Have you been given a generic diagnosis of "arthritis" as a cause of your low back pain? Many clients I see tell me they have arthritis, but very few have a good understanding of not only the pathology, but also any type of treatment. Often times at a doctor's office there is not enough time or a welcoming vibe to ask more questions. What does that mean exactly? What can I do to address it (besides pop pills)? Can it improve? So first, a brief explanation on what that means:
Osteoarthritis (osteo=bone, arth=joint, itis=inflammation) in the spine is also known as Degenerative Joint (or Disc) Disease. This is when the cushioning cartilage between each vertebrae wears down, causing compression in the facet joints, or the posterior (back)portion of the vertebrae. This can cause a chain reaction of inflammation and pain. One common condition this can lead to is known as Spinal Stenosis, which is a narrowing of the spinal canal, and can cause compression on the spinal nerves. This can result in pain in the buttock(s) or down the leg(s).
The description above is extremely concise, and is not meant to be absolute. I frame it in that way in order to introduce the purpose of this post: how yoga can help. The process described above, whether it is diagnosed as OA, DJD, or stenosis, has a typical presentation in terms of movement. Pain is usually increased with standing/walking, backward bending, or lying prone (on stomach). Pain is usually decreased with sitting, bending forward, or lying on the side or supine (on back) with legs elevated.
Remember earlier when you read that compression occurs in the posterior (back) portion of the vertebrae? Well, when one stands, bends backwards, or lies flat on their stomach, it puts the lumbar spine in relative extension. Extension further closes down the posterior portion of the vertebrae, where there is already compression. See how that would cause increased pain? Conversely, when one bends forward, or sits, or lies down with their legs elevated, this puts the spine into relative flexion. Flexion tends to create more space in the posterior of the vertebrae. See how that would relieve symptoms?
In Hatha yoga, postures are broken down into a few different categories: forward folds, backbends, twists, hip openers, and so on. For any arthritic process of the lumbar spine, I would say the most important category to focus on is forward folds. A close second is hip openers, which I will expand upon in a follow-up post. For now, we'll explore basic, safe, and efficient ways to forward fold, and create more space in the posterior portion of the spinal joints.
1. Standing Forward Fold (Uttanasana)
DON'T: keep the legs straight and round the upper back, dangling in space. This does not produce the lumbar/hip flexion desired for the therapeutic purpose that forward bending has on arthritis. See how my lumbar area is flattened here and I am getting most of the flexion throughout the thoracic (mid-back) area?
DO: Use blocks or something to rest hands on, in order to bring the floor closer to you. Bend your knees and keep relative extension in the upper back, while allowing the lower back and hips to bend.
2. Seated Forward Fold (Paschimottanasana)
DON'T: sit flat on the floor with the legs straight, letting the upper back round. This just adds extra strain on the low back.
DO: sit up on a pillow or rolled up towel or blanket. Let the knees bend and fold from the hips, keeping the upper back in relative extension.
3. Legs Up The Wall (Viparita Karani)
Lay on your side in the fetal position with your butt against the wall, and your torso perpendicular to the wall. This starting position is important in setting up the end pose correctly. As you roll onto your back, slide the legs up the wall. Once you arrive, your butt should be touching the wall, and your torso still perpendicular to it. If it didn't quite work out this way the first time, you might come down and try again. Again, if the set up isn't correct, it wont have the therapeutic benefit you are looking for. Once your positioning is aligned, bend your knees slightly, lift your hips up just enough to slide a pillow or folded blanket under the buttocks. Enjoy :)
There are many things people can do to address an arthritic process anywhere in the body. Yoga is one that addresses the physical and emotional symptoms of the process. But there are things that can actually affect the internal process itself, such as weight management, nutrition, and supplements, which I hope to have a guest writer (my extremely knowledgeable and well-read husband) expand upon in another follow up post. Please feel free to comment below, ask questions, or harass Brian to write about what he has to say about nutrition and supplements!
FYI, I recorded a video on nOMad's online studio entirely focused on relieving back pain with a legs up the wall sequence. Check it out!You can also view my Studio Schedule to see when you can join me in one of my studio classes, or make an appointment with me for a private session. Namaste!