Avoiding Lower Back Pain

Lainie Devina via Yoga International, 12/28/2016

Have you ever experienced lower back pain? If so, you’re not alone. Lower back pain is one of the most common modern complaints, with about 80 percent of adults experiencing it at some point in their lives. 

Lower back pain is often acute (defined by the National Institute of Health as lasting between a few days and a few weeks), resolving on its own without residual loss of function. But many people suffer from lower back pain that is subacute (lasting between 4 to 12 weeks) or even chronic (persisting for 12 weeks or longer). Any of these can have myriad causes, including accidents, repetitive stress injuries, structural issues, weakness, and more.

I am one of the 80 percent reporting lower back pain. Prior to becoming a yoga teacher, I was a professional dancer, and backbending was a regular part of my performances. Unfortunately, during my years of training, backbend safety was not emphasized, and I eventually sustained a career-ending injury. After a year of rehabilitation, I dedicated myself to a structured yoga practice that taught me how to support my body. This has allowed me to have a full and active physical life, despite the fact that the injury remains. 

By bringing consciousness to how we hold our bodies, however, we can re-educate these structures and bring them into healthy alignment.

Most importantly, I ultimately came to recognize the injury as an incredible gift because it led me to my current life as a yoga teacher. It has also allowed me to teach with a deep empathy for those suffering with similar pain, and it developed in me a commitment to keeping my students safe.

One may ask: With so many different causes of lower back pain, what is one of the most common, but largely hidden, causes for many of us? The answer is ”unconsciousness.”

In the case of back pain, ”unconsciousness” is a lack of awareness of or attention to how you hold your body. This allows your body to develop potentially harmful habits, simply because it feels easier and seems to save energy (the “path of least resistance”). When the body is repeatedly placed in unhealthy positions over long periods of time, the soft structures of the lower back (i.e., the muscles, tendons, ligaments, intervertebral discs, and nerves) can become imbalanced and sustain injury. The muscles can become weak, failing to properly support the spine and upper body; tendons and ligaments can be overstretched or torn; and the discs and nerves can be pinched and squeezed. By bringing consciousness to how we hold our bodies, however, we can re-educate these structures and bring them into healthy alignment.

In my experience, the two areas of the body whose alignment most affects the lower back are the feet and the pelvis.

Feet

The placement of our feet affects everything  positioned above them, including the knees, hips, and spine. While standing, take a look at your own feet—are they turned out like a duck (toes out, heels in)? “Duck feet” can compress the lower back, so try this to create space: Adjust your feet so they point forward, with the middle of the heels lined up behind the second toes. This brings the outside edges of the feet roughly parallel to each other. For many of us, this will be the optimal alignment for maintaining a neutral spine in tadasana (mountain pose), and for helping us to keep the knees tracking in line with the feet. 

This positioning of the feet applies not only to symmetrical standing poses (tadasana, utkatasanaand prasarita padottanasana), but to supine backbends as well (setu bandha sarvangasana and urdhva dhanurasana). In prone backbends (urdhva mukha svanasana and salabhasana), see that the toes are pointing straight back.

Pelvis

Think of your pelvis as a bowl filled with something precious. To avoid spilling the contents, we need the bowl to be balanced and stable. Although the hips are able to tilt and swivel in all directions, the lower back can be placed at risk if we habitually allow the pelvis to tilt excessively forward or backward. Most of the time, we want to seek a more neutral position, in which the frontal hip bones are level vertically with the pubic bone. You can cultivate neutral by pressing the tops of the thighs back as you draw the frontal hip bones up toward the lower front ribs. In addition, lifting the back ribs up off the waist creates space in the lower back. 

While it’s relatively easy to visualize a neutral position in poses in which your pelvis and torso are oriented in an upright position (like virabhadrasana II and tadasana), finding your ideal pelvic alignment can take more imagination in some other poses: 

In seated poses like sukhasana and dandasana, if the hamstrings and/or hips are tight, the pelvis can be pulled backward into a posterior tilt, causing the lower back to round. In this case, we can use blankets or even a bolster to elevate the sitting bones, lessening the demand on the tight areas and leveling the pelvis.  
 

In forward folds (like paschimottanasana or uttanasana), a similar limited range of movement in the hamstrings prevents the pelvis from tilting forward adequately as you come into the pose. Instead of being able to "hinge at your hips," the weight of the upper body rounds the entire spine right as you come into the fold and pulls on the lower back. Props are useful here as well: Placing blocks under the hands in uttanasana, for example, can relieve the strain by reducing the pull of gravity.
 

In backbends, the pelvis often risks moving too far forward, which can concentrate pressure in the lower back and lead to discomfort. To counter this tendency and stabilize the pelvis, we employ the action of lifting the pubic bone toward the navel. This enables us to spread the arc of the backbend throughout the entire spine, engaging both the middle and the upper back.
 

In plank pose, the pelvis often either collapses to the floor or sticks up like a teepee—instead of the long line we want to have from shoulders to heels. Support the lower back with strong legs (pressing the thighs to the ceiling) and engaged abdominals (drawing the frontal hip bones up toward the front ribs).

You will notice that we have the same goal in every pose, which is to give length and support to the muscles of the lower back. After integrating these principles into your yoga practice, try bringing your alignment off the mat and into your daily life. By mindfully improving your physical structure, you create new habits in your body that will sustain a healthy lower back for years to come.