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Written by Abbe Ciulla
*Hopefully at this point you have already read the first part of my Biomechanics of Back Pain article. If not, i suggest you go back and read it (or re-read it) before moving forward with Part II.
Achy back? Chronic tension? Lower back fatigue at the end of a long day? Each day we are reading more and more studies revealing the healing power of the ancient practice. While so many other fitness trends have come and gone, yoga has truly stood the test of time hovering between 5,000-10.000 years old. Although yoga may not be a good idea if you have severe pain, those with occasional soreness, chronic aches or those on the road to recovery may greatly benefit from certain postures that can help lengthen your spine, stretch and strengthen your muscles, and help return your back to its proper alignment. But is yoga enough? Let me start by saying I absolutely love yoga. As a practitioner, teacher, and devotee, I can personally attest to the numerous health, fitness, and spiritual benefits of a regular practice. With its impact on flexibility, core strength, balance, posture, comfort and mindfulness in the body and mind, yoga is arguably the best single activity for over-all wellness. However, as much as I hate to say anything bad about my beloved yoga practice, in my opinion- asana simply isn't enough (GASP!). There are very real limitations with yoga as a singular fitness source. This was something I learned personally. Long-term yoga practice as a sole fitness activity tends to lead to muscular and functional imbalances. We see this particularly in the posterior chain (back body) versus the anterior chain (front body). Yoga is heavy on our pushing muscles and so very light on the pullers. All those chaturangas and down-dogs really add up. To this day, I am still working to match my upper back strength to my chest. I couldn't understand why my now flexible upper back (thanks yoga) would cramp up when I twisted or even sat in a chair. Flexibility is only one piece of the equation. Weakness in my upper back and over-trained muscles in my chest were causing my shoulders to slope forward and an exaggerated kyphotic curve aka hunched upper back. Aside from simple front and back body imbalances, I also saw tissue fiber imbalances. This limitation of yoga has to do with the nature and relation to muscle fiber types. Every single muscle of the body is made up of two types of muscle fiber: slow-twitch and fast-twitch. Some people have more slow-twitch than others, but what we commonly don’t realize is that fast-twitch fiber still makes up at least 55% of our muscle mass and for some of us as much as 65%. Why is this so important? Well, fast-twitch fibers are only activated in two situations: during maximal lifts or explosive motion. That means that if you are exercising slowly or with bodyweight exclusive exercises (yoga), even if you are using every single muscle of your body, you are only really activating about 35-45% of your muscle. That's one hell of an imbalance. The connection with yoga should be obvious: even the most vigorous forms never come close maximal speed or load. Even though I was working up a next level sweat, utilizing muscles I had once never known existed, it wasn't enough to hit my high-twitchers, the hamstrings, glute max & calves. Stretch & Strengthen This post is broken up into two sections; Strengthening and Stretching. You will notice it is heavily weighted on the strengthening side (pun intended, ha). The reasoning being that although tight hips or hamstrings can create tightness in the low back, I believe weakness, imbalance and instability are a far larger instigators in the human back pain crisis. As I said in the previous article, the most important aspect to understand about how muscles function to produce a joint movement is synergy. Synergy means that two or more things work together to produce a result that is greater than any of those things could do alone. Even the simplest joint movement requires strong and stable muscles working together in this cooperative fashion. When one muscle is weak, it will feel immobile, inflexible and the others must work harder to pick up the slack. Your tight muscle may be trying to inform you of a weakness. When we feel stiff or strained, instead of asking "what can I stretch?" try also asking "what can I strengthen?". As I said in Part I, back pain by it's very nature is enigmatic and illusively difficult for target maintenance. In this article, I've put together my personal favorite asanas, exercises and stretches that helped alleviate my back pain. I believe these exercises can help target some of our most common imbalances, weaknesses and instabilities. *Disclaimer: I am not your doctor, your physician, your physical therapist or your mother. Nothing I say should be regarded as absolute truth or gospel. These are simply the tricks and regiments that have worked for me via my own trials, errors and research. Any new workout routine should be approved by your health care practitioner first! Good luck. Strengthening
Weak back and abdominal muscles can cause or worsen low back pain. Weak muscles are also far more prone to tightness- a weak muscle will not want to stretch. That's why stretching your back, hips etc. simply isn't enough. Strengthening your back, hips, abdominal and leg muscles are important not only for treating low back pain, but also for helping to prevent a recurrence of the problem.
1. Bridge Setu Bandha Sarvangasana
Targets: Glutes, Hamstrings, Erectors
Bridges are a mainstay in the healthy back toolkit- especially if performed in a way that prioritizes strengthening the lower posterior chain; glutes, hamstrings and erectors. In the image to the left we can see that the spine has moved into very little extension, it looks more like a reverse plank alignment. This variation will build strength without jeopardizing an injured spine or aggravated tissue, while still gently stretching the front of the hips. In this modified bridge, we engage the glutes and hamstrings without placing strain on the lumbar spine. The image on the right moves the spine into deeper extension while moving the cervical spine into a pretty extreme flexion. For many people this variation would be perfectly safe, however, for someone with a lumbar or even cervical spine injury it could be counter productive.
Above is a video of Karen Claffey teaching bridge pose. I really dig Karen's knowledge and biomechanic methodology. Karen is Founder-Director of Heaven on Earth Yoga Therapy and is a certified Yoga Therapist, Structural Alignment Therapist, Massage Therapist, Macrobiotic Health Consultant.
2. Locust Salabhasana
Targets: Glutes, Hamstrings, Erectors and Serratus Anterior and Posterior
Locust pose itself strengthens the muscles along the sides of your lower back as well as the glutes and hamstrings. When we incorporate unilateral movement, as seen in the image above, we force each side to work independently. This helps correct imbalances- a major component of back and hip instability. When you work each side independently, your stronger, dominant side can’t compensate and take over.
Esther Ekhart, face and founder of EkhartYoga, brings years of personal yoga and meditation practice, therapy training and study of yoga philosophy into her teaching. Here she shows some of my favorite variations on locust to help lower back pain, specifically SI joint disfunction.
2. Back Extensions and Revolved Back Extensions
Targets: Glutes, Hamstrings, Erectors, QLs & Lats
Performing the back extension correctly teaches the hips and glutes to work as your prime movers. When our hips, glutes and hamstrings are strong and intelligent they can help support the lower back as it moves into forward folds (like bending over to pick something up) or back bends (like leaning back to carry a heavy box in front of you). Simply put, this exercise will increase your ability to coordinate movement through your lower back. Revolved back extensions target less of the glutes and more the QLs and lower back stabilizers. Your stabilizers and QLs are your back's "walking muscles". They also enable you to twist or turn your torso, hold your posture and support extensions. Remember, a weak muscle is much more susceptible to strain, sprain or tension. Any stabilizing muscle is better targeted through multi-plane movement, which this workout is. Strengthening your quadratus laborus will help in alleviating pain and reducing lower back muscle strain. *Considerations: Some individuals should avoid the back extension exercise. Those who have a herniated disc should consult their doctor and possibly avoid this exercise as it may increase intervertebral pressure. Individuals who have sensitive spinal nerves or neuropathy should also avoid this exercise unless otherwise advised by a doctor. Individuals who are heavier in the upper body or have poor back control may not be able to do this exercise correctly and are prone to arching during the exercise. These people may be better served by using a back extension machine until their backs can handle the higher workload.
Don't let the basement gym and hostage grade video quality fool you, Bret Contreras knows his stuff. Awesome explanation on muscle activation and isolation in back extensions.
3. Supine Twists, and Russian Twists with medicine ball
Targets: Obliques, Rectus Abdominis, Hip Flexors & Intercostals
These definitely fall into the "more advanced techniques" catagory and should only be done when back pain has subsided, possibly even with professional guidance. These twists target the obliques directly and work to stabilize weak inner thigh muscles. Our obliques are the mirroring muscle group to our QLs and are often weaker in comparison to their posterior counterparts. Tight QL's are often a sign of either two things: weakness in themselves or overworked due to weakness in the obliques. This can cause an exaggerated lordotic & kyphotic curves, compression and increased muscle sprain in the mid lumbar spine which can feel like straining during twists, or aches after walking.
Above is a gentler, beginner friendly version of supine oblique twists. Below shows seated oblique twists which are a little bit more advanced and should be done slowly and mindfully. With any back or spine injury, these exercises should be approved first by your medical professional.
4. Pulling exercises lat pull-downs, rows, etc
Targets: Lats, Rhomboid, Serratus Anterior
We already covered the importance of pulling exercises in the previous article, but because it is so important we will cover it again. The saying in the fitness world is: Pull Before You Push and Pull More Often. If you're a die-hard yogi, chances are you are operating on the reverse of that. As yoga practitioners, we need to start kicking up our pulling workouts. As Lee Boyce, strength coach and internationally published fitness writer says "You need to keep a balance between pulling exercises (rows, pull-ups etc.) and pushing exercises (push-ups, planks etc) If you don't pay attention to that balance, you're setting yourself up for bad posture, muscle tightness, and even back & joint pain."
5. Chair Pose or wall sits or narrow squats
Targets: Quadriceps, Tibialis, Glutes, Transverse Abdominis
Standing with a much narrower stance while you squat targets the inner thigh, inner hamstring and all heads of the quadriceps- a weak point for most. I can honestly say that squatting narrow helped cure my back pain. I first started using this squat style with my personal trainer almost ten years ago (she's a champion body builder and all around fitness guru). I was really into lifting at the time and the first thought that popped to my head was Tom Platz, aka “The Quad Father” on the hack squat machine. He used to position his feet extremely close and perform the movement for a variety of reasons, one of them being quad hypertrophy. Needless to say, this guy had crazy thighs (see image) Four muscles make up our Quad (hence the name). First we have the rectus femoris which is a biarticulate muscle group, meaning that it crosses more than one joint. The other three quad muscles do not cross the hip joint, but connect on the femur itself just a few inches away from the hip joint. When these muscles get weak they misfire and become very tight. They can pull and rotate the hip joint into less than favorable positions. This is an often overlooked problem with this muscle group. The femur and pelvis make the hip joint. If these muscles get tight they will move that femur around, altering its position in the joint. This altered joint position changes how our body recruits muscles to perform dynamic actions (i.e. walking), dumping said actions into the lower back. Quad hypertrophy aside and stabilization aside, when it comes to back pain or instability foot positions and joint angles become big factors. Narrow squats, wall sits etc keep our knees and feet parallel. Any strengthening exercise that keeps the knees and hips facing the same directing will be safer while we are working through lower back injuries. A narrow stance will also help prevent you from capsizing into your dominant side, subluxation of the hip or strain at the SI joint.
6. Core Work All the planks
Targets: Abdominals, Pectoralis group, Hip Stabilizers
Luckily, there is one exercise that can reduce low-back pain while simultaneously strengthening your abdominals—the plank. Because the plank exercise requires minimal movement while contracting all layers of the abdominal fascia, it is an excellent way to strengthen the core, which, in turn, helps reduce low-back pain. Below is a link to a previous blow post about core stabilization for inversions. Even if you don't plan on ever going upside-down, these core work exercises help strengthen and activate the key core stabilizers that help support the lower back. Click the image below to follow the link. 
7. Low-Impact Cardio Recumbent bike, elliptical trainer, HIIT
(By now you've learn the terrible truth, sometimes I put memes in my blog posts.)
Targets: High-twitch muscle fibers Guys, I'm with you. Cardio is literally the worst. At this point, you may even be debating how bad your back pain really is. Maybe we just live with it, right? In all seriousness, low-impact aerobic exercise can help rehabilitate your spine and alleviate your pain. It reduces instances of lower back pain along with reduced levels of pain during an episode, preserves functional capacities and increases production of pain-fighting endorphins. And most importantly, I mentioned way, waaaay earlier in this article, it helps regulate high to low twitch muscle fiber imbalance which can be a major component in musculoskeletal instability and back pain. We need to be hitting those high twitch muscle fibers, and cardio is how we do it. We need to compliment our yoga practice with the missing activities that will restore muscular balance and stimulate the full, natural capacities of our bodies. By supporting the numerous benefits of our yoga with the other activities for which our bodies were designed, such as cardiovascular activity, higher-speed training; posterior-chain activity such as pulling or climbing; and explosive- or near-maximal training such as sprinting and the lifting of heavy weights, we can experience even better health, greater capacity, and even more joy in our yoga practice itself. Lengthening
1. Hamstring Stretches
Tight hamstring muscles are a common contributor to lower back pain. The hamstring muscles run through the back of each thigh from the hip down to the back of the knee. Incorporating hamstring stretches can gradually lengthen and reduce tension in the hamstring muscle, and in turn reduce stress felt in the lower back.
There's a general consensus among modern yogis that Viparita Karani or Legs-Up-The-Wall Pose may have the power to cure whatever ails you. #reallynotreally. In all seriousness, legs up the wall is an excellent hamstring and lower back release which is pretty much appropriate for everyone- and that is a hard statement to make in this modern fitness world.
2. Hip Mobility
Believe it or not, your hips play a large role in the health of your back and limited hip mobility can cause back pain. Your hip joints have to travel through a very large range of motion. There are thick ligaments and msucles that surround the hip joints and provide support. However, with prolonged sitting or repetitive movements, these ligaments weaken, then tighten, thus reducing the natural movement of the hip joints. This means that whenever you walk, instead of your hips moving naturally, the tightened ligaments pull on your pelvis, which attaches to your spine. This causes inflammation, strain and pain to the muscles in your back. Furthermore, the loss of hip motion can even cause your pelvis to tilt, altering the posture of your spine and increasing strain. Improving hip mobility can relieve back pain rather quickly.
Are your hips weak, tight or both? These are important distinctions to make when working toward even hip mobility. The video above shows one of my absolute favorite fitness gurus explaining the difference between tightness and weakness in the hip flexors.
Since there are 22 muscles that tie into the hips alone, it take a lot of different movements to target them all. Below is another great, but more advanced hip mobility exercised to be explored with caution.
If you've been to my classes then you have probably heard me refer to Malasana Squat as the holy grail of yoga poses. The hips tell the story of modern industrialized life that requires sitting at a 90-degree angle. As a result, the health of body suffers. Specifically, spine health is impaired and back pain increases. Malasana squat (as seen below in Erin Motz's video) helps drastically reverse the side effects of our modern seats, opening the hips and reducing the tension on the lower back.
The Figure Four, as picture below, is one of my all-time favourite piriformis muscle stretches to do, especially for lower back pain and sciatica relief. This is a great lower back exercise to help relieve muscle tension from sitting too long at a desk.
3. Lengthening the lower back
Gently lengthening the spine in supported release can help decompress tension on spinal nerves, open hips and rehydrate intervertebral discs. Child's pose on a bolster, or laying prone with a bolster underneath the low belly are two of my favorite restorative exercises.
4. Bodywork! thai massage, tissue work, acupuncture
Target: QL, Glute Medius
If you suffer from chronic back pain, it is time to implement a self care practice. Massage therapy can provide substantial healing and pain relief for people suffering from low back pain caused by muscle tension and strain, if the correct muscles are targeted. As I have said before, nearly 80% of backpain is from sprain, strains and tears. Two important muscles, the quadratus lumborum (QL) and the gluteus medius, may play a bigger role in causing pain than most people realize. The pain from a strain of either of these muscles can be severe and debilitating. The QL muscle, which connects the last rib to the pelvis, is responsible for pelvic stability and structural alignment. It is a common source of low back pain. The gluteus medius is a posterior hip (or buttocks) muscle that frequently causes pain when the QL muscle is irritated. The gluteus medius becomes triggered as it tries to compensate for the QL’s dysfunction. Having a CMT work on either of these muscles can help to provide immediate relief.
Putting in the work.
Okay, let's review.
resources:
Chris Beardsley biomechanics researcher, editor of Strength and Conditioning Research. Thomas E. Hyde, DC, DACBSP, CKTP, FRCCSS (Hon) Editor, contributer Spine Health Jeff Cavallier, Athlene X owner, Operator CPT CSN Kojo Hamilton, MD associate professor of neurological surgery and the Co-Director of the Spine Fellowship Program at the University of Pittsburgh Medical Center Stephanie Burke The CEO and co-founder of Spine-health Gavin Morrison, physical therapist specializing in exercise routines focused on core strength and relieving back pain. He holds a degree in physical therapy from the University of Washington and has been a member of the American Physical Therapy Association for over 10 years
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Abbe Ciulla
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