What?!? A longtime yoga teacher telling you that no, actually, yoga won’t cure your back pain?
Here’s why: Back pain isn’t a disease to be cured or an illness to be healed.
It’s a potentially recurrent condition to be managed.
Most of us will experience some sort of back pain in our lives. The good news is that for managing back pain, yoga can and will do you worlds of good.
The important thing to understand is that it’s not so much what you do in yoga as how you do it that will bring about the greatest benefit. This is why I won’t give you a prescription of ten poses for back pain. Instead, I’d much rather equip you with a new way to think about the relationship between yoga and back pain, and an understanding how yoga works to help minimize the frequency, duration, and intensity of bouts of back pain.
I spoke with two experts in the use of yoga to manage back pain, Dr. Geoff Outerbridge, Doctor of Chiropractic, and Clinical Director of World Spine Care, and Erin Moon, Certified Yoga Therapist and Co-director of The World Spine Care Yoga Project. Here’s what they had to say:
Q: What are some of the biggest misconceptions about back pain that are important for yoga students to understand?
Geoff: The health care system tends to over-medicalize back pain. This means we mistakenly treat it like a disease that’s managed with medication and can be cured. Imaging is overused and often ordered because the clinician doesn’t know what’s going on and thinks the imaging will give an answer – a booboo that we can now identify and heal.
However, what’s seen on the image is often unrelated to the pain, and is wrongly identified as the cause. A common example is disc degeneration. It’s often called degenerative disc disease. But in truth, it’s part of the normal aging process and not really shown to be correlated with pain.
It’s like saying someone with grey hair has degenerative hair disease and that’s what’s causing their memory loss. The truth is, you can have disc degeneration and be pain-free and still do all the activities you want to do.
Erin: And, movement, mindfulness, and breath practices help with this.
Geoff: Only about 15% of back pain can be attributed to a specific cause. The rest does not have a clear cause. We now know that back pain is a very multifactorial condition. Psychosocial issues play a more dominant role in the expression of pain than anything mechanical.
Q: How does yoga help to manage the frequency, duration, and intensity of back pain?
Geoff: We tend to think of the benefits of yoga in being in the physical postures, as in “If I do these movements, I’ll make my back better.” But the truth is that the mindfulness, breathwork, community, and agency that yoga offers are far more determinative of how yoga will help to manage back pain than the physical movements we do. (Learn more in Exhaling Muscle Pain & Tension: 3 Benefits of Yogic Breathing.)
This is because yoga helps to address the psychosocial risk factors associated with pain. These include:
- Fear avoidance – “I should not do any movements that will cause or increase my pain.”
- Low self-efficacy – “I have no control over this and am dependent on others to help me deal with my pain” (usually health care providers).
- Catastrophizing – “This pain is terrible, it is impacting my entire life and I will never be as I used to be” (and other such thoughts – we all have them!)
- Passive coping – “I’m just going to rest and wait until this goes away.”
- Perceived injustice - if the pain is from an accident – “Someone did this to me, I am the victim and they are going to pay for this!”
In short, the way we think about back pain can negatively or positively impact it. Yoga can help tremendously with this shift in mindset.
Erin: Yoga gets you out of the house and with people, it gets you active and this in itself can help in motivating you to be proactive in managing your condition. Being with others has been shown to have a great impact on our positive outlook in life.
Yoga reduces stress due to the vagal nerve interaction. Research shows that deeper breaths and long exhalations correlate to greater relaxation and ability to recover from stressful events and pain faster. (Learn more in Stress vs Self-Care: How to Elicit the Relaxation Response.)
Another reason yoga is so powerful for back pain is that it gives us more awareness of when we’re relaxed and when we’re tense. It helps us notice levels of pain as they shift and change.
We become more cognizant of where pain is and isn’t, what movements feel good, what feels weak and could use some strengthening, what feels stiff and could use some stretching.
If we take the mindful approach that yoga offers us and bring it with us into the rest of our day that’s very effective in managing back pain.
Q: Should I do yoga if I have back pain? Some of the exercises feel good, but others I’m not sure about. How do I know what’s beneficial and what to avoid?
Erin: Generally, if you have back pain, but you can still function and walk around, you can practice yoga.
Do what feels good. Don’t do what doesn’t feel right.
Listen to what your therapist says are the things to “work on.” Use props. Have your hands on bricks to get the ground up higher. Use a wall or chair. Do options of the poses that are easier and take breaks when needed. Take beginner and introductory classes that tend to have more instruction and move slower. (Learn more in Yoga for Everyone: The Top Organizations Making Yoga Accessible for Every Body.)
Above all, listen to your body and remember that there is no single best “way” to do a pose, there are many ways!
I advise students to work within a realm of feeling, where there is maybe a challenge and sensation, but nothing that is a big stop sign. Listen to those stop signs, listen to the yield signs, and you will be doing great yoga.
Always remember that you are the master of your own domain. This is the agency you have all the time. No teacher will ever fault you for taking care of you and if they do find a more open and kind place to practice!
Geoff: Generally, if you have back pain, the main movements to avoid are:
- Rounded back poses like forward bends, except for child’s pose
- Movements where the pain is on the side of the joint that’s closing, like pinching in the lower back in cobra
The sensations that are generally safe to move into are the ones that are on the side of the joint that is opening, as in the stretch in the shoulders in bow pose. This is a pain that is more of a stretching sensation, and it's generally safe.
Q: What style of yoga is best if I have back pain?
Erin: Again here, it's important to remember that whatever style of yoga you practice, the biggest benefits might be the ones you reap that are beyond the physical movements you do.
The key is to listen to what has some challenge, but still feels good. There are vinyasa classes that might be great because that teacher really knows their stuff, moves slowly and offers props. Others might move too fast.
There might be hatha classes that are too challenging and others that are just perfect. Alignment-based classes tend to move slower in and out of poses and use a lot of props.
If you have questions before you start taking public classes. Work one on one with a yoga therapist or an experienced teacher that understands physiology. They can help you learn how to work with props and explore options that are best for you.