re ready…

Ditch the Belly Breathing

One thing we need in order to bend backward without pain is a strong connection between our front lower ribs to our front upper pelvis. This means you need your abs to be working, and in the right way. And you need to be able to MAINTAIN that abdominal contraction as you inhale, i.e. no belly breathing!

Whaa???

You heard me right. Belly breathing is not good for you, especially not in a back bend. In fact, in a backward bend, it’s actually really bad for you! I know, everyone talks about all the amazing benefits of belly breathing, but hear me out.

Belly breathing (pushing your stomach out when you inhale) doesn’t allow you to maintain an abdominal contraction while you inhale, so your lower back has no support and basically gets way too compressed. This is painful and damaging if done repeatedly.

Secondly, belly breathing teaches you to breathe without moving your ribcage. When your ribcage becomes rigid, you are forced to move more from your lower back, creating it to be even more unstable and painful.

To breathe correctly in backward bends (and in general when doing physical activity) you should be able to move your ribcage and maintain some tone in your abdominal muscles, particularly the abdominals on the sides (obliques and transversus abdominus).

Exhale Focused Breathing for Back Bends:

pubic bone to demonstrate pelvis position to avoid lower back pain

Exhale completely and feel your lower front ribs drop down towards your pelvis and in towards your body.
Simultaneously draw your pubic slightly up towards your belly button.
Pause there, at the bottom of the exhale, for 3-5 seconds.
Then, quietly inhale without losing this ribs to pelvis connection. You should feel air move into your upper chest and maybe your upper back.

This breathing pattern teaches your core to turn on in the correct way, and stabilizes your back. Obviously, as you bend backwards, your abdominal region will lengthen, but you want to keep that action of lower ribs moving toward the front of your pelvis and the front of your pelvis curling up towards your ribs as you do so.

Some of us are already pretty arched in our lower back to begin with. If you are arching more on top of that to backward bend, you’re going to be in trouble. If you’re like me, and backward bending is really easy for you without much practice, you really need to work on developing some core stability before diving deep into backward bends.

Developing Core Strength

In forward bends and standing postures, keep trying to find that position of exhaling lower front ribs down and in, and bringing pubic bone up towards your belly button.

Use your Legs to Develop Core Strength for Back Bends:

In addition to exhale focused breathing, think about drawing your inner thighs towards one another, and rolling your inner thighs back behind you.
this is called hip adduction (together) and internal rotation (turning inward).
These actions are only helpful if you have the first concept of ribs down and pubic bone up, so if that is hard for you then work on that for a while before adding the leg actions.

These actions of hip adduction and internal rotation create spaciousness in your lower back and create stability in your stabilizing musculature, particularly in the pelvic floor muscles. the pelvic floor is a sling of muscles inside of your pelvis that assists your abdominals in stabilizing your lower back.

You can think of drawing your inner thighs together even when they are apart. Take anjaneyasana, or kneeling lunge, for example.

Instead of leaning forward into the lunge to stretch the front of your hip (and arching your back and losing all sense of internal stability) stay more upright, find ribs down and pubic bone up.
Then, draw inner thighs towards one another as if you were trying to close the gap between your legs without actually moving.
This may not look as pretty or as deep as in the picture, but it will feel a whole heck of a lot better, and will teach your body so much in regards to strength, true flexibility, and good habits.

Develop Good Habits

Before jumping into backward bending, spend some time in standing postures and forward bends, working on bringing your lower front ribs down and in, bringing your pubic bone up towards your belly button, feeling air in your upper back, and drawing inner thighs together and back. Only once you have this well established should you explore deeper backward bends.

Once you are ready to start experimenting with backward bending , a good place to start is with some gentle standing backward bends.

Start With a Gentle Back Bend:

Establish your lower front ribs down and in on an exhale, as well as pubic bone up.
Then, draw inner thighs together and roll inner thighs back.
From there, cactus your arms and see if you can gently arch your upper back WITHOUT letting your lower front ribs pop up or your pubic bone moving down away from your belly button.
You probably won’t go as far back and that’s okay, because now you’re actually lengthening your front body in a healthy way that supports your spine instead of just dumping into your lower back.

It’s always good to follow backward bending with a counter pose, which would be a forward bend. Child’s pose is great, or seated forward bend. However, try not to just flop into these poses, either. Remember the same actions from above (low ribs in, pubic bone up, inner thighs together and back) while forward bending as well.

Final Thoughts

The real practice of yoga is about being with ourselves in the moment. When we’re in a class, or even by ourselves, we may have ideas of how a pose should look or what we think we should be able to do. However, if we do not take time to establish a good foundation, or if we push our bodies beyond our limits, we will get feedback. In the case of excessive back bending, feedback will occur in the form of physical pain.

This is where the real yoga starts. Can you listen to your body and let go of what it’s “supposed to” look like, and meet yourself where you are? That is probably the biggest challenge, but will provide the greatest reward when you find that you can practice longer and more often because you are not limited by pain and injury.

Most of us remember being told to “sit up straight!” or “shoulders back, chin up!” as a child or maybe more so as a teen. While this advice was given with the best intentions, it may not have been that helpful. Don’t get me wrong, I’m not advocating the slumped computer posture with shoulders rounded and head poking forward.

This is certainly not a biomechanically sound posture and can lead to all sorts of dysfunction and pain. In an effort to avoid this unsightly slump, we may find ourselves in a position I call “reverse slumping.” This is the tendency to pull the front lower ribs up and push the chest forward. While this may look more upright, it is an overcorrection, and can be more problematic than helpful.

The Problem

So what’s wrong with a lifted chest and elevated front lower ribs? The problems that arise are largely due to how we breathe, and the important relationship between the ribcage and the pelvis. The Postural Restoration Institute has defined the relationship between the breath and function. Below is my meager take on their extensive understanding of the topic. For more information check out https://www.posturalrestoration.com/.

1. Poor oxygenation. If our front lower ribs are “flared” up and out, the mid-upper back is essentially closed off and becomes flat. This causes many problems, one of which is poor oxygenation. The human body is designed to breathe into the back mid and lower ribs, not just the front. These back middle and lower regions of the lungs have the largest area of lung tissue, and the highest blood flow to lung tissue ratio. This means that this area is very important for getting oxygen from your lungs to the rest of your body. When this is closed off (by pushing front ribs up) we are forced to breathe shallowly into our front upper chest, which may recruit neck muscles to help inhale and result in increased neck tension (among other issues). Further, it is harder to get air out because the chest is in a hyper-inflated state. This means less new, oxygen-full air in. Theoretically, if you improve the expansion of your mid back, you will use oxygen more efficiently and fatigue less quickly with sport and daily living.

2. Altered neck and shoulder mechanics. The spine is not meant to be straight, rather it has natural curves that allow a springy quality for shock absorption. When the front ribs are pushed up, the upper back spine becomes flat. This destabilizes the shoulders, as the shoulderblades are designed to function on an egg-shaped surface, not a flat one. As a result, the muscles that manage the shoulderblade cannot function optimally, thereby changing the mechanics of the shoulder in an adverse way. Many of the muscles that attach to the shoulderblades also attach to the neck spine and can create increased tension in the neck area if they are not functioning well.

The muscles that attach to your shoulderblades, back, and neck can become strained and painful with poor posture.

A flat upper back also burdens the point where the upper back spine meets the neck spine. The neck spine is naturally curved and is designed to follow the curve of the upper back. However, if the upper back is now flat, the spring-like shock absorbing factor is lost. Furthermore, the juncture from upper back spine to neck spine becomes vulnerable due to a sharp corner instead of a nice smooth curve between the vertebrae. This can create pain and sensations of tension in this area.

3. Increased stress levels. When we are stressed, that really means our body is entering a “fight or flight” state, which means that there is some imminent threat, and we need to either fight or get away. Blood is shunted away from the core and immune function and digestion are halted as the body prepares to fight or flee. This threat could be anything from being chased by a mountain lion to a steady drip of small daily stressors, like traffic, aches and pains, worrying about money, etc. Our body simply does not distinguish what the cause of the stress is, the same pathways and neurotransmitters are stimulated in the case of a lion attack or spilled coffee. The “fight or flight state” has its purpose, however it is not healthy to remain in this state for prolonged periods of time.

The part of our nervous system that promotes our “rest and digest” state is governed by the vagus nerve which passes from the brain to the abdomen through the ribcage. This state allows the body to be calm and relaxed, allowing for sleep, healing, and digestion. When we are in this state, our breathing is full and deep, with the diaphragm moving through its full range of motion.(1) This is the state that we should be in most of the time.

So what does this have to do with posture? Well, if we push the front ribs up and close off the back of the ribcage, the sympathetic ganglia (the nerves that promote a “fight or flight” state and live along the upper back spine) become overly stimulated due to compression. Furthermore, with the front ribs elevated, the body is in a constant state of shallow inhales and exhales, which is correlated with higher stress levels and promotes release of stress hormones in the body.(2) What’s really amazing about our bodies is that this system works both ways. That is, just as the state of our nervous system causes our breathing patterns to change, we can similarly alter our nervous system by modifying the way we breathe.

4. Poor recruitment of deep abdominals, especially upon inhale. Even if you have six pack abs, that doesn’t necessarily mean you are using the abdominals in the way they are meant to be used. Deep to the well known “six pack” of the abdominals are deeper muscles that create a cylinder around the center of the body. These are breathing muscles. They attach to the lower rim of the ribcage and the upper rim of the pelvis. They create stability and order within the body as well as reduce pressure on the lower back spine and associated nerves. They allow us to be both stable and mobile when they function correctly.

When the front ribs are excessively elevated, the front of the pelvis is often tipped forward as a counterbalance. This places the deep abdominal muscles in the front of your body in a state of excessive length. Our muscles do not function very well (or hardly at all) from their most lengthened state. It’s like trying to pick up a heavy bag of groceries with your arm totally straight instead of slightly bent. It just doesn’t work as well.

A deep stabilizing muscle, called the transversus abdominus, helps us maintain neutral posture.

So then what is good posture?

Essentially, your rib cage should be egg shaped, and sit atop your level pelvis. The spine should be lengthened while maintaining its natural curves. In sitting, you can achieve this by:

Sit in a firm chair with your feet flat, knees and hips at 90 degrees.
Feel your sit bones (the boney protrusions at the base of your pelvis). You may need to lean forward and back a few times to find where you feel them most. When you are most aware of your sit bones pressing into the seat, this indicates that your pelvis is level. It may feel like your pelvis is slightly “rolled under.”
With a long, relaxed exhale breath through your mouth, allow your front lower ribs to drop down slightly. Pause a few seconds at the bottom of the exhale. There should be a sense of your front lower ribs coming down to the front top rim of your pelvis.
Maintain this position as you imagine your lower back ribs expanding with each inhale, and your lower front ribs moving down and back towards your spine with each exhale. Hint: pausing after your exhales for 3 seconds will make it easier to feel back ribs expanding.
Below is a video on finding a neutral sitting posture.

And there you are! If you are used to pushing your chest up, it probably feels like you are slouching when you come into a correct posture. To assure yourself that you are still sitting straight, you can use a mirror to see that you are indeed not slouching. If you can see yourself from the side in the mirror you may also notice that now you have a little more expansion in your lower back ribs. Good job!

References:

1. Russo MA, Santarelli DM, O’Rourke D. The physiological effects of slow breathing in the healthy human. Breathe (Sheff). 2017;13(4):298-309.
2. Hirotsu C, Tufik S, Andersen ML. Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. Sleep Sci. 2015;8(3):143-52.
3. Tenney, R., KL Boyle, A DeBord. Influence of Hamstring and Abdominal Muscle Activation on a Positive Ober’s Test in People with Lumbopelvic Pain H. Posturalrestoration.com. Accessed January 26, 2019.

Tag: low back pain

Why Does Yoga Make My Back Hurt?