Flow time!

I love to move into Adho Mukha Svanasana from squat pose! It helps me take the weight from my arms and shoulders and into my legs. Moving into starfish (or whatever variation, both knees bent may be easier) by taking the leg underneath you is actually quite accessible. Shift weight between the sitting bones and rotate the hip joint in and out in Upavistha Konasana for increased hip mobility. I also like the reverse cobras, starting to lift from the middle of the back instead of from the upper back. The key is to pull your rib cage towards your hips while engaging around the navel and creating a wave through the back. And of course, starting out with an arm circle is a must before putting weight on your hands. Try it out and have fun!

Walking on the long and winding road to a pain free back

So what can you do to make your back pain free, to really get that feeling of having a spine as strong and viable as a tree’s trunk? First thing: get to know your pain! I mean really. Get to know it. I like to think of pain as an old relative that you wouldn’t say you like, because she’s nagging and complaining way to much, but still, she’s a relative and you need to make sure she’s all right. Most importantly, you would never do anything to hurt her. It’s the same with your pain, you may think angry thoughts about it, but it’s still a part of your body and your body deserve nothing but your unreserved love, no matter how deficient it is and how bad it works and how much it hurts. Especially than, when it hurts and doesn’t work the way you want I to. 

In practice: Keep a pain journal. Take notice of when you feel pain and how bad it is. For instance you can do it three times a day, when you wake up, somewhere in the middle and before you go to sleep. This will allow you to recognise any patterns that your pain follows. 

The importance of movement for the back cannot be pointed out enough. While it is beyond doubt good to walk, bicycle, run, swim or whatever you like to do, you can also try to move through conscious, slow yoga flows with focus on the somatic experience of being in the body. The reason why mind-body techniques such as yoga works so well for treating back pain is because they include both body and mind, and back pain is a body and mind issue. 

What I believe has been most valuable for me was a new approach to yoga. I did a teacher training with Julie Martin, who applies a rather rebellious approach to yoga. She works with freedom in movement and moves away from the old understanding of what constitutes a yoga position, or asana. Instead of being based on static strength like traditional yoga, it’s soft, fluid, dynamic. By moving ni this way, I have reached a whole new range of motion in my spine and in my hip joints. I work my hips a lot, because – surprise! – it’s all connected. The spine is part of the pelvis so naturally the pelvis affect the spine. I also work my feet, or rather try to keep them healthy by not (not anymore) squeezing them into shoes that are too small. 

Building stability and strength, especially if you have a tendency of hyper mobility (that is, if your joints can easily move beyond a normal range of motion), can rally help easing back pain. One of my favourite things to do when I start to feel that pinch in my lower back is to go to the gym and do dead lifts. Check out this guide if you want to learn how to do deadlifts! http://www.styrkelabbet.se/marklyft/ (in Swedish.)

There is also a lot to say about posture. Having a ”bad” posture is not connected to having back pain. This seems a bit counter intuitive but as you may have noticed a lot of people walk around life slouching like question marks without ever having any trouble with their backs. However, just because there is no correlation between posture and back pain does not mean that posture is irrelevant in treating back pain. Having a good posture, which I define as finding support for the spine from the feet, legs, and pelvis, takes focus away from the back. Imagine never having to think about where you place your spine, no more arching and no more rounding to find ease, the back can just be there without you thinking about it. 

A good posture should be one that offers support and stability for the spine to be in its natural curve. 

Last but not least something needs to be said about the illiopsoas. The psoas muscle has been called ”the muscle of the soul” (by Liz Koch of http://coreawareness.com). I really don’t want to go into the discussion about the validity of this claim, but limit myself to saying that the psoas is important as it connects the upper body to the lower body, stabilises the back and life the legs. It is one of the deepest muscles of the body and it originates along the spine and joins to the thigh bone. Typically most people would benefit from strengthening the psoas, more so then to stretch it. typically, what most people do is stretching it…
This is the illiopsoas:

An easy exercise: stand tall, arms alongside the body and lift and bend one leg so that you draw your knee towards your chest. Stay for a minute or so and make little circles with your knee, while allowing the pelvis to move with the circles. Do the other leg. Repeat. 

And of course, I’m announcing a workshop on back pain to the held at May 20. Please join me for a possibly life changing event! (Check out separate post!)

There is nothing as practical as a good theory….

Since I’m a used to be academic and a theory nerd I have taken time to really dig into the subject of pain research. I would like to provide you the basic theoretical insights I have gathered about the topic, if you’re not into theory you can just skip this section and wait for the next post.

What is pain? For a long time, pain was seen as a sensation produced by injury, inflammation or other tissue damage. This is the ’old’ – the Cartesian – understanding of how pain occur. Nociceptors – pain receptors in the tissue send information about damage to the brain and thus we feel pain. In this sense pain is a sound reaction preventing us from causing more damage by not moving or touching the place that hurts. This view, however, has come to be altered with progressions in pain research. We know now that pain is utterly complex and there is more to it then just the physical, structural aspects.

”While sensory input may initiate pain or other bodily awareness, it is not the sole, or even the dominant, causal mechanism” (Chapman 1996).

Physical pain is tackled from many different academic fields, such as neuroscience, psychology and physiotherapy. I also look into non research-based knowledge in the area of back pain; the topic has been adressed by alternative practitioners of therapeutic body techniques, such as yoga. Neuroscience, the science of the nervous system, focuses on nerves and nerve impulses, hence it concerns a rather high level of abstraction of the body. Physiotherapy, on the other hand, is more practice-based in its approach and concerns a lower abstraction level of the body. While the two fields produce different knowledge output, one is not more right than the other, they complement each other in a nice way.

There are two theories that really pushed forward our understanding of the causes of pain. The first one is the gate control theory from 1965. The neurologists Ronald Melzack and Patrick Wall showed, through a number of experiments, that non painful input closes the ’gates’ to painful input, thereby preventing pain sensations from travelling to the central nervous system (the brain and the spinal cord). So by creating other sensations in the body we may prevent the nervous reaction causing pain. It is generally believed that the gate control theory provides evidence of the psychological aspects of pain perception.

Ronald Walzack continued to work on the gate control theory, however, and later developed the neuromatrix theory of pain. Basically Walzacks insights came from studying phantom limb pain, reflecting on the fact that patients experience pain in a body part even though there is no body part there to feel. The neuromatrix theory of pain states that pain is produced by the central nervous system instead of the peripheral nervous system. Nociception, pain signals, travel from damaged tissue, via the peripheral nervous system, into the central nervous system. These are one part of what causes us to experience pain. The matrix, however, is made up of a network of neurons that consists of loops between the thalamus and the cortex, as well as between the cortex and the limbic system. Hence, pain is caused by this network, and by a characteristic pattern, the neurosignature, defining all the nerve impulses within the neuromatrix.

Does it seem a bit too complicated to grasp? In short it means that pain is in the brain more than in the body. Internal nerve impulses may be nociception – nerves sending signals about tissue damage. Nociception is an internal stimuli, it comes from within the body, just like an inflammation, a slightly irritable bowel, or stress. But nerve impulses in the neuromatrix comes from internal as well as external stimuli, that is, from changes taking place outside of our bodies as well as changes inside of our bodies. External stimuli could be we hear someone tell us we are strong, or weak, or maybe we read about someone having a strange and paralyzing disease that started out with a sore lower back. It could also be that we engage in some activity that we love to do and that makes us forget about the pain. Each part of the neuromatrix contributes to various aspects of the pain experience, the sensory, the emotional, the cognitive, motoric, behavioural, and conscious aspects of pain.

In short, pain is a nervous system condition rather than a structural, physical, condition. In the next post, I will look deeper into the causes of pain from a yogic perspective, how can we make sense of the complexity of pain and its connections to our general state of mind and all other things that provide inputs into the neuromatrix?