It was in the summer of 2017. I had just wrapped up my best friend's birthday celebration the previous night and was getting dressed to go to work when I felt a stabbing pain on the left side of my lower back. It wasn’t the sore kind of pain - the minute I felt this pain I knew this was bad news.
'Have I hit that age when birthday celebrations means back pain?' - I thought to myself.
I rushed to the clinic to my orthopaedic doctors to check what was wrong with my back. So there I was, sitting in the waiting room - waiting for the doctor to explain my report to me.
Disclaimer: this one’s going to get pretty technical in terms of anatomy.
As I sat there gazing at the X-ray of my pelvis, I could see the pronounced lop-sidedness of my hip. But then I noticed something - my sacroiliac joint also known as SI joint looked crooked - almost as if my hip was smirking at me. By the time I was called in and explained that I have early onset arthritis and osteophytes on my left hip joint due to the excessive hip friction (I used to run a lot then), I was already prepared for the barrage of anatomical irregularities I would be informed about. I was right about my SI joint too - turns out all these years when I thought I had a lop-sided hip; it was because of this very crooked angle of this joint.
So this threw me into a whirlpool of research. All these years I was the hyper-flexible girl - deep backbends, extreme hamstring stretches, deep forward folds - all these were my strengths, I thought. But this diagnosis changed EVERYTHING.
It was time for me to unlearn whatever yoga I had learnt, and re-learn movement from the perspective of maximum efficiency.
It took me some time to get back to my full practice. And I had to stop running long distance races all together. As I continued to research, I was intrigued to know that so many people from ages 20-45 complain of lower back pain - it is no longer a concern of just the old. What’s even more interesting is how this is coupled with stiffness around the neck, middle back and hamstring. This was also the time when I started getting more and more cases of slip disc and bulging disc for yoga therapy.
So what has happened to our generation? Why are we being hit by this wave of back pain when this also happens to be the time when health and fitness has become a major industry?
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The problem is poor posture & desk jobs. And the answer?
Back bends!
If you have ever met anyone with bulging or slip disc or have experienced one yourself, you would know that one of the first movement a physiotherapist will ask you to do during rehabilitation is back extensions - this look like cobra pose and other back bends in varying degrees. And while this movement is extremely helpful to push back the bulging disc; many of us get caught up in a cycle of backbend and back pain.
How do we do back bends to ensure maximum muscle engagement and joint-efficiency without putting excess pressure on our lower back?
Each back-bend; be it standing, supine or prone, will have different micro-movements. Today in this post, let’s look at one of the primary micro-movements around the pelvis, for a safe standing backbend. In the post to follow, I will cover the other two movements.
If you are a more visual person and prefer a video to a blog post, head over here.
The first micro-movement is to do with the sacrum. The sacrum comprises of the SI joint – this joint attaches the end of the spine to the tailbone. Biomechanically, one of the functions of this joint is to help the spine bear excess load and distribute the load evenly to the lower limbs. It acts both as a shock absorber for the spine above and conversion of torque from the lower extremities into the rest of the body. There are very few movements that this joint can do – two of those are nutation & counter-nutation. When the spine needs to bear load then we need nutation, otherwise counter-nutation.
During nutation, there is a slight forward and downward movement of sacrum. Counter nutation is opposite. To understand this better, you can watch this video.
Nutation of sacrum is further supported by posterior pelvic tilt a.k.a tucked tailbone – a common cue used in yoga class.
This is the first micro-movement.
But what does tucking the tailbone really mean?
The tailbone which is the Coccyx, is a bone comprised of 3-5 fused vertebrae attached to the sacrum at the end of the spine. This cue of tucking the tail bone requires one to visually pull the pubic bone forward towards the front of the room and up towards the navel, thus lengthening the lumbar spine – which is the very part of the back that is getting compressed from long hours of sitting on desks. It is very difficult to tuck the tailbone by simply moving the tailbone or SI joint; the entire pelvis moves posteriorly during this movement. However tucking the tailbone can sometimes flatten the lumbar curve especially for those without a hyper-mobile lower back. This means the pelvis would tilt excessively backward leading to rounded upper back, slumping shoulders, as well as tight hip flexors and hamstrings.
Please note, that there are several other movements and engagements like those around the hips that assist backbend, but in this blog post I have covered just the pelvis and core.
For those who prefer a visual cue, head over to my video here.
So the other two movements are - lifting the chest up to lift through the thoracic spine (mid-back) and drawing the navel in to engage the abdominal muscles. This will maintain the natural curve in the back while facilitating abdominal engagement.
What’s interesting about the biomechanics of the body is that everything is designed to work together. But over the years of bad posture, hunched over ill-designed classroom desks, we lose this ability to efficiently use all the muscles that support this load bearing function of the SI joint.
There are two muscle sets that further support the nutation of the SI joint – rectus abdominis (the good ol’ six pack abs muscles) and the psoas. Both of these muscles lie in the region we call the ‘core’. The core also comprises of the lower back muscles apart from these and collectively if all these muscles are activated, we can learn to bend backwards in a standing position without putting excess pressure on the lower back.
It’s important to highlight here, the importance of activating the middle back.
While many with back pain are told that they have a weak rectus abdominis or abs, which leads to more pressure on the lower back; another common outcome of poor posture is tightness around the mid back or thoracic spine and top of the lower back - usually from the tenth thoracic vertebra (T10) to the fourth lumbar vertebra (L4). And this isn’t just true for those who lead a sedentary life. Even the most advanced yoga practitioners tend to suffer from stiff middle back. This means that those with poor posture or stiff mid-back would rely on the movement and flexibility of the lower back region which is from the fifth lumbar vertebra(L5) to first SI joint (S1). This is why we can see that some advanced yoga practitioners hurt their back while practicing deep back-bends, because instead of curving the spine during a back bend they hinge from the lowest vertebras, which are hyper-mobile. Lengthening the lower back and CURVING the spine is so important during backbends rather than HINGING from the lower back.
When we introduce the movement of lifting the chest up, we are activating the middle back. The psoas muscle is attached to vertebras starting from the 12th thoracic vertebrae (T12) to 5th lumbar vertebra (L5). So when we lift the chest up, not only are we taking some of the pressure off the lower back by engaging the psoas, we are also supporting the nutation of the SI joint – activating the load bearing mechanism of the spine. Drawing the navel in engages the rectus abdominis, which further supports the nutation of the SI joint.
Now let’s take a moment to further relate this to the internal practice of yoga – connecting the movement (body) to the breath (conscious mind). While tucking the tailbone helps with more awareness of the pelvis – a posterior pelvic tilt; lifting the chest up while engaging the abdomen gives more stability and support to the pose. So when holding a pose, we must also learn to observe the way the micro-movement affects our breath. While coming into a standing backbend you would be asked to inhale as you lift your arms up (like the start of a sun salutation). This is because inhaling while we lift the chest up and lengthen the middle back allows the rib cage to expand through all sides – forward, backward AND sideways. However for deeper back bends it’s better to exhale because exhalation allows more abdominal engagement by drawing the belly in; this gives more stability which is paramount in deeper back bands like drop down Chakrasana in Ashtanga yoga practice.
So moving from standing backbends to advanced backbends requires greater understanding of which micro-movement is supported by which type of breathing.
As I started to practice again, with this understanding of the connection between the lower back, abdomen, middle back, pelvis and sacrum - I found my standing backbends were no longer as deep, but they were a lot more stable. I was able to feel the entire core engage as I held the pose with sukham(comfort) and sthiram(stability). This further shines the light on the fact that it isn’t about how deep you get into it an asana; it’s about feeling and engaging the muscles that are designed to support the joint that allows efficiency in the movement - which will help us to breathe more easily and fully. Our body has a well-designed machinery, where each part has several functions to support one another. Therefore our asana practice becomes a way experience this inter-connectedness within the body to expand our sense of connection to the breath and the universe around us.
Keep practicing, and stay connected!
Originally published May 2, 2019