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Spinal Movements: How to Keep Your Spine Safe

09:49 | Labels: safety, Shari Ser, spine, spine anatomy

by Shari

We recently received this query from a reader about contraindications for spinal movements:

When are extension and flexion of the spine contraindicated. I have a patient who has issues with L5 and L6. I guess extension (backbends) would be contraindicated, correct? Also what about folks who have issues with inter vertebral discs? And what about people who have a hump in the cervical-thoracic region?

These are actually very complex questions but I will try to stay on track here. My previous post All about the Spine gave some background on how the spine changes shape in various movements, including forward bending, back bending, twists, and side bending. Now I like to think about the spine as a train where the head on the neck is the “engine, the subsequent vertebra are the train, and the coccyx is the “caboose.”

All these separate vertebrae are connected to each other by numerous ligamentous attachments. Anterior is a long ligament that runs down the front of the vertebrae from C1-S1 and posterior is long ligament that runs down the back portion of the vertebrae. This sandwiches the vertebrae so they don’t slide forward or backward in relation to the individual top- and bottom-connecting vertebra. There are also many other types of connecting ligaments between different portions of the spine. Again, the function of all the ligaments is to keep the spine stable, and to allow coordination of movement but not too much movement at specific vertebral levels!

Anterior and Posterior Long Ligaments of the Spine

Now the interesting thing about ligaments is that they don’t have much stretch to them. In fact they don’t really stretch at all because they are stabilizing structures. What that means is that they limit movement in the spine. This is a good thing since the spine houses the spinal cord.We really don’t want to tug or pinch our spinal cord because it is the main power house that connects our brain literally to our bones and muscles and allows us to move when and how we want to.

Between each vertebra sits a cartilaginous structure called an intervertebral disc that is connected to both the top and bottom vertebra. The discs are the shock absorbers of the spine and they absorb the motion at each vertebral level.

Lumbar Vertebrae (L1-L5)

Now lets talk about what happens when there is a problem at a specific vertebral level. We can have “cranky” backs and sometimes it doesn’t take a whole lot to have your back “go out” (actually I dislike this expression because the back isn’t going anywhere so it can’t really go “out”). However, there can be areas of the spine that are more sensitive to movement. The question asks about L5 and L6 specifically. Now there aren’t a whole lot of people who actually do have an L6. Typically we only have 5 lumbar vertebrae (L1-L5), and L5 is often injured or fragile in a lot of people from different causes.

When there is a specific vertebral level that is injured, it is important to understand what the actual injury is because then you can understand how to take care of it.

There are specific spinal conditions where forward and backward bends should specifically avoided, including recent spinal surgeries, recent or acute disc injuries, or any acute injury where pain is a true warning sign not to proceed. For spinal instabilities like spondylolisthesis back bends should be avoided, and if you have facet arthritis of the spine in lower back or neck, backbends may aggregate this kind of arthritis pain. Also, with rheumatoid arthritis and other conditions where ligaments are adversely affected, all yoga postures will need modifications to avoid over stressing ligamentous attachments.

But specific level vertebral injuries can be challenging because you can’t just stop that area from moving Movement allows the intervertebral discs to get nutrition and hydration. When the spine is prevented from moving whether from medical intervention (like surgery) or wearing a rigid brace to prevent movement, sometimes the injured area heals but due to immobility a lot of other areas of the body aren’t very happy. When there is a disc injury, allowing some flexion and extension is encouraged but the issue is the degree of motion. So what you can do is to learn how to move without causing further injury.

When I say it is important to learn how to move, what I mean is that often when people do forward- or back-bending asanas, the movement isn’t well distributed along the spine and certain areas take more of the movement in an unhealthy way. When vertebrae are stiff or there is a particular loss of motion in one area, another corresponding adjacent area will move more to correct the motion loss. This isn’t a conscious action but the body learns how to make due with what happens. So if the L5 doesn’t move well then the vertebra above it, L4, will begin to move more to compensate for the loss of movement at L5, and S1 (the top of the sacrum) will also move more than it should to also compensate. This motion loss can occur anywhere along the spine, though certain areas are more predisposed to motion changes and this is how problems develop.

But in situation described by the reader (issues with L5 and L6), should the student practice forward and back bends? Well, there isn’t really a simple answer. Remember, the spine needs to move. So, the answer is yes, but with careful attention to form and detail. I like to think about making the movement long and soft, not short and tight. There is always a quality of “work” in every active asana, but the key is how much work is safe? There should never be sharp point of specific pain and there should never be asymmetrical pain.

Now the last part of the question, about the hump in the cervical/thoracic region, In a previous post Kyphosis (Dowager's Hump), Baxter described several causes for this rounding of the upper back. While it is sometimes caused by a structural issue like scoliosis or osteoporosis, other times rounding of the upper back is due to long-standing postural habits and a long life of sitting at a desk working with the head in a down position. At a certain point the individual may no longer be able to correct the curvature by standing up straight. In these instances, where there is no actual medical contraindication, then gentle passive backbends are a wonderful approach to the upper back rounding.

A passive backbend over a bolster or blanket roll (lying on your back with your knees bent using a bolster or a blanket roll perpendicular to the torso) to help change the upper back curve is beneficial as long as the neck and lower back are protected so they don’t arch too aggressively. Also, learning to relax as well as stretch the diaphragm are also helpful, which you can do with a gentle Cobra pose or supported Upward Bow (Urdhva Dhanurasana) with a chair. Another very accessible backbend for the upper back is Supported Bridge pose (setu Bandha Sarvangasana on low blankets (one for torso and one for legs, with or without a belt tied around the legs).

Ultimately, to keep healthy, your spine needs to move daily through a full range of motion. Our daily lives limit our motion dramatically, so this is where your yoga practice plays a powerful role in spinal health. With attention to your breath, intention of non aggression in your practice, and a healthy dose of common sense we can encourage our spines to move safely in our practice. Then the key is to take these skills back into our daily lives to encourage more healthy motion.

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All About the Spine: Anatomy and Movements

08:19 | Labels: anatomy, extension of spine, flexion of spine, safety, Shari Ser, spine anatomy

by Shari

Recently in my classes and private sessions I have been receiving a lot of questions about the spine and exactly how it moves in different yoga poses. I thought I would do a blog post to summarize basic spinal anatomy and what the yoga practitioner needs to consider when practicing. I believe it is important for us to learn about spinal movements so we can begin to understand why one movement feels good to do while another movement either hurts or just doesn’t “go anywhere.” Many of our teachers are very skilled in the instructions they give us, but, for me, I always think that it is important to understand the why (I have never been very good about blindly following orders).

Let’s start with the anatomy of the spine. The spine is composed of separate vertebrae, which are separated into five regions of the spine. The cervical spine is the neck area and there are seven cervical vertebrae. The thoracic region is the area that begins at the level of the collarbones (clavicle) and extends all the way down to the waist. The thoracic vertebrae connect to the ribs, and there are 12 thoracic vertebrae and 12 paired ribs. The lumbar region begins at the bottom of the rib cage and extends into the pelvis. There are five lumbar vertebrae and the last vertebra sits on top of the sacrum. The sacrum consists of five vertebrae fused into a single bone (the five are initially un-fused at birth, but begin to fuse in our late teens). It is joined on each side to the pelvis and sits deep to the pelvic basin. At the bottom of the sacrum, we find the coccyx, which is composed of three vestigial vertebrae—our “tail” of bygone days.

It is important when learning about the spine to view it from multiple angles, including sideways, front facing and back facing. When you view it from these three angles, you can begin to appreciate the beauty and complexity of the spine. Some of the things that you may notice immediately when looking at pictures or, better yet, a three-dimensional model, of the human spine is that the various regions look different. The cervical vertebrae are petite and small in size, the thoracic vertebrae are bigger, with longer and more angled spinous processes, and the lumbar vertebrae are much more massive and substantial.

Also, it is apparent that the spine is not a rod but has four basic curves. The cervical region curves inward (concave), the thoracic spine curves outward (convex), the lumbar spine curves inward (concave), and the sacral region curves outward (convex). The shape of the spinal curves are important for transferring the load/weight. Maintaining those curves with weight-bearing forces keeps the spine healthy with minimal deterioration of joint surfaces. The cue that we sometimes hear in yoga class to keep our spine “straight” is a misnomer, because naturally the spine is curved! We don’t want to take the curves away but we do want to balance where the movement occurs.

Another point to consider is that the shape of the spine will change when we move through a range of motion in our daily lives as well as in our asana practice. Whenever we sit, stand, walk, reach, lie down, and so on, we are changing spinal position. Sometimes the adjustments are small and imperceptible, and other times they are much more global. Going from sitting to standing changes the spinal curves in small degrees, while going into a deep forward bend or backbend changes the curves more dramatically. The muscles that attach to the spine are forever working to keep the spine stable in whatever position we are in.

There are four specific movements that the spine moves through. When we bend forward and curve the spine (reversing the lordosis of the cervical and lumbar region and exaggerating the curve of the thoracic region) this is called flexion. We cause spinal flexion in forward bends whether in a chair or seated on the floor. The degree of forward bend is generally limited by our leg and back flexibility. Some very common forward bends that require different degrees of flexion could be Seated Forward Bend (Paschimottanasana) and Plow pose (Halasana), which you could think of as an upside down from of Seated Forward Bend.

Why do I say there are different degrees of flexion? Well, for someone who is very tight in their legs or in their back muscles, just the act of sitting in Staff pose (Dandasana) with a lift under their pelvis is very challenging. Their natural inclination might be to sit in a rounded back or flexed spine position to start and then when they bend forward even more this becomes an unhealthy forward bend because there isn’t good distribution of the change in the spinal curve.

For the tighter student, learning to sit with their spine in neutral curves is the way to begin practice for spinal safety. The student who has a lot of flexibility in their hamstrings may have tight back muscles so when they bend forward there is no change in their spinal curves—both examples are extremes.

The key to healthy forward bends, whether in Paschimotanasana or Halasana, is for there to be “ease” in the bend. The same principles apply to standing forward bends like Pyramid pose (Parsvottanasana). Props like chairs, bolsters, and blocks allow you to find the shape of the pose without the struggle of getting into a pose you aren’t ready for.

The opposite of flexion is extension. In extension, the curves of the cervical and lumbar region are deepened and the curve in the thoracic region is lessened. We extend our spines in classic backbends like Upward Bow pose (Urdva Danurasana) Upward-Facing Dog pose (Urdva Mukha Svanasana), and Camel pose (Ustrasana).

Of course, our spines can also twist, as when we turn to look behind us in a car. We twist our spines in seated twists, such Bhajrajasana, or Marichyasana, and in standing poses, such as Triangle pose (Trikonasana) and Revolved Triangle pose (Parivrtta Trikonasana). And in certain poses we combine both flexion and twisting as in Parivrtta Janu Sirsasana. Poses with both extension and twisting are less common, but one example is the One-Legged Downward-Facing Dog pose with a twist.

Finally, we can side bend, as when we reach down to pick up something like a handbag or grocery bag that is next to our foot. We side bend our spines in side-bending yoga poses, such as Gate pose (Parighasana). And in many poses we combine both side bending and twisting, such as in Triangle pose (Trikonasana) and and Revolved One-Legged Forward Bend (Parivrtta Janu Sirsanana). Generally, we don't purely side bend without some twisting or purely twist without some side bending, though the primary movement will look like side bending or rotation.

The key concept to protecting your spine in all your poses is understanding where we want to encourage the movement and how to distribute the movement so as not to cause excessive motion at one vertebral level. Another key concept is to avoid using momentum to push through “resistance.” When we are overly aggressive in attempting to gain motion this is where injury will surely occur.

So let’s break down this concept of spinal motion a bit more. If we understand that different parts of our spine move more in certain movements, does this mean that certain asanas will affect different parts of the spine differently? Yes, absolutely! The cervical and lumbar regions are concave when the spine is at rest. When we move into a backbend, these areas become more concave in relation to the curve reversal of the thoracic region. Because the thoracic region is stabilized from the front (anteriorly) by the rib cage and from the back (posteriorly) by the long spinous process, there is relatively less curve reversal from convex to concave in this region. As we move into a forward bend, the rounding of the thoracic curve increases into more of a convex shape. The opposite occurs in the cervical and lumbar spines; they start in relative concavity and as the forward bend moves throughout the spine, their shape changes from concave to relatively convex.

In twists, it is important to encourage full spinal involvement, but also to understand that the majority of the twist will occur in the cervical region, followed by the thoracic region and lastly the lumbar region. There is very limited rotation of the lumbar vertebra due to their specific structural construction. Also, please try to avoid allowing your spine to round or flex whenever doing twists. The key to healthy twists is to keep the spine long, with a good conscious control of maintaining the curves as you twist. This is often erroneously called keeping the spine “straight”, but now you know better when you hear this cue from a teacher!

When you practice, try to picture how your spine changes shape from the starting position into the position of the asana and then back to starting position. This is your experiential anatomy lesson of flexion (forward bending) and extension (backward bending), and twists.

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Spinal Movements: How to Keep Your Spine Safe

All About the Spine: Anatomy and Movements