chapter 11  ( from Yoga AS Medicine ) > http://www.drmccall.com/

"... The first time Bonnie Willdorf’s back “went out” was in 1980 when she was lifting an infant out of a car. “I had sciatica, with pain going down my right leg all the way to the foot.

Nearly everyone experiences low back pain at one time or another. Current estimates rate back problems as the second most common reason for visiting MDs, the top reason for visiting a chiropractor, and the leading cause of disability of people under forty-five. The most common malady is referred to as low back strain, a catch-all phrase that includes minor muscle, ligament, and joint problems in the lumbar spine and surrounding tissues. While a seemingly trivial event such as sneezing or getting out of a chair can trigger a bout of back pain, doctors recognize that the pain is usually the culmination of years of subtle injuries and trauma to the back. Generally more severe is sciatica, a condition most commonly caused when the shock-absorbing disk that separates two spinal vertebrae bulges out and compresses a nerve root exiting the spinal cord, causing pain which radiates down the leg, sometimes all the way to the
foot. A few people have sciatic leg pain but no pain in the back. The medical profession’s approach to back pain has shifted a lot in recent years. When I was in medical training, bed rest was the standard approach, and that’s what was recommended to Bonnie early on. Doctors now realize that lying around is actually counterproductive, leading to a decrease in conditioning and an increase in pain. The longer you stay in bed the more muscle mass you lose (up to 3 percent per day, according to some authorities), and the resulting loss of strength can interfere with your rehabilitation, and force you to overwork other muscles to compensate. Rather than babying a back injury, doctors now recommend people start gentle activities the first day. How Yoga Fits In

scheduled for elective surgery, you might consider canceling the operation and seeking the opinion of the best yoga therapist or bodyworker you can find to make sure you’re not about to make a huge mistake. They may be able to figure out what set you up for back trouble in the first place, by examining factors like posture, your emotions, and your work and living environment. Failure to address these issues is another reason back surgery is less successful than it might be, and why many surgical patients wind up needing a second or third operation to address problems that develop at another level of the spine. Scary as herniated disks may sound, studies reveal that many people with no back pain have them, while others who have significant pain show no evidence of herniation. An MRI can tell you if you’ve got a herniated disk, but it takes sophisticated physical examination skills to know if that is the likely cause of your problems. Unfortunately, because of the ubiquity of high-tech tests, medical students no longer learn to examine patients as well as previous generations of doctors did, and when herniation shows up on an MRI, the risk is that some surgeon may want to operate on it without knowing whether it’s related to your pain or not. A good PT is often much better at doing a hands-on assessment than many doctors, including some orthopedists. Although conventional physicians tend not to examine the role of stress in back pain, many people, like Bonnie, see a connection between their back problems and psychological tension. When the body’s stress-response system is activated, tension in muscles increases, which by itself can cause pain. Some experts outside of the mainstream, most notably physician

Yoga teacher Aadil Palkhivala also sees the connection between emotional difficulties and back pain, which is reflected in the expression “unable to bear the burden.” He suggests writing in a journal to find relief. “Burden the page with your burden,” he says. As someone who has dealt with his own significant back injuries, Aadil reports that he “can feel the nerves starting to relax as I write.” When the nerves relax, when the balance in the autonomic nervous system is shifted to the restorative parasympathetic side, the deep muscles that may be the source of the pain start to let go. ... due to tightness in the hamstrings, the pelvis tips backward and the lower back rounds, reversing its normal inward curve. This position puts enormous strain on the spinal disks in the lumbar region and can lead to herniation and sciatica. For more on the yogic approach to improving slouching posture, see chapters 2 and 13. Doctors often prescribe abdominal exercises like stomach crunches to people who have had back pain, to prevent recurrences once they are out of the acute phase. Such advice reflects the notion that most back pain is related to weak abdominal muscles. From a yogic perspective, abdominal weakness is often part of the problem, but that approach is imprecise. Indeed, too many crunches or other abdominal exercises can increase the tightness in hip flexors like the psoas (a large muscle deep in the abdomen that connects the lower spine to the top ... of the leg bone), potentially exacerbating some back problems. Besides tight hamstrings, many people with back pain have tight hip rotators in the pelvis. Yogis also realize that often the back extensors, the muscles that run on either side of the spine and keep you from slumping, are weak. The yogic approach is to determine which specific muscles need strengthening and which ones need stretching, and design a program to address those needs. This individually tailored yoga approach is much more likely to be effective than the kind of blanket recommendation to strengthen your abdominal

of the leg bone), potentially exacerbating some back problems. Besides tight hamstrings, many people with back pain have tight hip rotators in the pelvis. Yogis also realize that often the back extensors, the muscles that run on either side of the spine and keep you from slumping, are weak. The yogic approach is to determine which specific muscles need strengthening and which ones need stretching, and design a program to address those needs. This individually tailored yoga approach is much more likely to be effective than the kind of blanket recommendation to strengthen your abdominal

... navel toward your spine is the instruction yoga teachers often give), students can learn to flatten out some of the excess in the lower back curve. While sit-ups may be useful in this situation, a number of asana systematically address weakness, as well as lack of flexibility, in the four different layers of muscles in the abdomen, in ways that exercises like stomach crunches don’t. Independent of the effect on individual muscles, asana movements help back pain by improving the circulation that brings nutrients to the intervertebral disks while removing toxins. Gelatinous shock absorbers that cushion vertebrae that are adjacent to each other, the disks don’t have their own independent blood supply, and thus depend on movement of surrounding structures to aid in the delivery of nutrients. Movement causes the disks to be compressed, which squeezes out stale disk fluid,

... Attention to breath, as always, is part of the yogic prescription for back pain. Slow, deep breaths help ratchet down an overactive stress-response system, which can lead to muscle relaxation. With the fuller exhalations that occur when the abdominal muscles assist in pushing the air out, more oxygen is brought into the body on the subsequent breath. In addition, the undulations of deep inhalations and exhalations gently massage the spinal column, which also helps bring nutrients to spinal disks. 

 ...