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The Role of Posture in Back Pain

Part I – Coming to the Floor

Image from Gray’s Anatomy 1932

Yoga can be an excellent modality for managing and healing low back pain. Just as many poses in Yoga are ideal for healing certain kinds of back pain, other poses may make back pain worse. It depends on the nature and cause of your back pain.

I agree with Robin McKenzie, a New Zealand Physiotherapist, that poor postural habits play a big role in most back pain. McKenzie has developed a body of work that successfully treats back pain. Many of the exercises that are prescribed by the McKenzie are the same postures that can be found in many gentle or beginning Yoga classes. (Unfortunately, many of these same postures have been dropped from more advanced Yoga classes today.)

We live in a world in which we are sitting — at our desks, in front of the television, at our computers — for many hours of the day and night. We sit in slouched postures, with our spines rounded forward, our heads jutting forward (check out your posture right now). The position of the spine in this curved forward “C” position is called flexion. We have four natural spinal curves, at the neck, the thorax, the lumbar and the sacral spines which form a gentle S from the top down. However, with the demands placed on us from early childhood, when we begin to sit at uncomfortable desks, we begin to alter our natural spinal curves. We begin to lose our ability to find a neutral, or comfortable, position. We begin to slouch. We slouch when we’re sitting. We slouch when we’re standing up.

We slouch because we can’t find a comfortable position in which to counter gravity, a constant force pulling on our bodies. When we give into dysfunctional postural habits, then we end up fighting gravity, one of the strongest forces in the Newtonian universe. What happens next is that the anti-gravity/postural muscles in our necks, extending to the entire length of our spines begin to overwork. As they overwork, they fatigue. As they fatigue, they begin to hurt. It’s not that we don’t try to sit up straight, but we end up slouching because we don’t have the strength to maintain an upright position anymore. It becomes a vicious cycle.

These long muscles, the erector-spinae muscles, extend in series from the base of the skull to the sacrum. In a slouched posture, not only do they overwork and become tense, but at the same time they become over-lengthened, weak and painful. They are not able to do their jobs in holding the trunk upright against gravity. Once these muscles become weak and over-lengthened, other muscles in the hips try to compensate. The hip muscles, working to keep the body upright against gravity, depending on their placement and your anatomy, become short, tight, weak and painful.

At the same time, the Core muscles, the deep abdominal and pelvic stabilizing muscles surrounding the hips, become weak and flabby. Breathing is often shallow. With a slouched posture, the ribs are compressed in the anterior body and the diaphragm, the primary muscle in breathing, is placed in a disadvantageous position.

The body may feel tense and tired. Trying to sit or stand erectly becomes more and more difficult. Our bodies are out of balance and out of sync with gravitational pulls. The body ends up fighting gravity rather than working efficiently within the gravitational field.

How do we restore balance to our bodies?

The best way is to go to the mat, to the floor, where the body can rest into gravity, without having to fight it. The flat surface of the floor provides maximum support and feedback to a body out of sync. Once lying on the floor, you can begin to realign yourself, front-to-back, right-to-left, head-to-toe. The four spinal curves are supported. Where the spine is rotated, a common occurrence in people who suffer from back pain, it can begin to unwind.

The body craves balance. Coming into the floor, embracing gravity and relaxing into it, combined with breathing mindfully, is the beginning of healing your back pain.

 

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How Yoga Physical Therapy Works With Pain

Day 2. I started this blog because I want to get the word out about NY Yoga Physical Therapy. Sometimes I come home after working with a patient who has chronic pain with a great idea that we discovered during our session, and I want to share it. So this is a way to get me started writing about the work, to explain what it is that we do in Yoga Physical Therapy.

First and foremost, I look at the body with the eyes of a Physical Therapist. The training was the best I could find for understanding the components of the human body and how it moves in space. From my background in dance and yoga, I became a Physical Therapist because I was hungry to know about muscles, joints, the nervous system, and how it all fits together. Then, by studying the pathology of injury and disease, I learned what happens when something goes wrong. My job as a Physical Therapist is to find a way to help the injured body in pain recover. These 20 plus years of working with injuries and disease have only increased my understanding and intuitive approach.

Yet as great as the Physical Therapy training was, it didn’t give me a way to deal with the whole person. Often I would find people were tense, upset and holding tension in their bodies, especially those with low back pain, upper back pain, neck pain and those with frozen and painful shoulders. (I also see people holding tension in their feet, knees and hips.) At first, I didn’t know what to do with this growing observation. I wasn’t trained in how to deal with stress and the psychological components of pain, disease and injury.

Once I consciously started practicing holistically, incorporating Yoga, mindful breath work and other holistic practices into the sessions, I began to be able to help people help themselves with the effects of stress held in their bodies – physically, emotionally and psychologically. The introduction of the breath, not only into the exercises, but as a separate activity in itself, began to transform the effectiveness of the therapy sessions, especially in those with chronic neck pain, upper back pain, middle back pain and low back pain.

By helping you learn how to breathe into area injury and pain, you become aware of your own experience of feelings, holding, tension and tightness in that area of the body. On a physical level, getting breath into a tight or tense area literally begins to open up the area. As the muscles relax, they loosen their hold on the bones. The affected bone(s), pulled out of line by an overactive muscle, can begin to relax back into place. When the muscle, then the bone(s), release back into a relaxed state, then the affected joint can begin to realign itself. Yes, you can learn to breathe into targeted areas of the body. As the body relaxes, or disinhibits from tension and pain, then the breath can freely move the trunk.

Secondly, blood does not flow freely through tense muscles. So another result of using a mindful breath is that it helps muscles to relax. Relaxed muscles allow blood to freely circulate through these affected muscles. With more blood flow, more oxygen gets into the area. More oxygen equals more healing. The molecules and chemicals for healing can now get to get to the injured, painful area. Not only that, but the byproducts and waste molecules from cellular respiration – or cleaning up the debris from the injury –  is now able to move out of the area more quickly. This aids in decreased swelling, inflammation and therefore improved healing.

On the psychological level, mindful, meditative breathing is documented to lessen the effects of stress, including lowering blood pressure and decreasing heart rate. It lessens the effects of cortisol, the stress hormone of the fight-or-flight reaction. As a person becomes more aware of  bodily tension and learns to breathe into it, often the emotions or thinking that contributes to that tension begin to loosen their hold as well. As the mind begins to relax, so too does the body. Once the body begins to relax, so do the mind and emotions. It’s a dynamic, interactive process.

I’ve had patients thank me for helping them to identify and learn to work with the stress that is contributing to their pain and injury. Once they developed an awareness that they were holding tension in their backs, necks, feet or hips, they were able to begin working with, and begin lessening, that tension. Their pain started to go down, too.

For one patient with chronic back pain and neck pain, a sudden awareness and acceptance of how he held tension in these areas was the turning point in his treatment. He said, “I thought about what you said last week about accepting the discomfort. And over the weekend, I got it. It was weird, but my experience of the pain changed.” He stopped therapy shortly after.

Awareness is key. So is acceptance. With aware breathing into an injury, combined with specifically targeted positioning or stretching of the body, the healing process is powerfully supported. Using a gentle and mindful breath also gives us an effective tool to support the entire healing process, body and mind. Paradoxically, acceptance of pain can reduce the anxiety and fear surrounding it, which then contributes to the relaxation of the tension that we hold because these feelings.

Sharon Gary of Yoga Physical Therapy in mid-town Manhattan can help you with this holistic, integrative approach to healing.