This was the second in an ongoing series on the therapeutic applications of yoga to appear in LA YOGA Ayurveda and Health magazine. A copy of the article can be viewed at: www.layogamagazine.com

I clearly remember the moment when shooting pain in my back sent me down on my knees, unable to breathe. I remember the numbness and tingling in my right foot – no matter how much I commanded, my foot would not obey. As a physical therapist, I knew exactly what was happening, I just couldn’t believe it was happening to me. I was young, healthy, active and a dedicated yoga practitioner. How could it be that I had herniated a disc in my lower back? The fear surrounding any significant injury began to surface. My main question was, “Would I be able to stay active and do the things I love, the activities that fulfill my soul and inspire me daily?”

The doctor took one look at my MRI (revealing a significant disc herniation at L5-S1 with nerve root impingement) and told me I would have to modify my activities for the rest of my life. Knowing better, I began to heal my injury with what I loved most – yoga. Six years later, I am pain-free, enjoy a full practice with no limitations and help others overcome their injuries with therapeutic yoga.

What went wrong?

The injury and my subsequent self-inquiry forced me to look closely and honestly at the way I was practicing yoga and living my life. I became aware that I was performing asana (postures) the way I thought they should look. I was missing an inner awareness of how each pose could serve me and my body. I would repeatedly overextend my lumbar spine while avoiding opening up tight areas in my body, namely my hip flexors and external hip rotators. I also have a mild scoliosis, which creates some restriction in my thoracic spine. In backbends, I continuously used the flexibility in my lower back to push into what I perceived was a deeper pose, instead of backing off to create more movement in my chest and upper back. In addition, I was not engaging my lower abdomen correctly, which contributed to constant compression in the lumbar spine. I was able to practice, even with this imbalance, for a number of years until the straw broke the camel’s back. I herniated a disc after performing a deep forward bend.

My experience led me to develop a growing awareness that injuries are not necessarily caused by a specific pose or even the yoga; rather it is the way one consistently practices over time that creates the problem.

When I examined how I approached my life, I was forced to recognize the competitiveness I had with myself both on and off the mat. I have been a perfectionist for as long as I can remember and although competition can be healthy, it can be accompanied by self-directed violence and aggression when motivated by a feeling of not being good enough. In this case, I was never fully present in the moment because of constant striving for my perception of a ‘better’ version of the pose, and ultimately myself.

In Healing Back Pain, Dr. John Sarno states the personality type who most often suffers from back pain is one who appears calm on the outside but tends to internalize stress, putting a lot of pressure on themselves to succeed. This stems from a lack of trust in life and a lack of awareness that the universe supports us. Since the lower back is the support for the torso, it is no surprise my pain manifested there.

Finding Purna Yoga

After the opening Om of a daylong workshop on Yoga for Low Back Pain with Aadil Palkhivala, I knew I wanted to study with him. Purna Yoga, founded by Aadil and his wife, Mirra, offers many advanced and innovative therapeutic techniques. Aadil studied with BKS Iyengar from the age of seven and developed a system based on his work with Iyengar emphasizing awareness and alignment accompanied by applied philosophy, nutrition and transformative spirituality. Purna Yoga encourages the student to look deeper into the causes of injury and disease and to work with lifestyle modification and meditation in addition to asana to ensure complete and true healing.

Therapeutic Asana for Low Back Pain

When working with any injury, it is important to look at the cause by identifying areas of tightness, weakness and misalignment. In my case, the root cause was tightness in the hips, thoracic spine and chest as well as weakness in the core. I also needed to learn to be more present in my body, to feel what was happening instead of forcing into a pose.

The first and most important action to tearn to protect your back in all asana is the engagement of the pit of the abdomen, what Aadil calls the POA, the region between the belly button and the pubic bone. To protect the lower back, lift the POA toward your head, enabling the navel to move into the body and upward, helping the sacrum descend. This action creates length in the spine, relieves compression in the low back and protects the back during backbends and twists.

Although each individual is unique in her or his therapeutic needs, the following asana are generally safe and effective for individuals with sub-acute or chronic conditions. These are suggestions for back health, but remember that it is important to work with a yoga therapist who can evaluate you and design an appropriate program for your specific condition.

Tadasana (mountain pose) [pictured, above] is a wonderful place to start at any stage in the healing process. Placing a block between the legs facilitates opening the outer hips, strengthens the adductors and core, and relieves pressure in the spine. Place the block between the upper thighs and ground all four corners of the feet into the earth. Engage the thigh muscles and roll the thighs in toward one another, squeezing the block and moving it backwards. As you maintain the internal rotation in the thighs, lift the POA. Draw the shoulder blades away from the ears and keep the chest lifted. When working in harmony, this action helps the descent of the sacrum, places the pelvis in a neutral position and creates space between the lower lumbar vertebrae.

Most individuals with back pain and disc herniations have tightness in one or more areas in the hips. The hip muscles attach to the pelvis and the sacrum attaches to the pelvis via the sacroiliac joints. When the hip muscles are tight, the alignment of the spine is directly affected, especially during the performance of yoga asana. Most injuries and disc herniations occur in the lumbosacral area between L4-L5 and L5-S1. The Purna Yoga Hip Opening Series is a wonderful sequence of postures that increases range of motion in the hips in every possible direction along with traction. I have observed students and clients finding relief from years of back pain after practicing the sequence regularly. The Hip Opening Series is comprised of six postures that open the hip in flexion, adduction, abduction, internal and external rotation and extension. The following excerpts from the series are safe for most back conditions.

1) Supta Padangusthasana:

(Lengthens the hamstrings.) Lie on your back and place a strap in the arch of the left foot. Bring the left leg up and extend the right leg out. Engage both thigh muscles and press out through the right inner heel. Make sure the bottom thigh does not roll out to the side. Instead move the inner knee towards the floor so that the knee and toes point directly upward. If the top knee is bent, move the leg further away from the head and engage the thigh muscles. Keep both hip bones level. You should feel the stretch in the hamstrings, behind the left knee or thigh. If you feel the stretch in the buttock area, back off a little bit until the stretch moves out of the buttock and into the posterior thigh. Repeat on the other side and hold for six deep breaths.

2) Parvritta Supta Padangusthasana:

[pictured, above] (Lengthens the external rotators of the hip.) Begin this in the same way as the previous asana but hold the strap in the right hand. Take the leg across the body so that the heel of the left leg lines up with the right shoulder, but no further. Press up through the left heel as you bring the left buttock down toward the floor. Hold for three breaths and repeat on the right.

3) Hip Internal Rotation:

[pictured, above] (Increases internal rotation of the hip and stretches the psoas major, one of the hip flexors.) Lie on your back with knees bent and feet together. Step the right leg out to the side and let the knee fall toward the floor. Make sure the thighbone and shinbone are perpendicular to one another. Cross the left ankle over the right knee and allow the hip to come up off the floor. Strongly lift the POA toward the head and move the right thighbone away from the head. If there is any pain in the right knee, support it with a block. Hold for six deep breaths and repeat on the left. For all injuries, it is important to approach the healing process in stages for a complete recovery. All too often, we jump ahead to strengthening before the structure is properly aligned.

The five stages of healing:

• Re-Align: Identify what is tight and weak and correct it.
• Create Space: Open up the tight structures and surrounding connective tissue to reduce joint and nerve compression.
• Re-educate: Identify faulty movement patterns that contribute to the imbalances and learn how to move in a different way.
• Stabilize: Once the structure is aligned, stabilize.
• Practice: Be consistent for long-term results and transformation.

It is my belief and experience that injuries happen for a reason. Although, it may not be apparent at the time, if we can step back and see our pain as a gift, we can work on it with more acceptance, patience, and clarity. If our bodies send us a clear message, it presents an opportunity to reexamine the way we have been living our life physically, emotionally and spiritually. This can point us in the direction of making changes, enabling us to new levels of health and awareness. My injury certainly guided me to cease pushing toward my concept of perfection. It helped me learn to accept myself in this moment. It brought me face to face with my ego and insecurities. While neither easy nor pleasant, I am grateful for the ability to practice compassion and acceptance for myself and others.

Rachel Krentzman is a licensed physical therapist and certified Purna Yoga instructor at the 2000-hour level. She is the co-founder and director of Embody Yoga and Physical Therapy in San Diego, where she sees private clients and teaches weekly Happy Back Yoga, Women’s Yoga and Purna Yoga classes.

Written for www.active.com

Have you ever experienced a nagging pain in your shoulder blade area that just won’t go away? How about chronic neck tension while sitting at your desk? Do massages feel great but a few hours later the pain returns?

Upper back and neck tension are complaints that are becoming more prevalent in physical therapy offices. With the increasing use of computers, desk jobs and time sitting in traffic, it’s hard to avoid these aches and pains regardless of how active you are.

Here’s why–most of our daily activities are done in front of us while seated. How many times a day do you spend driving, writing, typing or eating? Over time, gravity takes over and the shoulders begin to round forward, the chest becomes constricted, the head juts out, and the upper back becomes stretched out or rounded.

The result of this posture is tight pectorals, shortened neck and weak upper back muscles. Consequently, smaller muscles that were not originally designed to be ‘postural muscles’ have to kick in and work hard to keep our bodies upright. In addition, certain sports including cycling and running can exacerbate the problem. Pain in the upper back and neck is often just a sign that your muscles are tired of doing a job they weren’t meant for. The solution is to fix the problem, not the symptoms.

In order to combat chronic tension in these areas, you first need to work on stretching the tight structures that prevent you from sitting or standing with ideal alignment. If you strengthen the upper back without stretching the front of the chest, you will just keep falling back into the same faulty posture. Once you open up the chest and stretch out the back of the neck, then it’ll be time to work on strengthening the upper back.

Yoga is a wonderful way to accomplish both stretching and strengthening in a gentle and effective way. Here are a few suggested poses that you can work on at home or at the office.

Postural Awareness and Breathing

Deep breathing is the first step to relieving neck tension. When we breathe in a shallow manner, the muscles of the neck (instead of the diaphragm) contract. To begin to breathe deeply using the diaphragm, sit upright at the edge of a chair with your feet planted firmly on the floor. Make sure the knees are lower than your hips. Place your hands on your belly and close your eyes. As you inhale, feel your belly rise into your hands and as you exhale, feel it fall. Notice any tension in the neck and relax your neck muscles as you direct the breath into the belly.

As you breathe, bring your awareness into the front of the chest and the collar bones. Broaden your collar bones so the front of the chest lifts up. Drop your shoulder blades away from the ears and lift the crown of the head towards the sky.

Continue to breathe this way for 10 deep breaths. Try to do this every hour by setting an alarm as a reminder to stop, breathe and notice your posture.

“The Clock” (Pec Stretch)

Stand along side a wall and place your right hand up on the wall to 12 o’clock. Slowly move your hand from 12 to 1, 2 and finally to the position at 3 o’clock. Take your left hand and place it on the right rib cage. Take a deep inhalation and as you exhale, pull the rib cage forward without moving the right arm. You should feel a stretch in front of the right shoulder or down the right arm. Hold for six deep breaths. To intensify the stretch, move closer to the wall. Repeat on the other side. If there is any tingling in the arm, move away from the wall until it resolves or discontinue the exercise.

Arms Overhead With Strap

Using a yoga strap or belt, take your arms overhead, shoulder-distance apart. Make sure the palms face away from each other. If you cannot straighten your elbows in this position, take the arms wider on the belt. Drop the chin into the chest in order to relax the neck muscles and pull the strap apart. Hold for six deep breaths and repeat two times.

Downward Dog at the Wall

Stand facing a wall with your hands at waist-height. Walk your feet back into a table top position with your feet directly underneath your hips. Lift the sitting bones towards the sky as you press the hands into the wall. Feel as if your heart is melting towards the floor. If you feel a great deal of stretching in the hamstrings, keep the knees slightly bent. Hold for six deep breaths, focusing on opening the chest and lengthening the spine.

As with all things, consistency is the key and the more regularly you practice these exercises, the better off you’ll be. Ideally, you should get up every hour to stretch even for a minute or two. Remember–we are fighting a battle against gravity. With regular practice and the right guidance you can stand tall, proud and pain-free for life.

It is possible that your pain is coming from a different condition and therefore is important to consult with a doctor or physical therapist prior to beginning any exercise program.

PHYSICAL (1.)

The physical benefits of yoga can be addressed through the postures (asana). The emphasis of the
postures are to open up the hip and pelvic region in both men and women in order to break down any scar
tissue and release tight musculature that can impede optimal circulation to the reproductive organs.
Other postures work on creating strength in the pelvic floor area to prepare for childbearing and childbirth.
All postures increase awareness of the body with special emphasis on the pelvic and abdominal region so
that the practitioner can feel what is going on in his or her body and create more relaxed and receptive
conditions for conceiving.

Recommended Asana:

• The Morning Series
• Hip Opening Series
• Mula Bandha – lifting the pelvic floor
• Standing Poses
• Viparita Karani Sequence

PHYSIOLOGICAL (2.)

The benefits of yoga go way beyond the physical form of the poses. Regular practice of the appropriate
asana sequences create significant changes in the practitioner’s physiology and work to restore balance
where it is needed most. The two most important physiological effects are on the endocrine system and
the nervous system.

Endocrine System: Responsible for hormone regulation and reproductive health.
Nervous System: Moving from a sympathetic (fight or flight) state to a parasympathetic state (which is
essential for the reproductive system to work).

Recommended Asana:

• The 5 Tibetans – to stimulate the endocrine system
• Inversions (Sarvangasana – shoulder stand) for the pineal and thyroid gland
• Chest openers and Twists – for the adrenal glands
• Restoratives – to move towards a parasympathetic state

MENTAL / EMOTIONAL (3.)

This is the most important aspect to address when working to create a new life. The stress of trying to conceive can actually be the one thing that is preventing it from happening. Yoga works to bring calmness to the mind and emotions by bringing your attention to the breath and bringing you into the present moment. Its aim is to connect with your heart and inner wisdom in order to find the joy that is already there. In Yoga, we rediscover our sense of oneness with all things and learn tools to manifest what you want through visualization and imagery.

Recommended Asana/Pranayama/techniques:

• Ujayi and Bhamari breath
• Body Scan / Guided Imagery / Yoga Nidra
• Increased awareness of the pelvis and internal organs
• Letting go of the old and making way for the new
• Preparing for baby/ Setting Intention
• Meditation

Related New Report:

For www.active.com – March 19, 2010 – The Great Yoga Wall™

Many of you may have experienced both the exhilaration and peaceful state that a yoga practice provides. One of the reasons we feel so good after doing yoga is because it is a balanced physical practice designed to open the spine in every direction.

This is also what sets it apart from your average sport. Most sports are a function of repetitive movements that can often cause repetitive stress on the body or tightness in certain areas because of the posture adopted during that specific sport. In yoga it is said that “you are only as old as your spine.” In other words, as long as you have a healthy and flexible spine, your ability to participate in life is endless. The spine is your vitality; it houses all the nerves that keep your muscles and organs functioning optimally. It is also the home of the central channel or “Shushumna Nadi” in the yoga tradition, which is where we hold our “Prana” or life force.

For the spine and joints, gravity is not always our friend. It causes wear and tear over time, loss of height, osteoarthritis in the joints and loss of mobility. Imagine what the possibilities would be if we could open the spine in every direction without compression, in other words in a state of traction. The only way to do this would be to practice while hanging upside down. Impossible? Not so. The Great Yoga Wall ™ makes it possible.

What is a Yoga Wall?

The Yoga Wall has been around for decades, originally designed by BKS Iyengar in the form of ropes attached to wall hooks to assist students in various yoga asana (poses). The Great Yoga Wall ™ is a newer version of this wall with a system of adjustable straps and more comfortable pelvic swings to accommodate every height and body type. The new system was designed by Kedric Wolfe in the early 80’s after he injured his foot on one of the older system’s wall hooks. It occurred to him that there must be a “better way” to use the wall with more ease and versatility.

In San Diego, physical therapist and yoga instructor Diana Smith teaches classes and works with clients individually on the Yoga Wall to help improve their overall flexibility and mobility in the spine and joints. Diana describes the benefits of the Yoga Wall as twofold. “It (the Yoga Wall) can help a healthy Yoga practitioner find a new way to access different muscle groups in a pose that they were unable to do without the ropes,” she said, “and it can be used therapeutically to help individuals heal from injuries, especially from arthritis and degenerative disc disease.”

She says that many of her private physical therapy clients have been able to avoid surgery and recovered from herniated discs with the help of the Yoga Wall.

There are hundreds of poses that can be practiced with the help of the Yoga Wall system. At Embody Yoga and Physical Therapy Centers in San Diego, we teach special sequencing including one called “Rejuvenation of the Spine Series.” The series, which is taught by Purna Yoga ™ co-founder and Yoga Master, Aadil Palkhivala, incorporates flexion, extension, lateral flexion and rotation all while the spine is in traction. The beauty of the system is that the traction begins at the low back compared to inversion tables which first traction the ankles, knees and hip before reaching the spine. The Yoga Wall uses positioning, action, breath and awareness to open the spine and joints.

Other poses that are practiced on the wall include standing postures, forward bends, back bends, twists and inversions such as headstand, which can be done without any weight on the head.

Long time student and physical medicine physician, Dr. Lance Stone, said he liked it so much, he installed one in his house.

“The Yoga Wall system has enabled me to reach deeper into each pose and experience improved alignment,” Stone said. “It is a remarkable tool that has strengthened both my practice and motivation. I feel results that I generally only achieve with a hands-on instructor. It also looks good and doesn’t take up much space.”

Once you have tried the Great Yoga Wall ™, it is hard to resist coming back. It is unlike anything you have experienced. The only side effect I have seen is a smile that won’t go away.

Rachel Krentzman, RPT, E-RYT is the Cofounder and Director of Embody Yoga and Physical Therapy, a charming studio with a full Yoga Wall system in the heart of Bird Rock, in San Diego CA. She is a licensed physical therapist and a certified Purna Yoga Instructor who is passionate about integrating Yoga into Rehabilitation.

For information on the Great Yoga Wall ™ visit www.yogawall.com.

Dr. Lance Stone – Medical Director of Rehabilitation Services UCSD Hillcrest and Scripps Mercy Medical Centers

Kim Bell DPT, CSCI, CWMI – Doctor of Physical Therapy

Combining our knowledge and experience as licensed physical therapists with our extensive training in Iyengar and Purna Yoga TM allows us to find new ways to promote complete healing where conventional methods may have fallen short.

At Embody, your physical therapy experience is both personal and profound.

I had always thought of yoga as something like meditation. No time for that. But when an injury sidelined me for several months my physical therapist recommended a yoga session with Rachel. What could I lose?

From the very first yoga session with Rachel, I was hooked. The benefits of yoga became self-evident immediately. I couldn’t believe the physical challenges to which this quiet, calm, easy-going yoga instructor gently pushed me. I couldn’t believe the utter relaxation that followed every session. Soon I was showing my yoga poses and positions to friends and co-workers, and getting them into sessions with Rachel, all of whom were likewise amazed by the benefits of Rachel’s instructions.

Rachel is not only a great yoga instructor, but a certified Thai massage therapist as well. Depending on a student’s physical condition Rachel may mix different yoga styles with certain Thai message techniques. Rachel tailors each session to the particular needs of her clients.

I leave every session with Rachel both invigorated and relaxed, ready to take on the world!

Douglas W. Grinnell – Epsten Grinnell & Howell, APC

Our studio boasts a 12 station Yoga Wall ™, the only of its kind in San Diego, for spinal traction and deepening your practice.

We accept most insurance plans and are in network with Tricare, Blue Shield of California and Medicare.

Contact Us for a free consultation today!

Rachel  is a member of the International Association of Yoga Therapists (IAYT), Yoga Alliance and the Yoga Education Society (Y.E.S).  Rachel is a regular contributor to www.active.com and has been published in LA Yoga and San Diego Dance Magazine.