yoga – Essential Physical Therapy

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.

With the exponential growth of yoga in the last few years, class sizes are getting bigger, and the content more imaginative. It is wonderful that more people are exposed to yoga. As a physical therapist, what concerns me is the lack of emphasis on internal stabilization. This stability comes from deep muscle activation, in sanskrit called bandha, which translates to “Lock.”

In our fast-paced lifestyle, we are often tempted to put ourselves in a position of compromise to “just get things done.” We skip the part where we find our sense of center, and we forget to return to it repeatedly. This is what the practice of bandha teaches us. Developing the bandhas takes effort to build strength, vigilance to maintain, and patience to master. However, once the bandhas are in place, all the other aspects of yoga practice become more accessible, fluid, and enjoyable.

Bandhas stabilize the body during dynamic movement. Some yoga postures can even be damaging if done repeatedly without this awareness. Sure, a teacher might now and then mention a bandha, or advise students to “engage the pelvic floor.” . The problem is that many people have never been taught how to access the bandhas in the first place.

yoga on a mountain top representing internal and external stability — Yoga and the bandhas can apply to every day life.

What are bandhas, and how do we access them?

In yoga there are essentially three bandhas in the body. The main two we will discuss today are “mula bandha” and “uddhiyana bandha,” which represent the pelvic floor muscles and the transversus abdominus muscle, respectively. These are the deep stabilizers of the trunk and pelvis. The third bandha is “jhalandara bandha,” which involves the core muscles of the neck and head known as the deep neck flexors (longus colli and longus capitus muscles).

Mula Bandha (Pelvic Lock)

Let’s start with mula bandha, the root lock, or the pelvic floor. In physical therapy practice we often teach patients to engage their pelvic floor if they have hip, back, and leg pain. I even now teach pelvic floor exercises to help patients who have neck pain, because the pelvic floor is the “foundation of the house.” If the head and neck are the roof of the house, you can imagine how a poor foundation would result in an unstable roof.

In my experience working with patients, these muscles are inherently difficult to engage for several reasons. The first is that they are “postural muscles.” Unlike big mover muscles, like the thigh muscles that bend the knee, the postural muscles are under subconscious control. This makes it difficult to fire them at will, and they are harder to feel. The thing that makes pelvic floor muscles really hard to access is the fact that we can’t see them, and many people have never even heard of them.

How to access Mula bandha

As mentioned above the pelvic floor is hard to access, but visualization can be helpful.

Sit on a firm chair with knees and hips at 90 degrees and feet flat on the floor.
Sitting up straight, hinge forward and back from the pelvis until to feel ventered on your sit bones (the boney protrusions at the base of the pelvis).
From here, draw the sit bones closer together, without tightening your gluteal muscles.
Keep this as you visualize the sit bones pressing down into the chair, as the space between them moves up (this is the doming up/activation of the pelvic floor muscles that make mula banda).
If you can achieve this lifting sensation, you can try maintaining that while visualizing your coccyx (the tailbone) and the pubic symphysis (the very front of your pelvis) also moving towards each other.
These four points (the sits bones, coccyx, and pubic symphysis) all are moving towards a central point.
Even if you feel nothing initially, with continued visualization you will begin to feel something. It is a process.

Uddhiyana Bandha (Navel Lock)

Also known as “flying up” bandha, this is the place between your navel and your pubic bone that wraps around your waist. It creates lightness and lift, and stabilizes the trunk and pelvis during movement and during static standing and sitting. A long, flat sheath of muscle, this bandha is made up primarily by the transversus abdominus and the internal oblique muscles.

The transversus abdominus muscle which activates navel lock, or uddhiyana bandha — The transversus abdominus muscles that make up uddhiyana bhanda.

How to access Uddhiyana Bandha

One accessible way to feel uddhiyana bandha is by activating the leg muscles strongly.

Stand with your feet hip width apart, feet parallel.
Draw up through the inner arches of the feet, while rooting the base of the big toe, base of the pinky toe, and straight down through the heel. You may feel something light up in your core with just this! If not, no worries, keep going.
Imagine you are drawing all the musculature of your legs up towards your pelvis.
Maintain that as you tighten the front and back of the thighs simultaneously.
At this point you should feel the area below your navel turning on. That is uddhiyana bandha.
Now see if you can relax your legs somewhat while keeping the activation in your abdomen.

Jalandhara bandha (Throat Lock)

While the full expression of Jalandhara Bandha is more applicable during breathwork, a sense of this lock can help with asana practice as well.

Due to our lifestyle that now frequently involves sitting, the head tends to come forward with the chin protruding. Then, when it comes time to practice yoga on the mat, we carry this poor posture with us.

Jalandhara bhanda can mitigate this effect by teaching us to draw the head back over our spine. In the full expression of the bhanda, the chin is nestled in the nook of the breast bone between the collar bones, called the sternal notch. This can be a good release of the fascia along the back of the neck, but is impractical for asana practice and may cause strain for some individuals.

A lighter version of Jalandhara bhanda can help us find a neutral and stable position of the head and neck by recruiting the muscles that make the “core of the throat.” These deep muscles return the head to a neutral position.

How to access Jalandhara bandha (throat lock)

Sit in a firm chair, feeling your sit bones.
Exhale completely through your mouth as you let your neck and shoulders relax and your front lower ribs move down and in (for more info about the importance of the ribs here, see my other post “the posture myth”)
Now, draw your head straight back so that it sits atop the rest of your spine.
Maintain a relaxed posture of your neck and shoulders as you draw slightly nod your head down as if you are holding a small orange between your chin and the space between your collarbones.
Imagine the base of your skull floating up as your chin drops slightly, lengthening the back of your neck.
Check to see that your shoulders are still relaxed. If not, take another exhale and let them drop.
Stay here a few breaths, inhaling to lengthen through the back of the neck, exhaling to settle the shoulders and the front lower ribs.

Yoga and Injury

As a physical therapist, the most common yoga injuries I see are in people who are naturally flexible (usually young to middle-aged women, which happens to be the largest demographic of yoga practitioners). These individuals can put themselves in many challenging postures but lack the deep stabilization of the bandhas. I also see stronger men and women who are able to muscle through arm balances but end up with neck and shoulder pain because really it is the deep connections of the bandhas that create a sense of levity in arm balances, not the arms. Practicing poses with correct activation of the deep stabilizing muscles may mean that you have to approach the pose in a new way, and you may not be able to make the pose look as good initially. This is where the yoga really happens- when we shift our focus from what the pose looks like to what it feels like, when we move from place of integrity and patience.

It can take time to develop a keen awareness of the bandhas and to incorporate them into practice. However, by learning to engage the bandhas, yoga injuries can be prevented and healed by practicing with increased awareness, intention, and patience.

Tag: yoga

Why Does Yoga Make My Back Hurt?