Continuing with our series on back problems, in this article we will try to shed some light on another major setback to the spine, commonly known as bulging disc or herniated disc in the lumbar region. We will also take a look at the application of yoga practices for spinal disc herniation.
Spine is crucial part of human body, connecting brain with the rest of the body. It sets up a line of communication to and from the brain, delivering messages in the form of electrical impulses travelling at different speed and frequencies to let the brain talk to our body. This is achieved with the help of very sophisticated structures called Nerves. Nerves form a complex network as they travel through the distance to each and every tissue. They work as excitatory and inhibitory channels allowing any function to occur or to stop. These nerves branch out from Spinal cord, which is seen as an extension of brain, as it’s made up of the same tissues as of brain. It runs vertically through the Vertebral column, which is an arrangement of vertebrae stacked on top of each other and total 33 in number. Here the spine fans out in pairs at each intersection of the vertebral bodies through specially created holes called vertebral foramen. There are in total 31 pairs of spinal nerves branching out from spinal cord and supplying to different parts of the body in upper and lower extremities as well as the viscera.
In between these vertebras a soft cushion like structure is provided in order to ensure comfort in movements and a safe passage for nerve roots branching out from there. As shown in the picture, the disc acts like a buffer, absorbing shocks and thereby preventing damage to the spine. It also provides for flexibility of the movement to the vertebral column, giving it a wide range of motion from forward, backwards and sideways.
This disc is engineered by an arrangement of connective tissue on the outskirts, which form a shell. It is connected with the vertebrae on top and bottom as a fibro cartilaginous joint. It is called Annulus Fibrosus. This annulus provides for slight movement in the spine. It also acts as a ligament holding the vertebrae together. In side this shell there is the inner core called Pulposus Nucleus. This is a jelly like substance which is mainly water (mucoprotein gel or proteoglycan) with some loose collagen fibers. This pulposus is responsible for withstanding the forces of compression and weight being put on our spine constantly in almost all the postures we move into.
Any damage to this disc results in herniation of the exterior casing and as a result, the fluid inside is dispersed on the external surface of the vertebrae. When this happens, this fluid might interfere with adjacent nerves while irritating them. At the same time, as the spacing between two vertebrae is lessened due to the fluid moving out of its casing, they are tend to come more closer to each other which is termed as compression. This compression then might become another reason to irritate the corresponding nerve branching outward from between them.
This is a very difficult condition on part of the patient as it might lead one into intense pain and even immobility sometimes. There is huge amount of stress on psycho physiological level with decreased confidence and efficiency. Person feel restricted in common day to day action. Sitting becomes difficult, getting up from sitting becomes difficult, walking, climbing stairs, driving, cycling, and doing chores and almost all range of activities induce pain. In extreme conditions a complete bed rest is recommended unless the inflammation subsides and pain reduces. Even after that, there are very strong chances of the pain recurring on the slightest of disturbance of anatomical structures in the affected area.
What makes Spinal Disc Prone to Injuries
The causes for a lumbar disc bulging can be multiple, but we can count on certain factors which are responsible for it.
- The foremost point to remember is that the discs have a very limited supply of blood for their nourishment and waste disposal. As both the portions of disc are avascular, which means they don’t have blood vessels directly supplying them, they depend almost entirely on the end plates of the vertebrae to supply them. At the time of birth the pulposus is hydrated nicely, but as we age, the water starts drying up. For exchange between the disc and vertebral end plate to happen properly, it has been observed that movement in the particular segment of spine is extremely essential. To put simply, the disc sucks the nutrition when we provide proper movement to the spine. As per the vertebral physiology, there are certain factors responsible for the nutrition to take place effectively. First of them is the arrangement of connective tissue fibers. The fibrous structures around the spine work efficiently under a particular amount of load. They are designed like that. That is why movement and weight bearing is equally important for them to stay healthy.
- Secondly, the endplates of the vertebrae to which the discs are connected, need to maintain sufficient thickness in order to effectively allow the capillaries to transfuse between the two structures. This is made possible only when they are exposed to particular amount of loads which is neither too much nor too less.
- Thirdly the blood vessels themselves should be in a healthy state.
- Fourthly the composition of proteoglycan in the disc must be maintained in order to ensure the proper absorption hydration within the disc. This is also achieved when disc undergo the permissible amount of load.
Studies have shown that spinal disc can retain their normal character and well being, if we intelligently choose to put them under a constant workout with the desired quantity of weight along with the movements executed in the right direction.
Any movements that put excessive weight on the spine and are channelized in the wrong directions can induce structural as well as compositional deterioration.
As we know that the muscles in the lower back are very well complimented by the muscles in the abdominal region. Hence if the abdominal area shows any significant weakness, the additional load over the spinal muscles leads to deterioration in the disc due to overload. That is why it is often seen that a sedentary lifestyle comes out to be a common reason for lower back issues. Disc rupture in particular.
The diagnosis is usually prescribed at the onset of pain in the region. Radiological tests include
- MRI scans : Magnetic resonance Imaging
- CT scans: Computer Tomographic scans
- X rays
Physical examination might also be considered by the examiner to determine the condition. It includes
- Muscle Strength Test : The examiner will test the strength of certain muscles in legs and feet to see for any signs of a pinched nerve.
- Knee Jerk : Tapping the patellar tendon just under the bone. If there is any compression in the nerve, there will be very less or no reflex in the knee.
- Raised Leg Test : The doctor will test you by raising your right leg up towards the head in a lying position. If there is any compression at the nerve root, there will be a pain near the back of the leg.
Apart from these there are a variety of other tests which can be used by the doctor to reach to a conclusion along with the above mentioned radiological scans.
How Yoga Works Here
One of the most common methods recommended and used in such disorders is Traction. But this term must not be confused with stretching. Traction employs the force acting in two opposite directions, thereby pulling apart two vertebrae from each other with a particular weight load. Clinically, tractioning is performed mechanically with the help of machines. Studies have revealed traction can be useful for rearrangement of pulposus if done carefully. But when the disc is sequestered, i.e. when the fluid pieced out on the outer surface, traction is not helpful.
Yogasanas are a natural method of tractioning the spine without using any external mechanical device. Body is worked against the force of gravity pulling it away from the same. There are plenty of asanas, which if done carefully with expert guidance, can actually prove to be helpful in relieving off the pain and also ensuring the recuperation of the disc. Also they reinforce the vertebral ligaments and muscles which are crucial to spinal health. Along with that pranayama also helps in realigning the energy pathways for healing to take place as well by establishing harmony at the level of mechanoreceptors in the spine to speed up the process of repair and regeneration.
We are compiling some of the techniques which can be used. However the practitioner must remember that the load on the spine must be carefully controlled. Also range of movement should also be regulated so as to not aggrevate the condition. Deep flexion and extensions must be avoided. They should be replaced with gentle and supported movements which are at least halfway to the range.
- Trikonasana with a support of brick : Use a brick to place by the side of front leg and rest the arm on it while bringing the trunk in partial flexion.
Important : Make sure that the spine itself do not flex laterally. It is the trunk that needs to be moved from its base in the pelvis.( See figure 1).
If seems difficult to do, you can also rest against the wall to evenly distribute the body weight. (See figure 2)
It must however be remembered that the legs must be strongly attached to the floor and trunk must be pulled altogether away from the legs, thus bringing about the traction of the vertebrae. The effectiveness of the asanas depends upon how intelligently one can use gravity in relation to the body as well the specific part of the body that in intended to be worked upon. Stay in this position for 1 minute at least on each side. Repeat twice or as per the requirement.
Parsvkonasana with support of a brick : Similar to above parsvkonasana also acts as a strong tractioning asana. Please refer to the picture below to see how to place brick. The alignment of shoulder and arm resting must be correct. Also the leg which is at the back should be hooked strongly into the ground to act against the pull exerted on the trunk. (See figure 3).
Again it must be remembered that the trunk as a whole should be pulled. It needs some engagement of your Vigyanmay kosha, the intellect, on how to engage the entire length of the spinal column. Stay in this position for 1 minute at least on each side.
- Adhomukha swanasana with wall : This indeed is a convenient asana to prevent extra load from the disc and giving them a chance to heal and rejuvenate. It must however be done with assistance while somebody is there to support you in and out of the asana. To do this, a belt must be tied to a bar or on a hook on the wall, at the height of your pelvic rim. Place the belt across the pelvis, on top of the groins. Gradually shifting the weight on the belt, place your arms in front raising the buttocks upwards. If needed, the heels can be attached to the wall for support.(See figure 4 & 5).
The distance between the legs must be well observed, the arms must be extended as much as possible. Neck must be in a relaxed position. The attachment of the belt to the wall acts as the other side of the load pulling the legs in the opposite direction to that of the trunk and bringing about the traction due to the effect of gravity. Stay in this position for 1 to 3 minutes.
- Shashankasana modification : Another effective method for tractioning is a variation of classical Shashankasana or Rabbit pose. Sitting in vajrasana place two bricks in front of you approximately 3 feet away from the knees. Now very gently bending forward, try and reach for the brick and place your palms on top of them. Now inhaling, raise the pelvis up from the heels and start gripping the bricks with your hands. Then exhaling, gently push the pelvis down towards heels while maintaining the grip on the bricks. (see figure 6).This action helps in stretching the spine between sacral and thoracic region. Stay in this position for 2 to 3 minutes. Repeat twice.
- Shalabhasana : This asanas helps in strengthening and toning the structures around the spine. It particularly works on reinforcing the ligaments and contracting the erector spine. Also it helps in reinstating the harmony in the sensory apparatus situated all along the lower section of the spine.
To do it, lie down flat in a prone position with hands closer to the body and legs together. Palms must be facing to the floor.Now inhaling hold the breath and raise the right leg slowly up from the floor to a comfortable height. The movements must be slower. Hold the position and continue to breathe naturally. Then exhaling bring the leg into original position. Repeat on the other leg. (See figure 7)At least 8 to 10 rounds can be performed at one time.
When the leg is raised up, it must be kept stiff like staff in order to keep all the muscles engaged and activate the muscle chain the lower region of the body.
- Sphinx position : Can be used as a restorative pose to relax the muscles and ligaments of the lower back and let them get rid of the stress accumulated.
To do this, lie down in prone position and place your hands straight up on the floor.Inhaling raise the head up and bending the elbows, place them just perpendicular to the shoulder, bringing the upper arm in a vertical position to the floor.Keep the lower back, buttocks and legs loose and relaxed. (See figure 8)Breathe naturally and stay in this for 1 to 3 minutes.
This posture can be performed whenever it feels necessary to rest and relax.
Following a holistic approach towards the problem involves the practice of pranayam as they are crucial in strengthening the pranic connections and nervous pathways.
Nadi Shodhan pranayama for 10 minutes every day is very beneficial in handling stress and managing painful condition. In addition it also helps in redefining the brain and body communication towards a more positive side. To get details on nadi shodhan refer to our article here.
It must be remembered that yoga is more a preventive medicine. The practices and techniques mentioned in the classical system of Hatha and Raj yoga helps us to stay away from any Dukha (diseases). Prevention of dukha depends upon Ek Tattwa Abhyas (continuous practice in particular direction). But at the same time, these practices also prove to have remarkable curative effects if performed under guidance while all the fundamental rules are followed.
The purpose of this article is to provide insight and assistance in understanding the problem. If you have any such problem persisting, we recommend consulting an experienced teacher before commencing any yoga routine for yourselves.
Jeevmoksha Yoga Gurukul