Skip the Back Bends!
Do you get pain from doing back bends? This motion takes the low back vertebrae and compresses them into what we call a 'closed packed position'...It can JAM an already unhappy joint or for those who are OVERLY mobile, it can create havoc!
Here's a great patient story about an athlete who is also a yoga teacher. I've seen MANY yoga teachers for low back pain, and avoiding the deep back bends is all it takes to protect that delicate spine.
History:
Janie Stretchipantz is an 38 year old yoga teacher. Her low back began hurting after an intensive weekend yoga teacher training camp in which she did yoga 3-4 hours every day for a week.
Flexible and well versed, her technique has been honed over the years and she would rate herself at the high teacher level.
On the third day of her training, Janie began feeling pain in the bridge pose, which is a position of full back extension. Her low back became tender and sore as the camp went on and two weeks afterward she was still having pain. The focus of the training camp was on back extensions and chest openers. Her pain increased as the week went on. Focal to the last facet joints above the sacrum (the L5-S1 facets), the pain was symmetrical and felt on both sides evenly. Worse with extension or arching the low back, Janie’s pain had now become constant and any extension of the low back had become unbearable with shooting pain down into the back of the hip and thigh. At this time she had no numbness or tingling in her legs and she had experienced no muscular weakness, just pain. She also noted that she felt that heat was radiating from the area and that the are was stiff and sore with a feeling of weakness.
Discussion:
Janie’s case is a common case of jamming or over compressing the facet joints.
The joints that allow motion in the back of the spine, these facet joints will open up with forward flexion of the torso.
These joints also close down (right side of image above) into a hard packed position in extension of the spine...With anatomy in mind, what Janie had most likely done was to jam the joint, compacting both sides of the joint firmly against each other...
NO wonder why she has pain!
Treatment/Education:
As this athlete is prone to injuries due to her flexible body type, Mrs. Stretchipantz needs to be educated and instructed in how to protect her spinal facet joints from future injury.
Due to her flexibility, she also needs to learn how to use her overly flexible spine in a safe way.
The over flexibility of her spine is a risk factor for injuries through the years.
My advice- KEEP DOING WHAT YOU LOVE but... Instead of regular yoga motions, avoidance of the end range is needed. In regards to back extensions, this is all she has to do to continue her yoga without pain.
With this said, sitting and waiting for her back to heal is the last thing that she should do to help her healing process. Going on walks or runs to tolerance and letting pain be her guide, she should be fine doing her regular activities while avoiding the motions that hurt. If her pain continues and/or comes back in another flareup, advanced imaging would be recommended to ensure she doesn't have a genetic anomaly (facet tropism) or an underlying condition (spondylosis, degenerative disc disorder, facet encroachment) that could be exacerbated by her activities.
Once healed, Janie should be able to go back to her yoga and to continue her activities with modification and understanding that overarching her back can recreate this condition... As a mobile soul, she can focus on other aspects of her yoga besides hitting this end range. For many of us, we can't even come close, but Janie is a special case as her body is more prone to joint injury because the tissues around it aren't protective enough.
There are 24 types of Collagen, or the tissue that makes your ligaments, tendons and muscles stretchy. Some of us have a LOT of it, others cannot touch our toes. We all have different strengths and weaknesses that we need to be educated about to ensure life long health.
Thanks for reading this post! If you have a question or need help with prevention and your body, please don't hesitate to reach out...
-Dr. L
