Pain

Last September I tore some ligaments in my lumbar spine while gardening. I lifted a bag of mulch laterally from a squatting position, and immediately felt I had been stabbed in the back. Walking, sleeping, standing up straight, and getting out of a chair were all extremely painful, and yoga was out of the question—I could not even sit on the floor. Although an injury of this type is clearly structural, when it comes to healing, a variety of approaches can be helpful, such as rest, physical therapy if necessary, sometimes medication (I didn’t use any), massage, oils, and mental imagery. When we look to Yoga and Ayurveda, pain in the body is said to be caused by internal air, called vata, becoming trapped in the muscles, tendons, ligaments, or joints. Two qualities of vata are dryness and coldness, and therefore it follows that by warming the blood through deep and steady breathing, and then directing that warmed, lubricated tissue to the muscles and joints through particular postures, vata can be encouraged to become warm and relinquish its cold and dry hold. So, for example, when yoga is done with vinyasas, heat is created in the body, and the blood is warmed, and circulates freely as the capillaries open.

When our breathing in yoga practice is free and resonant, we also can become more aware of how we use our bodies, and that will help us to understand how to work with pain when it finds us. Pain, or injuries, usually occur in that split second when we are not paying attention. However, injuries can also occur even when we are paying attention! One way or the other, a little bit (or sometimes a lot) of suffering in life is bound to arise. Bringing our attention to breathing is the best way to start working with pain, and the sensations of pain that we experience. Breathing can also help us with our perception of pain, which is a whole other, but very important, topic. The lengthening of the breath with a focus on the exhale also activates the parasympathetic nervous system, which is responsible for monitoring inflammation and tissue repair. Ten to fifteen minutes of simple equal breathing of five or six seconds on the inhale and exhale, or a slight extension of the exhale, will help to activate the parasympathetic nervous system and relax the muscle tissues. The parasympathetic is responsible for overseeing growth, restoration and repair.

A recent study on Bikram yoga tested whether or not external heat was a factor in improving the function of the endothelial cells, the inner lining of our blood vessels, which create a one-celled-thick wall that lines all of our blood vessels. Among their many functions are to maintain and regulate the permeability of the blood vessel walls (for example, the brain-blood barrier) and to help regulate blood flow. They support homeostasis of the vascular functions, and help regulate inflammatory processes. The inflammatory process control comes in part from the endothelial cells releasing nitric oxide that leads to relaxed vascular tone and low levels of oxidative stress. Nitric oxide, which does many things in our cells, and has a host of beneficial effects including fighting bacteria and reducing inflammation, is also created through nasal breathing, but not by breathing through the mouth. The study showed that the 26 postures of Bikram Yoga improved endothelial function equally, whether the room was heated or not (but only in middle-aged and elderly populations; young adults were unaffected). From this, we can possibly infer two thing:

  1. Bikram and hot yoga studios could save a lot on heating bills, and,
  2. Pattabhi Jois’s assertion that the internal heat created through yoga could improve blood circulation appears to be correct (though we do not know if it is the internal heat that is created, or simply the effect of breathing, moving, and holding static poses).

Regardless of study results, it is well known that movement, breathing, internal heat, and blood flow all can contribute to healing. Blood will repair torn tissues, which is why the first 10%-33% of the meniscus can repair itself, because it receives blood supply. The other parts do not, so deeper tears can be problematic (but not necessarily impossible to fix) with yoga.

It was very slow going to begin healing my injury. It was only after about two weeks that I could start moving a little, and did only some simple, lying down back stretches. After about six weeks, I was able to do some very modified Sun Salutations. I made the videos below at about the six week period. They show the entirety of the practice I was doing at that time. Video 1 is an example of some of the lying down positions that I did at week number two.

Video 1: Lying down strengthening and releasing poses for the lower back and hips.

Video 2: My modified Sun Salutations. Bending forward was not possible.

Video 3: “Standing poses” —the quotation marks will make sense when you see the video! These specifically seemed to help strengthen my quads and gluteus muscles, and supported my lower back so I could stand comfortably while teaching.

How am I now, you ask? First of all, thank you for asking. Second of all, I’m quite a lot better. Ligaments take six months to a year to heal, so all things being equal, I am on track. Modified practices were necessary, and a couple of visits to my Yoga + Science colleague Marshall Hagins, who is a physical therapist, were very helpful. I hope the videos are helpful to any of you who experience severe back pain, or have students that you are trying to help.

Thank you Professor Alexandra Seidenstein for fact checking this article.

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