What Is Yoga and
Why Yoga for
Back Pain?
Many people experience back pain from time to time. Whether this pain is severe and chronic or mild and short-lived, it often causes misery and curtails everyday activities.1 Why practice yoga for back pain? Yoga has been associated with healing through the millennia. It is without cost, self-administered, and silent, and it demands no equipment beyond a pillow, a belt, or a chair. Yoga relieves pain and promotes calm to endure any pain that remains. It can address back pain generally, through prevention, and directly with attention to the specific cause of existing pain. No special beliefs are required in the practice of yoga.
What Is Yoga?
Yoga means “yoke” (a link, a harness that joins together) or “unity.” This unity refers to the oneness of body and mind. The purpose of yoga is to bring together the body and mind to create harmony, or well-being. The word yoga also means “discipline” or “effort.”
Some people think of yoga as an art; others call it a science. Most would agree that although it is associated with Hinduism, it is a secular practice that can be done by individuals of any faith or no faith. I like to think of yoga as a system of behavior that encompasses mankind’s social context; that is, it exists in a social environment, influencing and being influenced by the community around it. Certainly yoga has gathered devoted practitioners from many different faiths and lands.
The classical form of yoga has eight limbs, or branches, the first two of which are relevant for anyone who considers using yoga to aid in the healing process, to relieve back pain or any other type of pain.
Universal moral commandments having to do with our relations with others, called Yama, constitute the first limb. These are concerned with nonviolence, truthfulness, not stealing, temperance, and noncovetousness. The second limb of yoga, Niyama, contains individual moral directives, including purity, contentment, austerity, introspection, and dedication to a higher being.
There is no question in my mind that Yama and Niyama serve the purpose of anyone seeking healing. Following these codes—living an uncomplicated life, with dignity, purpose, and compassion—is very strong medicine. As the gyroscope’s internal motion resists deflecting influence, reasonably disciplined striving toward personal improvement creates its own momentum.
Asanas, or “postures,” make up the third limb of yoga. In the West, these positions—lotus position, headstand, and so on—are typically identified with yoga. Hatha (physical) yoga is made up of asanas. When I was in India, Mr. Iyengar demonstrated various asanas for his classes; these poses had been practiced and refined for thousands of years. Within the various schools of yoga, the style of these asanas differs; also, some poses are still evolving. Some asanas have biological names based on the gestalt of the position. The Tree and the Scorpion are examples of these. Others are named for their “attitude,” for example, after gods in Hindu mythology: Hanumanasana or Virabhadrasana. A third group of asanas is known for the anatomical parts that figure most prominently in their execution, such as the headstand or arm balance.
The fourth limb is Pranayama, which concerns the apparatus and technique of breathing. This practice is used in a number of respiratory and psychiatric conditions but also to help the student progress beyond mere physical health and toward a state of liberation. Many yogis believe that breathing is the bridge between the body and the soul.
Pratyahara, control of the senses (desires), is the fifth limb. Dharana, the sixth limb, focuses an individual’s mind and promotes concentration. Next, Dhyana is a blissful state in which one selflessly devotes one’s time and energy to seeing the spiritual essences and giving all of one’s resources for the betterment of the world. Finally, Samadhi is the attainment of liberation or enlightenment.
In the type of yoga you will likely be practicing, “the yogi frees himself from physical disabilities and mental distractions by practicing asanas,” as Mr. Iyengar wrote in his classic book, Light on Yoga. It isn’t an accident that one of the first textbooks on yoga was written by Patanjali, who lived thousands of years ago and is believed to have been a physician.
Although all of the hundreds of different yoga postures are aimed at improving health and increasing personal calm, some poses are noted to have specific effects and are considered to be especially appropriate for individual conditions such as back pain.
Why Practice Yoga for Back Pain?
My friend Tom provides a dramatic example of the way yoga can speed the healing process. Tom was an eighteen-year-old learning to rock climb when he had an accident that involved a long fall from the top of a cliff. He was lucky to survive; unluckily, he cracked two of his lower vertebrae. Tom’s physician happened to be a native of India, and a yoga practitioner. He knew that the boy’s injuries could be treated through yoga. At first he taught Tom how to sit properly, so that his spine was properly aligned. This, Tom remembers, was instrumental not only in alleviating his pain but also in facilitating his eventual cure.
Prevention
At one time or another almost everyone suffers from back pain, the cause of more lost days of work than anything but the common cold, so the world has turned to secondary prevention as a principal means of addressing it.2 Yoga is an ideal preventive for those who have either chronic or occasional pain. Tom is an example of someone who learned that yoga can heal, but even now he has to take care of his back and his whole person to prevent old injuries from flaring up. He accomplishes that with yoga.
Secondary prevention involves taking steps to avoid the consequences of a condition. For example, currently there is no cure for diabetes mellitus. But if diabetics carefully regulate their serum glucose and diet, then neuropathy, cardiovascular complications, peripheral vascular disease, and ocular problems can be minimized or avoided.3 This applies in full force to lower back pain, where reduced activity leads to stiff muscles and joints and to weakness, which are the main causes of chronic back pain.
Overall prevention is impossible. For example, you can’t prevent all colds and flu; you can’t prevent the accident that causes a broken leg; you can’t keep all misfortunes from happening. What you can do, however, is reduce their frequency, severity, and duration. For colds and flu, for example, washing your hands and strengthening your immune system with a healthy diet and lifestyle may make a difference in how often you contract a cold or flu, how badly you suffer, and how long the illness lasts.
Paradoxically, for back pain, prevention constitutes cure. In practicing prevention, your goal is to stop pain from becoming chronic. Yoga does this in eight ways: stretching muscles to reduce spasm and increase flexibility, strengthening muscles and bones, increasing range of motion, sharpening focus, heightening self-awareness, and producing calm. It also improves balance and agility.
You can practice yoga just about anywhere, without spending money, without props, without making noise, and without wearing special garb or giving up your beliefs.
Reducing Spasm
There are two types of sense organs that record the tension within: One type inside the muscle fibers themselves is called intrafusal fibers. These actually have their own tiny muscles that adjust the tension according to the larger muscle’s length. Intrafusal fibers are embedded within the muscles themselves, and when tension increases, either through external pull or because other muscles are contracting, they influence muscles to contract. When there is stress on them, the muscles react by tensing. The intrafusal fibers are dynamic. Tiny muscle fibers inside each intrafusal unit adjust the sensing mechanism to the current conditions of the muscle. Therefore they have a large immediate effect when you move, but that effect gets weaker and weaker as they adjust and as a result movement or tension continues.
The golgi tendon organs, on the other hand, give off a constant inhibitory signal that varies only according to the tension on the muscle. The golgi tendon organs (located in the tendons) cause the muscles to relax when they are stretched. They are static. They produce a constant, unchanging level of signals to the central nervous system to relax the muscle.
At first, the intrafusal fibers actually intensify resistance to stretch, increasing the amount of spasm that is present. But over a short time, their own adjustment mechanism cuts down their input. Usually in less than two minutes the force of the intrafusal fibers falls below the relaxing influence of the golgi tendon organs. Cumulatively, the forces that cause muscles to contract—to get tight when stretched—decrease. The constant inhibitory influence of the golgi tendon organs prevails. The result of this is that stretching a muscle and keeping it in that extended position for any length of time allows relaxation to overtake excitability. The muscle relaxes. Then there is a domino effect that may travel elsewhere in the body, making other muscles become less tense. When you begin a yoga pose, the relaxation that results when the golgi tendon organs go into action is masked at first by the effect of the excitable intrafusal fibers, but that effect falls off quite quickly, while the damping action of the golgi tendon organs continues as long as you are in the pose.4 Slow and steady wins the day. It is one essential way you can help your body to counter spasm and reduce back pain.
This strategy of staying in a given stretch position for a length of time relies on a reflex, a natural and “hardwired” mechanism that functions at the spinal cord level. It works without our consent. Although we set out to do it on purpose, the effect is mediated on a wholly unconscious level. There is no question that the calm it brings has effects farther up in the central nervous system. We will encounter that benefit of yoga soon enough. But we should first consider another reflex mechanism that can be used to relax involuntarily constricted muscles in spasm.
Every time you flex your elbow, you use your biceps. And every time the biceps contracts and flexes the elbow, its opposite, the triceps, which straightens the elbow when it contracts, must relax and stretch to allow the elbow to bend. Two muscles in this relationship are called “agonist” and “antagonist,” depending upon which is doing the contracting. There are many such pairs in the body, of course, and the absence of either partner of the set, through amputation or paralysis, for example, often brings severe spasm to the one that remains.
This opposition is obviously extremely useful. What good is a hand that can grasp if the fingers cannot be opened? These pairs of muscles, mutually dependent for their utility, require precise coordination. Another reflex simplifies the operation: Contraction of one member of the pair works unconsciously to relax the other member of the pair. So as you raise your head by contracting the muscles of the back of the neck, relaxation takes place in the muscles beside the throat that would bring your head down.
Yoga uses this simple but powerful mechanism in many ways. For example, bending forward by contracting the stomach muscles simultaneously relaxes the antagonistic muscles of the lumbar spine. Holding that forward position for a length of time, keeping the abdominal muscles contracted, invokes the relaxing effect of stretching both the golgi tendon organs and the agonist-antagonist mechanism, formidable adversaries of the painful back spasm that we want to vanquish.
Flexibility
A joint in the human body is really miraculous, moving back and forth, as many as hundreds of thousands of times a day for as long as a hundred years, without ever getting stuck! When something does go wrong, however, wear and tear may take place and range of motion may become limited.
Through well-known stretching postures, yoga extends the range of motion of the joints. The inside of the joint capsule, which surrounds the joint much the way a gasket surrounds the juncture between the sink and the faucet, secretes a thick, lubricating substance called synovial fluid, which greases the joint, lubricates it, and allows it to move freely and smoothly. If tendons, ligaments, or muscles associated with the joint become tight, there may not be enough fluid to keep it working properly. Movement may be limited, or there may be pain. No studies have been done on the effect of yoga on synovial fluid, but yoga can safely enlarge the capsule and therefore allow it to continue to function as a secreter and container of synovial fluid.5
Ligaments around the joint are made of basically the same material as the capsule, but they are much stronger. Their function is to protect the capsule against overly vigorous movement or movement beyond the normal range of motion. Hatha yoga can stretch ligaments little by little if they become tight or stiff.
Apart from resolving spasm, yoga can also stretch otherwise tense or shortened muscles, changing their length through the continuous pressure exerted on them when an individual attains and holds a particular pose. The stretch itself may engender some discomfort. While that isn’t always entirely pleasant, the pain does serve a purpose. It calls attention to the problem area and is likely to provide motivation for an individual to gain control of, say, a particular muscle. Through repeated effort one learns to make that muscle relax. A relaxed muscle can stretch farther. That is key. After controlling the muscle spasm that is so common in back pain, yoga then stretches the muscle farther, so that more movement is possible with less pain. Around joints, yoga increases range of motion; joints at one remove from the painful one adapt by increasing their range of motion to take on some of the strain from the places that are actually producing the pain, allowing them to heal.
Strength
There are two ways yoga increases strength. First, as with any exercise, muscles get stronger when holding a specific position for any length of time, even for a few seconds, because the body has to fight against the forces of gravity to keep itself in position. In this way, yoga is a little like lifting weights.6 The counterforce is the weight of your own body and the resistance to movement that different muscles and joints provide. But yoga often increases strength isometrically. Isometric exercise takes place when muscles contract without joints moving. For example, if you lace your fingers together and then try to pull your hands apart, your muscles will contract without any movement taking place. Isometric exercise increases strength with stunning efficiency.7
Unlike some activities, the goal of yoga is to gain control, not lose it. Students of yoga who do poses, or asanas, develop personal techniques for relaxing their muscles. These techniques are enhanced by involuntary processes. Nerves have what is called a refractory period. After conducting signals, there is a short period during which they cannot be stimulated to carry any signal, no matter how strong the stimulus. And muscle fibers fatigue from contraction. If one stimulates a previously resting nerve fiber, attached to a calm muscle fiber, it is likely to arouse a maximally powerful contraction. If fifty workmen have the job of moving a heavy block, and some are pulling while others rest from having pulled a moment ago, they will not be as effective as fifty workmen who all pull at once and together. Not only is the muscle stronger; its fibers contract more simultaneously: Strength is more effectively utilized.8
Strength is not only a matter of muscles being strong and all their fibers contracting simultaneously; strength is also related to strong bones. The unorthodox and quite sharp pulls that tendons and ligaments make on the bones in the course of doing yoga have been shown in humans and animals to arrest and possibly to reverse osteoporosis.9
Calm
It’s well known that stress can contribute to back pain and that yoga reduces stress. Yoga, however, approaches this in a way unfamiliar to Westerners. We believe our minds cause our bodies to move, our brains sending signals down nerve pathways to our muscles. And, of course, that’s true. However, in yoga, the opposite also applies. The state induced by yoga in our bodies calms our minds.
Breathing exercises are another resource of yoga that produce calm. These exercises are actually an entire realm of yoga as large as all of hatha, or physical, yoga. Breathing, or Pranayama, is the rhythmical and sophisticated use of one’s breath to produce a specific effect. There are centers in the brain that control inhaling and exhaling. Gaining some mastery of these centers seems to control not just breathing itself but a number of other rhythmic and alternating patterns in the brain that, when regulated, produce salutary effects. The individual practicing Pranayama not only becomes calm through breathing in and breathing out regularly; the calm also seems to “spread” through the central nervous system, giving a model of mastery that can be replicated elsewhere in the nervous system. When this is done, it produces an overwhelming level of calm and self-control.
Herbert Benson, MD, of Harvard Medical School described this type of breathing, which is taught in the mantra meditation used in transcendental meditation, in his 1975 book, The Relaxation Response.10 Basing his thesis on studies at Boston’s Beth Israel Hospital and Harvard Medical School, Dr. Benson showed that relaxation techniques such as meditation have immense physical benefits, from lowered blood pressure to a reduction in heart disease, and he made these techniques accessible to everyone. Other introductory texts on Pranayama have been written by B.K.S. Iyengar and Mira Mehta.11
Self-Knowledge
There are two more interlocking ways in which yoga helps, especially if you have back pain. A type of self-understanding comes from practicing yoga. Both watching your own reactions to pain and stress and experiencing your own determination to gain mastery over the asanas contribute to your knowledge of yourself. You gain simple understanding of the way your own body works and the things that are better and worse for it, the things that are easier to do and more difficult. This is knowledge in the usual sense of knowing that your back bends only to a certain extent, but it is also knowledge in a deeper sense. You become more than acquainted with yourself; you become familiar. Being familiar with your own body—knowing what you can and cannot do—is a cardinal way to avoid back pain in the first place.
And now for the final advantages to achieving calm. In addition to reducing the drone of anxiety in the background of one’s life and increasing the understanding of yourself, yoga contains a means of keeping yourself from getting too excited. Through the practice of yoga you learn how to avoid getting yourself into desperate situations in which you are likely to injure your back or injure it further. Far from trivial, the most important thing in treating back pain (because you can’t always avoid it) is to prevent it from becoming chronic. Yoga is the best means I know of for reducing back pain to manageable levels, if not completely abolishing it, and keeping it from becoming a dominant factor in your life.
There are now scientific programs to prove how and how well yoga “works.”12 Yoga actually increases your sense of well-being and self-reliance and is a strong combatant to depression, which may lead to increased somatization of any symptom. But basically it is for aesthetic reasons that people embrace yoga—because of the combination of humility, kindness, consideration, strength, temperance, generosity, and expecting much from yourself and little from others that attracts people to yoga. Essentially people do it not only because they believe they should, but because they want to.
The idea of being able to coordinate one muscle with another presupposes familiarity with one’s body, strength and flexibility, focus and self-knowledge. In addition, yoga promotes balance, symmetry, and grace.