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My Aching Lower Back
By
Chieu T Nguyen, Ph.D.
chieutnguyen@gmail.com
I
am sixty-three years old. Many a time, I heard myself thinking out loud in
French, “Si jeunesse savoir, si vieillesse pouvoir”…-- “If only young
people knew, and if only old people could”… The problem is, like seventy
percent of the population in the USA, I have a weak lower back. Several
years ago I threw my back badly and was in bed for two weeks. A few months
later it happened again. I am fine now but I know that this is a very
serious problem to people of all ages, but especially old age. So I set out
to do some research on how it happens and how to treat and to prevent it
from happening again. I have been practicing yoga for a number of years and
have now obtained teacher’s certification and know enough about yoga to
believe that it can help. So I have concentrated my research on yoga
literature in addition to medical books and journals.
How does it happen?
Looking at the drawing
of a human skeleton, one is amazed that man—or woman—is made to walk
straight. It is like a tall structure with a flimsy rod in the middle
supporting a heavy top. Worse, there are two long arms which are always
trying to use that rod as leverage in lifting heavy things! It is
definitely a flawed design from an engineering point of view! Walking on
all fours--like most animals—would probably be much more logical! And
riding a bicycle would be a lot better for the back (and for the
environment!) than driving a car.
So how does lower back
pain happens? Books on anatomy talked about the importance of the famous—or
infamous—inter-vertebral disc. White (1983) described it as “a tough bunch
of fibers and cartilage with a jellylike center, like a jelly-filled
doughnut” connecting adjacent vertebral bodies. These discs compose one
quarter of the total length of the vertebra and act as shock absorbers.
Like any other tissues in the human body, they contain living cells which
require nutrients and which produce wastes that have to be disposed of. But
one thing is missing: blood vessels. According to Coulter (2001),
nutrients are “imbibed,” or absorbed, into these discs from the vertebral
bodies, which themselves are well supplied with blood. Little is known
about this process except that healthy inter-vertebral discs contain 70-80%
liquid and that the spine gets shorter during the day and longer during the
night. From this information, Coulter suggested that as the discs are
compressed during the day by gravity and muscular tension, the liquid is
squeezed out, and that as tension is taken off during the night, the discs
can spread apart, allowing them to absorb nutrients and repair themselves.
This would help explain why medical literature has indicated that one of the
most effective treatments for acute back pain is a two-week bed rest--which
was exactly what I did when I got it years ago and it worked!
Abuses on these
discs—which are common when you are young and do not know better—weaken the
doughnut rings and let some of the “jelly” leak out. Age and lack of
nutrients also make the rings less elastic and the jelly in the nucleus
dried out. When a disc is so degenerated—or herniated—that it impinges on
the nerve cord running inside the hollow section created by the vertebral
bodies, back pain occurs. Particularly, the lumbar region is very
vulnerable. The intervertebral discs and the vertebral bodies in this
region are held together by whole systems of ligaments and muscles. As
mentioned above, the mechanical design of the human skeleton leaves
something to be desired. When you lift an object with your arms extended,
the force exerted on these discs is multiplied many folds since the weight
of that object has to be balanced by the muscles and ligaments which are
right next to the spine. It’s the law of physics. According to White, when
you do some strong twisting motions, especially while lifting a heavy
object, not only the discs might become degenerated but the ligaments and
muscles could be stretched or even torn. The degenerated discs could then
affect the nerve cord which would send pain signals to nearby muscles to
tighten up or go into spasm causing you to walk with a crooked, funny
allure! It happened to me a few times.
So the three main causes of
intervertebral disc degeneration and “loose” ligaments in the lower back
are: abuses, lack of nutrients, and last but not least, age.
How to treat and
prevent it?
Among these three
causes, there is nothing you can do about age if age means the number of
years you have lives. But age could mean something very different—not the
topic of this discussion—and working on the first two causes could
significantly slow its process.
First, to stop the
abuses on your back, you have to be smart in your daily activities. There
are lots of DO’s and DON’T’s that books and magazines keep repeating. For
example, do swimming (but don’t do butterfly because it could hurt the
back), do have a good back support at the lumbar region when sitting, do
keep heavy objects close to the abdomen when lifting, etc. The problem is
that you are not always conscious of the vulnerability of the lower back in
everything you do, not the least of which are the sports activities. That’s
me when I was young! So now I wear back brace when I set out to do heavy
work, if anything else, just to keep me aware of my lower back and not to
abuse it.
Secondly, there is the
issue of nutrients for the intervertebral discs. Yoga practices showed me
that there are poses that could help a lot in this regard. Moreover, they
could also help strengthen the muscles and ligaments in the lower back
region and even the bones. Of course once the discs have degenerated it
would take time for the body to repair them. So one must have perseverance!
In the end, I believe a
good regime of exercise and diet to keep slim and healthy is still the best
thing to do. My current regime is to swim every day for at least half an
hour (that was how I got 8th place nationally in the 50-meter
breaststroke in the 60-64 age group last year when I raced at Rutgers
University) and yoga, every day if possible. My back is good now, but I
definitely don’t dare to abuse it like when I was younger.
To have a yoga program
that is appropriate for your state of health, it is best to find a good yoga
teacher. For the perennial lower back sufferer, I would recommend the
following:
In the morning, when you
wake up and while still in bed, a hard bed if possible, do the following to
tighten up the muscles and ligaments around the core and get the discs and
the lower back ready for the day:
Start deep yoga
breathing (ujjayi breathing), five seconds in-breath and five seconds
out-breath. Then, while waking up, do some gentle Spinal Twists by bringing
both knees up to one side while looking at the opposite side, holding for
three breaths each side. Then roll the shoulders forward and backward for a
few breaths and the head one side and then the other side—lifting it up
slightly off the pillow if possible--a few times to straighten out the
spine.
When you are ready, next
do the following: On the in-breath tense all muscles, tighten the arms, the
fists and the legs, toes pointing up, and arch up the back; on the
out-breath lock the core, scoop up the tail bone while pressing the lower
back to the hard bed and raise the head to look at the toes pointing
straight down, hands slightly raised and pointing to the toes. Do that a
few times. Next, take the bed cover off and raise the legs up straight and
twist the ankles around a few times, then stretch the hamstrings by pushing
the heels out, pointing the toes toward the head. You can then spread the
legs out or bend them and do the “Huggy Baby” pose to stretch them further.
Then do the “Tear Drop” Pose, reaching the hands to the ankles, lifting the
head and engaging the abdominal muscles. Then do the Bridge Pose (Setubandha
Sarvangasana) and follow that with the Head-to-Knee Pose. For all of these
poses take three full breaths each. I would do the Child’s Pose for three
to five breaths then roll up to a Cobra Pose or Sphinx Pose before a brief
Downward-Facing Dog Pose which could be done on or off the bed by pushing
the hands on the bed or the floor. Then slowly get up.
Do not start serious
yoga practice—or any serious exercises—before the spine is tuned up and
ready for it, at least two hours later, this according to White. The
important thing for people with weak back to remember is to always pay
attention to the alignments of the body: spine, shoulders, neck, etc...
Therefore, it’s not a bad idea to do the Mountain Pose (Tadasana) in front
of the mirror for a while to straighten your alignment first thing in the
morning.
When practicing yoga,
naturally you have to choose the classes appropriate for your level. Yoga
is not trying to wrap your leg behind your neck! Generally, the good thing
about yoga is that there are many poses that can help stretch tight muscles,
increase circulation, lubricate the joints, increase flexibility and
strength of the ligaments and tendons, strengthen the bones. For
strengthening the lower back and increase nutrients to the intervertebral
discs, I would suggest including the following poses in your practice:
Reclining Knee-To-Chest Pose (Eka Pada Supta Pavanmuktasana), Reclining Big
Toe Pose (Supta Padangusthasana), Upward-Facing Dog Pose (Urdhva Mukha
Svanasana), Downward-Facing Dog Pose (Adho Mukha Svanasana), Standing Spread
Leg Forward Fold (Prasarita Padottanasana), different Spinal Twist poses,
different Mountain Poses (Tadasana), Triangle Pose (Trikonasana) and its
different variations. These poses are well known to yoga teachers and well
presented in various books such as Iyenga (1977, 2001) and Sparrowe and
Walden (2002).
I have not mentioned the
other benefits of yoga in helping to calm the mind and improve the spirit.
These benefits decidedly help in providing for good, deep sleeps which in
turn would do wonders for the spine and the lasting youth…
Reference
Coulter, H. David. Anatomy
of Hatha Yoga: A Manual for Students, Teachers, and Practitioners.
Honesdale, PA, USA: Body and Breath, 2001.
Iyengar, B. K. S. Light on
Yoga. Revised Edition. Schocken Books, 1977.
Iyengar, B. K. S. YOGA,
The Path To Holistic Health, A Dorling Kindersley Book, 2001.
Sparrowe, Linda and Walden,
Patricia. The Woman’s Book of Yoga and Health: A Lifelong Guide to
Wellness. Shambhala, Boston & London, 2002.
White III, Augustus A.,
MD. Your Aching Back. Simon & Schuster, 1983.
Mountain Lakes, New Jersey
October 2004.
Revised in Mountain View, Hawaii
June
2007
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