Last weekend I had the good fortune to co-teach a workshop with my partner Debbie Gilman, who is an amazing and seasoned yoga teacher from the Yoga Room Berkeley (Iyengar) tradition. I thought it was going to be straight forward – she teaches the asanas and I teach the anatomy. But we realized the topic was so broad that it became a really difficult task to pull together a comprehensive three hour workshop that we could both agree on! I also wanted to shar what I’ve learned about back care from my 18 years as a chiropractor, in a context that was congruent to a class of (mostly) yoga teachers. Below are some of my handouts for the class.
There are many causes of back pain. In my practice I use functional muscle testing to assess for the underlying cause of imbalance. From Applied Kinesiology, I work from the framework of the Triad of Health.
Triad of Health = Structural, Chemical, Emotion/Energetic
Chemical/Emotion/Energetic = often triggered from stress, leading to a Viscero-Somatic reaction (the nervous system inervates both the soma (muscles) and viscera (guts). An imbalance in one will often trigger a response in its correlate.
- ICV (Ilio-Cecal Valge) irritation often leads to low back trigger
- Low back is often correlated with money worries in some systems of healing
- Emotional Polypeptide receptors located throughout the fascia / connective tissue, and may possibly correlate with the meridian system
Structural
In the structural arena, I think of the following –
Posture:
- Sitting on Sacrum, static/seated work postures
- Forward-rolled shoulders & forward neck = weak posterior chain, tight Pecs & Scalenes
- Standing with excessive tuck (shortened Glutes & Hams) = weak posterior chain
- Standing with excessive Tilt (shortened Psoas & lumbar erectors) = weak anterior chain
Movement patterns:
- Hinging from lumbar spine vs hips
- Squatting with head or knees forward of toes & not engaging Glutes
- General lack of movement in our modern life: we evolved to move and live a more sedentary lifestyle
Muscle imbalances:
- Back pain often causes inhibited Glutes, tight Psoas & Hamstrings
- This pattern leads to further imbalances
- Failure to properly / adequately engage abs
- Push abs out, don’t pull in, for optimal spinal support
- Muscle imbalance: front to back, side to side, diagonally
- Agonists and antagonists need to balance each other like guide wires
Review anatomy:
- There are 206 bones: 24 spinal segments
- Three major curves to the spine (cervical, thoracic and lumbar)
- There is the Axial Skeleton (spine, Sacrum, skull, ribs) & the Appendicular Skeleton (all else)
- Ligaments = duct tape. Connective Tissue limits end-range motion and holds parts together.
- There are 600 major skeletal Muscles = rubber bands (movers)
- The muscles of the back = spinal erectors, QL, Lats, Rhomboids, traps and deep spinal muscles (layers)
- Muscles linking the spine to the pelvis = Psoas, Iliacus, Glutes, Quads and Hamstrings
- Muscles must work together to stiffen the spinal column to be able to bear load
- Limb muscles create motion while Spinal/torso muscles (think core) control/stop motion
- Optimal function = power generated at hips & transmitted through a stiff torso.
- Movement should be from the hips/shoulders
The following excerpts are from Stewart McGill, “Back Mechanic” www.backfitpro.com
They are in no particular order, but I found them thoght-provoking and of particular interest to this topic in the context of the yoga class:
- Goal = Spine-sparing biomechanics and finding pain-free function. Uncover and remove the cause of pain and exacerbation and don’t replicate it in everyday movements, exercise, yoga, rehab, etc. Meanwhile, strengthen
- Tight Hamstrings are often a related symptom but not a cause of low back pain
- Stretching for the sake of it does not help and can further hurt back issues. It provides 15-20 minutes of pain relief by stimulating the stretch reflex, but may further aggravate discs. If a spine is damaged, it is better to focus on stabilizing and controlling. Avoid knees to chest!
- Injury happens when load exceeds tissue tolerance (ie disc herniation)
- Rest between poses, exercises or exertion to increase back tolerance
- Exercise is most effective for chronic back pain, not acute
- Anatomy Trains = muscle, fascia & connective tissue transmit forces along their length in series. Dysfunctional movement in one area transmits along this linkage to other “normal” tissues.
- Often pain is nerve-related and not muscle or joint caused. Nerve pain can’t be stretched away. Neural mobilization works when stretching doesn’t. An example of this is nerve flossing
- Avoid forward flexion of the spine first thing in the morning, as the discs are hydrated from sleep and need to compress for about 30 minutes to stabilize
- Back injuries are a result of putting a spine under load and then breaking healthy movement patterns, which require endurance. Developing too much strength without endurance leads to further damage.