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What poses are best for lower back pain?

This is an excerpt from Adaptive Yoga by Ingrid Yang & Kyle Fahey.

We know that, generally, yoga can help patients with LBP, but how do we select which poses are best? A multitude of yoga asanas coincide with the treatments recommended by current medical guidelines. The American Physical Therapy Association’s practice guidelines on LBP recommend physical therapists (PTs) use trunk exercises to improve core coordination, strength, and endurance to reduce LBP and its consequential disability. A key principle of yoga is to engage and strengthen the trunk and core muscles. We also recommend the use of spinal extension–based exercises to increase spinal flexibility. There are countless poses that incorporate spinal extension. In some cases, it is recommended that PTs use spinal traction techniques. In this chapter, we will teach you how to perform self-traction with two yoga straps. It is well established that sitting with slouched posture increases the risk of developing LBP¹⁰ and yoga can help to prevent or mitigate LBP through its emphasis on upright posture and body awareness.

Extended Triangle: Utthita Trikonasana

This pose is a great core stabilizer, but the real benefit is to help you differentiate movements of the spine and hips. The spine should remain in a relatively neutral (slight rotation) position in reference to the legs; to achieve this, the pelvis rotates at the hip joints to avoid side bending the spine. Learning to move the trunk at the hip joint rather than through the low back is a valuable skill to reduce stressful, injury-causing forces through the low back.

In Extended Triangle, there is a co-contraction of the spinal extensors, flexors, and obliques, which keeps the spine neutral. Furthermore, the back leg’s abductors activate to control the amount of lateral pelvic tilt: too little and the spine will side bend, too much and the weight of the torso will be incorrectly distributed over the front arm and leg.

Benefits

• Increases body awareness and control.
• Strengthens the hip abductors.
• Stabilizes the core.

Precautions

Avoid looking up if you have a neck injury; you can perform this pose with your gaze down toward the floor.

How To

1. Start in Warrior II (pages 104-105), with the left foot forward (left foot pointing forward, right foot parallel to the short edge of the mat).
2. Keep the arms extended.
3. Straighten the left leg and extend the left fingertips forward, lengthening both sides of your waist.
4. Continue to extend your torso forward in line with your left leg, grounding through the right foot and leg to anchor your movement.
5. Rotate the torso, hinging at the left hip and extending both sides of the waist.
6. Your right hip will roll slightly down, which is okay. Make sure that both sides of the torso extend equally long and you are not rounding the right side waist.
7. Rest your hand on a block or your shin.
8. Lengthen through your tailbone and engage your abdominal muscles to support your spine.
9. Point the right arm to the sky, in line with your shoulder and your palm facing forward.
10. Maintain extension of your neck in line with your spine and look up or forward (or down if looking up strains your neck).
11. Hold for 5 breath cycles.
12. To exit the pose, bend the left knee slightly and press firmly into the feet to lift your torso upright again.
13. Switch sides by pivoting your heels or resetting in Downward-Facing Dog (pages 90-91).

Modifications

Practice with a wall behind you for additional support and a block under the hand.

Variations

To challenge yourself, hover the bottom hand in front of the shin, rather than on the shin, to engage the abdominal muscles and increase core strength.

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