Low Back Pain & Spinal Stabilisation

I encounter many students who tell me they are nursing an old disc injury, which in some cases occurred ten or more years ago. Whether your back pain is recent, long-standing or reoccurring, spinal stabilisation is an important factor that needs to be addressed for complete healing to occur. If we look at the anatomy of the spine from cranium to sacrum we can count (and I just did) 150 articulations where movement can occur! As yogis we tend to focus on increasing range of motion in our joints, however, especially in the spine stability is of utmost importance!

So What Stabilises Our Spine?

Often ignored but very important is our PASSIVE stabilisation system – the spinal ligaments of which there are many. If you suffer from Joint Hypermobility Syndrome you will be more susceptible to injury. Our ligaments keep the integrity of one vertebra in line with the next and each disc neatly sandwiched in between its neighbouring vertebra. It usually takes a significant amount of force to disrupt these ligaments. Some of the important ACTIVE stabilisers are the deep intrinsic muscles of the spine (multifidi, rotatores, intertransversari and interspinalis). Of these the multifidi are the most talked about because of their know association to low back pain. Diagnostic ultrasound studies have shown an inversely proportionate relationship between multifidi health and low back pain, i.e.: the healthier the multifidi the less low back pain and vice versa.

The multifidi are some of my favourite muscles, not only because they have a cute name but also because they are deep, highly responsive VIMs (very important muscles). The multifidi are layered; the deepest span one or two vertebra and lie close to the centre of rotation. The more superficial span up to five vertebrae, can extend the lumbar spine and control our lumbar lordosis. The deep fascicles stabilise the vertebral segments controlling shear, translation and torsion. These short deep muscles provide us with flexible stability (as when you groove) while our larger more superficial muscles provide us with rigid flexibility (as when you brace yourself in a strenuous posture) as well as the ability to make large movements.

The multifidi muscles span the lower 4 cervical vertebrae, all the thoracic and lumbar vertebrae and the sacrum. They are innervated by the corresponding spinal nerve at each level. For this reason a multifidus muscle at one single vertebral level can ‘switch off’ and become dysfunctional. MRI studies have shown that as the muscle atrophies it is often replaced by fat. Without the function of this muscle there is a lack of stability leading to increased wear and tear of the joint and often accompanying pain.

The multifidi are postural muscles and our postural program is stored in our central nervous system (CNS). As the multifidi have a greater number of muscle spindle cells they can relay a large amount of sensory information to our CNS. This protects us from both predictable and unpredicted perturbations. Even the dynamics of movement when we breathe require postural stability as these same muscles also support normal breathing patterns. Our CNS will protect our spine first (because it houses an important part of the CNS – the spinal cord) even if this means interrupting our breathing. For example, if you need to suddenly brake when driving you will hold your breath as you brace your spine. Unfortunately, these alterations to our breathing pattern sometimes get ‘fixed’ in our CNS and become a habit long after the emergency is over. A similar pattern happens when the multifidi muscles are traumatised by a disc injury and in this way dysfunctional loops become established. Although direct control of the intrinsic spinal muscles is not possible, co-ordination can be learnt and in that way the ‘fault’ corrected. Using the breath with the movements enables us to repair the altered respiratory and postural programs in our CNS to restore spinal stability.

Restoring Spinal Stability

For the sake of brevity and focus I will presume that as a yogi you have already learnt a healthy, functional breathing pattern. This is imperative for progress and success when it comes to the spinal stability needed to eliminate back pain. There is a close linkage of axial movement and breathing. In fact, the muscles involved in healthy breathing are the same as those required to stabilise the spine (mainly the diaphragm, pelvic floor, transverse abdominis and the deep spinal intrinsic muscles). In the accompanying video clip I quickly revise how to breathe to activate the muscles of spinal stability. These exercises especially focus on activating the multifidi. These movements are especially beneficial for those with acute painful injuries that lack the ability to perform other large movements.

These yoga-based spinal exercises are derived from human locomotion, i.e. the normal torsional movements our spine goes through as we walk. Like our breathing and posture, our gait is fully automatised as a fixed movement pattern in our CNS. Just as with breathing this also become modified especially after a painful episode. Often the result is that our low back and/or neck becomes unstable while our thoracic cage becomes rigid, which further inhibits our ability to breathe optimally. The aim is to have a relaxed ribcage on a lengthened spine with horizontal respiration and centration of the thoracolumbar junction. In this way all the deep stabilisers of the spine will be activated (abdominal wall, diaphragm, pelvic floor and multifidi).

The exercises are done horizontal to eliminate axial pressure and to lessen the influence of our automatic postural program. In this way we can retrain our muscles in the most fundamental way in which they hold us in relation to gravity. It also allows better concentration. Keep your eyes open to add more sensory input to your nervous system. Although the movements are simple they are not easy to perform with correct timing, co-ordination and control. Deep motivated concentration and patience is required. Pain is often the very motivator we need.

The Scarecrow 

View how to do this yoga-based spinal stabilisation exercise.

Pelvic Tilts, Figures of 8 & Infinity

Although not yoga based, these exercises on a fit ball are invaluable in healing discs and recovery from Facet Syndrome and other causes of low back pain:

A painful back can be the result of many different causes and often the insult is not from one specific trauma but from the non-relenting micro-trauma of poor posture. Non-traumatic injuries do not just happen there is always a root cause and whichever way around we develop pain, eventually the mechanism is the same: an aberrant motion or motor pattern. Some experts have suggested that damaged tissues should heal within 6 to 12 weeks, however, both biomechanical and neurological changes can linger for years following an injury.

The vertebrae and discs of our spine have such a complex interplay with other tissues and muscles that damage to one part changes the biomechanics and loading on many other parts. For example, initial disc damage can lead to muscle imbalance, joint instability and subsequent secondary arthritis. This sequel takes years to develop and even though the experience of ‘pain’ remains a constant, the etiology or cause of that pain has changed considerably. An integral step in healing is retraining the intrinsic stabilising muscles of the spine. When our CNS registers that our spine is ‘safe’ we can naturally progress to building strength and regaining motion. I apologise for this rather ‘brainy’ post… it does, however, reflect the complexity of the marvelous and magnificent engineering and architecture of our spine!

Monica

About Dr. Monica Gauci

Monica has studied and practiced Yoga for 38 years and is an authentic example of a life-long commitment to Yoga. Monica is one of the few registered Yoga Therapists with the Australian Association of Yoga Therapists. She is also a full member with the International Association of Yoga Therapists. Monica is registered at the highest level with both Yoga Alliance (ERYT 500) and Yoga Australia (Level 3 Membership). Since the age of 24 years, Monica has studied many disciplines of the Healing Arts, including Reiki, Australian Bush Flower Essences, Applied Kinesiology, Lomi Lomi massage and emotional release techniques. In 2008 Monica graduated with 1st class honour as a Doctor of Chiropractic. Additionally, she received numerous awards for Academic Excellence. She currently practises as a Chiropractor in Perth and Crabbes Creek, Australia. Monica has published ‘Ashtanga Yoga Beginners Course Manual for Teachers‘ which is a step-by-step guide on how to teach Ashtanga Yoga safely and effectively to beginners (www.lulu.com). She is also a contributing author to Ashtanga Yoga, Practice and Philosophy and Ashtanga Yoga, The Intermediate Series in the areas of asana, anatomy, injury prevention and rehabilitation.
Posted in Anatomy/Rehabilitation.

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