A Yoga Practice to Relieve Lower Back Pain

One of the most common musculo-skeletal complaints that my clients come to yoga for is relief of their lower back pain. The reasons for lower back pain can be wide and varied, and this is one instance in which one-to-one private yoga therapy work can be invaluable.

 

No two back pain clients are the same and I find that students can react very differently to the same set of poses thus necessitating a very personalised, exploratory and slow approach to the practice.

 

That said, there are some poses and exercises which I have found generally to be beneficial for clients presenting with lower back pain or tension. The overarching principle of all of these exercises is to create a sense of spaciousness and very gentle traction in the lower back, helping to relieve compression between the vertebral discs and reduce clenching or spasm of the muscles that attach to the lower back, ribcage and pelvis.

 

As always its best to get yourself checked out and diagnosed by a health professional so that you know what you are dealing with. Most of my clients come to me once they’ve gone through that stage, and this is the type of sequence that I might give to a client working with a low-grade chronic ache in the lower back, rather than any acute severe or sharp pain. It’s worth reiterating that none of these exercises or poses should be acutely painful and if they are, it’s best to come out.

 

I like to sometimes give my clients the concept of an intensity scale to help them make sense of and interpret the sensations that they’re experiencing as they practise. If you think of a sensation intensity scale of 1-10, with 1 being extremely mild and 10 being distractingly intense, then we ultimately want to be working between a level 4-7. Any less intense and we may not be getting the fullest benefit of the movement, any more intense and it tends to cause the body to tense up and tighten, having the opposite desired affect.

 

Do have a read through of the instructions before having a go at the following sequence. There are some important alignment points to take into consideration to protect and support the lower back throughout each pose. As always keen to hear feedback and feel free to ask questions in the comment section below!

 

Thanks to Tummee.com for the sequence images!

 

Supine Pelvic Tilt Tuck

Why it helps: A simple movement-based exercise that helps to bring greater awareness and sensitivity to the lower back. This is a nice subtle movement to massage the muscles of the lower back, sacral area, pelvis and buttocks. Done with sensitivity this can help to give more understanding of where may be tight or tender and to bring a gentle sense of release and relief to any gripping or tightness in those places. Note that all of these movements are quite subtle and the hips remain on the floor throughout.

How to do: Start on your back in constructive rest pose with the knees bent and feet flat on the floor.  Lie on your back with your knees bent, feet flat on the floor about hip-width apart, knees pointing straight up. Put a blanket under your head so your forehead and chin feel level and your neck is comfortable.

  • Pelvic tilts
    Inhale and allow the spine to gently arch away from the floor, creating space between your lower back and the floor. As you exhale press the lower back into the floor and feel the tailbone tuck under as the lower belly and glutes firm. Note that the hips stay on the floor the whole time. Repeat this arching and lengthening movement 10 times in sync with the breath.
  • Pelvic side-to-side rocks
    Rock your weight from one buttock to the other. Repeat 10 times
  • Pelvic circles
    Now imagine you’re tracing a circle with your hips on the floor. Go 5 times circling in one direction and 5 times circling in the other direction.
  • Figure of 8s
    Now start to trace a figure of 8 pattern with your hips on the floor. 5 times in each direction.

 

Constructive Rest Arms Overhead Pose

Why it helps: This pose can create a mild sense of traction or lengthening in the spine, helping to decompress the vertebral discs, whilst promoting a subtle sense of core support on the exhale. Lovely to do if you’ve been stuck in front of a computer for too long!

How to do:

Start on your back in constructive rest pose with the knees bent and feet flat on the floor. Sense that your spine is in a neutral position – there is a natural gentle inward curve in the lower back away from the floor, an outward curve of the upper back into the floor, and a gentle curve of the neck away from the floor. Support the head with a blanket or cushion if it feels like the head is tilted back – the forehead and chin should be level.

Start with your arms resting by your sides. Inhale to slowly reach your arms up and overhead towards the floor behind your head. As you take the arms up try to keep the lower back ribs on the floor and avoid overarching the lower back. Instead feel for lengthening the spine as the arms reach overhead.

Exhale and gently drawing the lower abdominal muscles back towards the spine lower the arms back down by your sides.

Try to keep the movement smooth, slow and controlled, moving with the breath and avoiding rushing.

Repeat this movement 5 times.

 

Half Wind Release Pose

Why it helps: This can be a useful pose for lengthening the back of the hip and same side of the lower back as the bent knee, reducing tight or cramping muscles. Be mindful to keep the lower back in neutral.

How to do:

Gently hug the right knee in towards the chest, holding it with both hands either on the shin or behind the knee. You can keep the left knee bent, foot on the floor or for a stronger release straighten the left leg out along the floor.

Try to maintain a neutral lower spine here (it should feel like you could still slide a pencil behind the small of your lower back) and allow both buttocks to rest evenly on the floor so that the hips and pelvis are level and balanced. Relax the upper back and shoulders. Place a blanket or cushion behind the head if needed to keep the neck neutral. Take 5 slow deep breath into the right side of the lower back and hip. Switch legs.

 

Table top to Child Pose Flow

Why it helps: This soothing movement is a nice way to combine breath with a subtle opening up of the lower back. This can help to reduce spasticity in the muscles of the lower back and hips whilst taking pressure off the discs of the lower back.

How to do:

Start in table top position. Bring your hands under the shoulders and knees under the hips.

Inhale keeping the spine in neutral. As you exhale gently draw the lower abdominal muscles in towards the spine and pressing through the hands and arms draw the hips back towards the heels. Allow the elbows to soften and bend bringing the head to or towards the floor. Inhale to return back to table top position.

Repeat this movement forwards and backwards 5-8 times with the breath. On the last rep, if comfortable hold childs pose with the hips towards the heels, elbows bent and head resting on the mat for 3-5 breaths.

 

Downward Facing Dog Pose Variation Both Knees Bent Chair

Why it helps: Another great posture to mildly traction the lower back. It is also gives relief and length to tight hamstrings, calves, upper back and shoulders all of which can contribute to lower back tension.

How to do:

Hold onto to a ledge, table or back of chair and place your hands shoulder-width apart. Walk your feet back, bend your knees and align your heels under your hips as you stick your hips backwards. Work on maximising the length in your spine. Check that your knees are also in line with your toes.

Gently lower the chest down so that eventually the spine is parallel to the floor (or just above) and the ears and upper arms line up with each other. Relax and soften the upper shoulders away from the ears.

Make sure your breath remains fluid and easy without strain or tension. Stay for 5 breaths then draw the belly back to the spine to support the back as you lift the chest and with a straight spine walk the feet in coming out of the pose. Repeat one more time.

*Optional variation: Straighten one leg as the other knee bends. Keep the weight even between both feet. You should feel a good stretch on the outer hip/thigh of the straight leg.

 

Sleeping Pigeon Pose Wall

Why it helps: This is a great pose for releasing tension and tightness in the back and sides of the hips and pelvis which can be  a contributing factor to lower back discomfort. Be sure to keep the lower back in neutral and fully supported, avoid rounding the lower back.

How to do:

Start by carefully taking your legs up the wall – your hips will be about 1-2 feet away from the wall and you may want to put a folded blanket or towel under your hips and under your head for more comfort. It is important that the lower back stays neutral and on the ground during this pose so additional support with a blanket under the hips may be needed.

Bring your right ankle above your left knee and slowly slide your left foot down the wall until you feel a good stretch through the outer right hip. Keep your hips on the floor (or blanket) and keep the natural inward curve of the lower back intact. Try to make sure that both hips and buttocks are evenly resting on the floor or blankets. Rest your arms wherever is comfortable.

To make the stretch less intense have your hips further away from the wall, for more intensity scoot your hips closer to the wall.

Breathe deeply and steadily into your lower belly for 1-3 minutes. Gently explore extending and lengthening the exhale.

Switch legs.

 

Corpse pose Variation Chair

Why it helps: This variation of Corpse pose is often much more comfortable than the traditional variation lying on the floor with the legs straight. Using the chair helps to take any pressure off the lower back and can help to bring a sense of neutrality back to the lower back, hips and pelvis. The guided breath practice is helpful for relaxing the body and restoring the nervous system to a state of ease and relaxation.

How to do:

To finish practice bring your lower legs up to rest on a chair, so calves are supported and the legs are bent to roughly 90 degrees with the thighs vertical and shins parallel with the floor.

Put a folded blanket behind the head for more support and comfort.

Visualise breathing in and out of your right nostril for 5 breaths. Then visualise breathing in and out of your left nostril for 5 breaths. Finally breathe slowly and smoothly through both nostrils for 5 breaths.

Then let go of the guided breathwork and allow the body to rest fully for 3-5 minutes before ending your practice.

A Yoga Sequence for Knee Health

Please remember that this post only provides general guidance around knee health. If you have had a knee injury or recent knee surgery there are many factors that need to be considered before engaging in any rehabilitative exercise regime and its best to consult your doctor, health-care team or physio before starting yoga. 

It may seem a rather obtuse or clinical title for a yoga sequence – certainly not as sexy as A Yoga Sequence for Better Sleep for example (although that is coming soon!) – but building greater knee strength is a subject matter close to my heart, and has been a massive part of my yoga regime for years.

In fact the whole reason I came to yoga was because I had dislocated my knee several times and I faced the hearbreaking realisation that a dance career was just not going to be for me. Yoga early on presented an alternative. I loved the movement, the mindful connection to breath. The grace. It’s not a coincidence that many yogis and yoga teachers are ex-dancers.

Whilst yoga is often touted for its ability to enhance flexibility and range-of-motion, what I often find gets missed is yoga’s fantastic strengthening and stabilising qualities. To be sure it doesn’t have the grunt appeal or forehead-mopping benefits of lifting heavy weights or working with a resistance band but I believe yoga has a LOT to offer those of us with sore, sensitive or unstable knees.  As always it’s all about what you practice.

 

5 Reasons Why Yoga is Great for Knees:

  1. Its low impact i.e. in most forms and styles of yoga we don’t jump or bounce therefore reducing the amount of load, force and therefore stress on the joint.
  2. We use a lot of Closed Kinetic Chain (CKC) style movements and postures which are generally safer for knees that feel weak or unstable and are easier to control and therefore maintain good form whilst doing. CKC movements involve having the foot fixed on a solid surface e.g. the floor, as you do the movement or posture.
  3. We move slowly and mindfully which gives us a chance to focus on good tracking alignment of the knee (misalignment of the knee is a big factor in weak, unstable or injured knees). By taking our time as we consciously move in and out of positions we can retrain our habits and postural tendencies.
  4. Yoga recognises the holistic nature of the body and that knee problems often have their source in musculo-skeletal imbalances further up or down the body. Remember that the site of the injury is often not the source of the problem. When I have clients come to me with knee injuries, I always look at what’s happening in the position and alignment of their feet, hips and spines.
  5. In yoga we build isometric and eccentric strength which are fantastic for building strength and stability in our joints.
    • In isometric work we are holding the muscles and joints in a loaded static position – think of what happens to the muscles of your legs as you hold a Warrior 2 position for example.
    • In eccentric strength work, we gradually lengthen the muscles as we load them, for example, when we hinge forwards from standing into a forward bend the hamstrings are eccentrically lengthening.

 

Designing a Well-Balanced Yoga Practice for Knee Health

With the above in mind, the following sequence is designed to not only work all of the muscles that surround and stabilise the knee but also some muscle groups that seem relatively distant and unconnected. We will also work on stretching out some muscles that when tight can often cause knee tracking issues. Here’s a nifty table that outlines some of the major muscles and connective tissues you need to address for optimal knee health.

Strenghten Stretch
Quadriceps (muscles on the front of the thigh) Iliotibial Band or ITB (a tract of connective tissue running down the side of the upper leg)
Hamstrings (muscles at the back of the thigh) Outer quadriceps (when tight can pull the knee-cap outwards)
Glutes (your bottom!) Tensor Fasciae Latae or TFL (a muscle on the outer side of the hip)
Adductors (the inner leg muscles) Adductors (the inner leg muscles)
Vastus Medialis Obliqus VMO (a small tear-shaped muscle in the inner knee)

 

A couple of tips for practice:

As always the devil is in the details. I often say to my students – you spend the first 6 months in yoga just learning the basics, where do your hands and feet go, the general shape of a pose, remembering to breathe. You spend the rest of your life learning all the little details that make this practice so rich and exciting!

With that in mind there are a few small alignment tips that I think make all the difference when you are working on knee health.

 

  • Root down through the heel bone. When you press your heel firmly into the floor you will feel the muscles and connective tissue around your sitbone engage helping to strengthen the glutes and stabilise the hips. Strengthening the glutes plays a HUGE role in knee health.
  • Check your foot to knee-cap positioning again and again. The knees are the prisoners of whatever is happening in the feet and the hips! If the feet are turned out but the knees are pointing forwards (or even inwards) then your knees end up taking the strain of this misalignment. Happy knees are ones which track in the same direction as the centre of the ankle/2nd or 3rd
  • Engage the VMO. Getting the VMO (that tiny little tear-shaped muscle at the inner knee) to switch on can be tricky. If you’ve injured your knee it is likely that this muscle won’t be firing properly. Rooting through the heel bone can help to switch this muscle on but I also like to bring my fingertips to the area to help give me tactile feedback so that I know when it’s engaging.
  • Do not lock the knee. There is a tendancy for many students to “lock” the knee cap backwards in standing poses, particularly balance poses. Unfortunately this can often lead to torsion, instability and potential wear and tear of the knee joint. Instead we want to keep what I refer to as a slight micro-bend of the knee joint (the leg will still look straight) whilst engaging ALL of the musculature evenly around the knee (front-to-back and side-to-side).

The following practice gives some ideas for the sorts of poses that I regularly use with clients when working improve knee health. All of the poses/movements are designed to be repeated several times through until you feel a comfortable level of fatigue in the muscles without losing good form and technique. The exception to this is the two standing balances – Standing Quad Stretch Pose and Tree Pose which should be held for 30 seconds on each side, and the supine stretches at the end of the sequence which you can hold for up 1 minute on each side. Enjoy and feel free to leave any questions or comments below! 🙂

 

3 Great Exercises for Core Strength

In my last blog post I talked about how to engage two muscle groups that are responsible for stabilising the lower back, pelvis and torso. The Transverse Abdominals (TA) and Multifidi can be tricky muscles to tune into as their engagement creates a more subtle sensation of stabilisation compared to the muscle burn we might be used to feeling in say a bicep curl or a squat!

Nevertheless these stabilising muscles play a very important role in maintaining good hip and lower back alignment and creating a seamless fluid transition between movements making us more efficient and less prone to injury in daily activities and sport. These muscles are also particularly useful to look at when it comes to rehabilitation after a period of lower back pain.

So now that you are a bit more familiar with the actions of these muscles and how to enagage them in simple postures (if you need a recap click here) let’s take a look at three of my favourite core stabilisation exercises that I use regularly with my clients:

 

Supine opposite arm to leg extensions

Start by lying on your back with your knees bent, feet on the floor hipwidth apart and parallel in constructive rest pose. Bring your fingertips to the skin just to the inside of your frontal hip points. To engage the deep lower abdominal muscles, imagine you’re trying to narrow the hip-points and at the same time zipper the skin of the lower belly in and up towards the naval. The skin under your fingertips should tighten and draw down slightly as the lower back stays in a neutral position.

You will feel your breathe move more into your chest as the belly remains still.  Breathing naturally and maintaining the awareness of the lower belly bracing on your next inhale extend opposite arm to leg out along the floor. As you exhale return to the starting position, arms by your sides, knees bent. Then inhale to switch sides. Continue to go side to side with the breath for about 1 minute.

As you do this movement avoid letting the hips rock or the lower back overarch or flatten. The arms and legs are moving but the torso, lower back and pelvis remain still throughout.

To make this movement more challenging, you can explore hovering the heel away from the floor.

Supine opposite arm to leg extension pose

 

Toe Taps

For toe taps start by lying on your back, bringing your knees up over your hips, shins parallel to the floor and the feet flexed, as if you were sitting in a chair.

Avoid allowing your lower back to hyper-arch away from the floor but also do not flatten your lower back down – try to find a neutral curve in your lower back. At the same time, bring your hands to the skin to the inside of your hip points. Feel for narrowing the frontal hip points and drawing the lower belly in and up. Both these actions will ensure that the transverse abdominals and the multifidi are switching on.

Inhale, and as you exhale lower your right foot towards the floor, tapping the toes whilst keeping the knee bent and minimising any movment in the lower back or hips. On an inhale return to the starting position. Continue going side-to-side for about 1 minute.

If this proves difficult to control and your lower back is starting to over-arch or your abdominals start to bulge out, explore not lowering the legs as far, maybe hovering the foot a few inches from the floor as you lower.

Alternatively if this becomes easy and you want more challenge try straightening out the leg that you lower, floating the leg 1-2 inches off the floor, all the while keeping your lower back, hips and torso still and steady.

 

Toe Taps

 

 

Bird-dog

Start in an all-fours position. Knees hip-width apart and hands under your shoulders with the fingers spread and knuckles rooting into the mat. Gently draw the shoulder blades down the back away from your ears.

Feel for bringing your spine into a neutral position (use a mirror if needed) with its natural, neutral curves intact. Become aware of a long line of energy from the crown of your head out to your tailbone.

To engage the the lower abdominal muscles imagine you are narrowing your waist as if to tie up a belt a couple of extra notches, and at the same time zipper the lower belly from the pubic bone up to the naval. Maintain this abdominal bracing as you continue to breathe steadily in and out through your nose.

Keeping your lower back long in neutral (don’t allow it to overarch), on an inhale slide your right leg back behind you. Lift the leg only as far as you can whilst maintaining length in your lower back and keeping your hips square to the floor.

For more challenge you can reach the opposite arm forwards, spinning the palm to face inwards (like you’re going to shake someone’s hand) keeping the shoulders away from the ears.

Hold for 5 breaths. As you next exhale lower the right leg (and arm if lifted) back to the starting position. Inhale to switch sides. You can also vary this work by moving more fluidly with the breath, going side-to-side for about 1 minute.

Bird-dog

 

Image credits: Tummee