Hatha Yoga as Physical Therapy for Low Back Pain
Another cause of low back pain is lumbar facet and sacro-ilial joint compression in extension. This mechanical stress to the joints inflames the surrounding tissue, including the nerve roots. When one stands unskillfully with increased lordosis, pelvis in tilt and forward shift, lumbar facets can be compressed unevenly. If there is no grounding or lift, this uneven compression can be quite excessive. If one is asymmetrical, collapsing on one leg, the mechanical stress can be injurious to that side's joint structures. As well, spondylolisthesis is exaggerated as the lumbar vertebrae are translated anteriorly due to the mechanical stresses of this unskillful stance.
People report low back pain upon prolonged standing. Maybe even slow walking brings on pain, but brisk walking can be relieving. In brisk walks, they have enough skill of spine lengthening to stay out of compression. They might even report S/I pain in weight bearing of one sit bone when sitting upright.
In this scenario, forward bending is relieving and extension is provocative. One issue is that standing and sitting upright is extension, and therefore, provoking inflammation from joint compression. One cannot, of course, avoid upright postures in one's daily activities, unless in the most extreme of restrictions of movements, bed rest. One needs to learn the motor skills of standing and sitting upright without injurious joint compression.
Lumbar facet joints will compress on a neighboring facet and the sacrum will compress on the ilium with too much nutation/ extension. An ilium will compress on a sacrum with femur in extension, as the ilium anteriorly rotates. With the femur in external rotation, the ilium outflares to compress against the sacrum. The sacrum can compress into the ilium as the spine rotates the sacrum into the ilium. If the thoracic spine sits too heavily on the lumbar spine, injurious compression may result. If the thoracic spine is hypomobile, then spinal movement has to come from too few joints of the lumbar and sacro-ilial area. The thoracic and cervical spine needs to have the skill of lengthening in order not to excessively compress above or below the stiffer thoracic spine.
The inhalation allows one to open up the field of awareness to the space below our feet to grow roots into, and to the space behind us to help us from thrusting ourselves forward with muscles, and into the space above us to rise into. The exhale is when we more effectively can ground, center, and lift.
We need to be vigilant to detect any sensation of muscular holding from unskillful standing or breath-holding. Awareness of specific sensations brings our attention to that area and to a specific direction of energy [downward in rooting, upward in lifting].
The skill of lengthening the spine is a whole body and mind activity. All of the body and mind needs to participate to accomplish the whole of skillful posture. No isolated soft tissue or joint work or muscular activity is enough individually to create a light spine in stance.
The skills of standing poses are exactly what one needs to learn. One will start with the symmetrical poses, before moving to the wide legged, asymmetrical poses. The poses challenge us to keep grounding, centering, and lifting in many different alignments.
This decompression takes the mechanical compressive stress off the joint surfaces and allows more room for the nerve roots through the foramen. Slump sitting, squats, standing child's pose, standing back against wall, supine with legs up on a support are restful positions for the back vulnerable to extension compression.
Skills necessary not to excessively compress in extension are the inner actions of standing poses and backbends. The upper inner thighs move back against the perineum forward. The inner spiral predominates over the outer spiral as both direct energy into the earth. The belly keeps the pelvis relatively neutral against the inner thighs back. The "ball" in the belly rotates the navel back to the spine with the perineum forward, along with the back heels rooting. The lift of the spine can too easily overarch the lumbar spine with too much back extensor muscular activity. The relative tuck of the pelvis from this roll of the belly keeps the lumbar spine out of increased lordosis.
But the lift of the spine is very important to keep the facets from compressing too heavily. As the energy goes into the earth from belly through the legs, the root [in between the sit bones] rises through our centers through the crown of the head. We use a vision of these exact inner actions of ground, center, and lift. The vision is of the movement through our centers into the spaces below and above us. This coordinates the nervous, muscular, and bony systems to stand with the skill lightness and length. This movement of energy keeps us from too dull a stance or too tense a stance.
We can even provoke ourselves to even more skill with a deeper backbend in the spine, and still not injure ourselves with compression, if we are skillful with the ground, center, and lift.
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