When I finished Paul Harvey’s four-year practitioner course in 2004, I spent a while pondering on where my yoga journey would take me. I was currently teaching two group classes which I enjoyed, but colleagues around me were deciding whether to teach yoga for pregnancy, yoga for children, to look at training future teachers or teaching in a corporate environment – the list went on. At that point I didn’t feel drawn to any particular field and I hoped that the particular field would find me!
I was lucky to have maintained a couple of my 1-2-1 students who had been the subjects of my 1-2-1 project. I didn’t advertise, but gradually I picked up a few more 1-2-1s from mums at my children’s school to friends of friends and word of mouth. I seemed to be attracting students who had health issues and were looking to use yoga to help them cope with their problems. Initially, I was concerned as I didn’t feel I had the experience to do this, but I remembered the wise words of Paul Harvey who, when I raised concern about using yoga as a therapy, said to me, ‘Well, you won’t kill anyone from giving them a yoga practice!’ That was indeed helpful as I told myself that I would just take things slowly, not change the practice too much, listen to what the student told me about the practice and observe them.
I found that one of the main reasons people came to explore yoga was for help with back issues. Drawing on my notes from Paul Harvey together with my own research online and reading books, I eventually developed my own practices for helping students with their back pain. I was amazed at how a regular gentle yoga practice of approximately 15–20 minutes daily could sometimes transform an intense back pain with sciatica to within weeks, no pain at all. Obviously, this outcome doesn’t happen for everybody as there are many different causes of back pain and not everyone will recover, but, as we know, yoga helps us to deal with our problem on many levels, not just the physical.
Many years on, I still have more students coming with back issues than for any other reason and it is a very rewarding area to work in. It is beyond the scope of this article for me to include the various back conditions and corresponding practices. However, I will give some general guidelines and a sample practice. The same principles in designing a practice for general low back pain can be used for the treatment of sciatica (pain resulting from irritation of the sciatic nerve, commonly resulting from a disc herniation pressing on the nerve).
Generally, in the beginning, avoid postures that stretch the legs where the back is vulnerable – for example, in standing work (flank forward bend, straight leg uttanasana). Leg movement should be mild. There are four general stages of therapy:
- Rest and recuperation – this is used mainly when there are painful spasms in the back. Movement is limited to lying on the bed, gently bringing the arms out to the sides on the inhalation, making the exhalation longer than the inhalation. Also taking simple ujjayi – again, exhalation longer than inhalation – several times a day.
- Passive movement – used when the spasm has lessened or there is pain in the back. The cat is useful in this stage but moving the hips and keeping the back flat (no arching, etc.), also using ardha apanasana (apanasana with one leg at a time) possibly up to 8 times each side. A very gentle lying twist can be helpful but with feet on the floor and only moving the legs a few inches each side.
- Active movement – this is where more movement can begin. A gentle warrior can be included with the arms coming out to the sides and the stride reduced. A cat movement can be taken against a wall to include arching and rounding the back. Also a kneeling forward bend with one arm coming on to a chair.
- Strengthen – starting to access and strengthen the back. Squats (provided there are no knee issues) can be useful because there is no forward loading on the back. The practice here can build up to standing forward bends, two-foot support and cobra.
An important principle to teach fairly early on is to contract the abdominal muscles on the exhalation which has the effect of stretching the lower back muscles while strengthening the muscles of the abdomen (this principle is familiar already to anyone within the viniyoga tradition).
Initially, for many people, forward bending from a standing, kneeling or seated position is not advisable, although for some it can bring relief. Regular practice is a key element to recovery. Relief of symptoms will occur slowly. However, progress cannot be forced. When meeting with the student, it is important not to radically change the practice at each session because if symptoms return, you will need to discover the potential cause or the particular asana that aggravates the problem. I find that it is extremely important to question the student about how and when the problem began, the type of pain they have (and marking it on a scale from 1 to 10), what activities they undertake, etc. I feel I am almost a detective! At each meeting, continue to question and mark the level of pain/discomfort. Be curious.
There are many books on the market dealing with this subject, but one I found useful initially and still refer to is Healing Back Pain Naturally by Art Brownstein.
Looking back, I needn’t have worried about what path to take – it certainly found me!