The Point Of This Article Is That Physical Therapy Yoga And Pilates Will Work Better If Strong Ligaments In The Spine Are Present To Provide The Resistance Necessary To Achieve Gains
In this video, Ross Hauser, MD explains and demonstrates a Prolotherapy treatment into the lumbar spine.
Video Summary and Learning Points
- Prolotherapy is multiple injections of simple dextrose into the damaged spinal area.
- Each injection goes down to the bone, where the ligaments meet the bone at the fibro-osseous junction. It is at this junction we want to stimulate repair of the ligament attachment to the bone.
The treatment begins at 1:35
Yoga Can Be Best Effective When The Spinal Ligaments Are Strong If Spinal Instability Is The Problem Yoga Will Not Be Successful For Very Many Patients
January 2017, a study lead by the University of Maryland published in The Cochrane Database of Systematic Reviews.
The authors concluded:
- “There is low- to moderate-certainty evidence that yoga compared to non-exercise controls results in small to moderate improvements in back-related function at three and six months.” .
- “Yoga may also be slightly more effective for pain at three and six months, however, the effect size did not meet predefined levels of minimum clinical importance.” (Confirming again if spinal instability is the problem, yoga will not be successful for very many patients.
- “It is uncertain whether there is any difference between yoga and other exercises for back-related function or pain, or whether yoga added to exercise is more effective than exercise alone.” .
- “Yoga is associated with more adverse events than non-exercise controls, but may have the same risk of adverse events as other back-focused exercises.” .
The Popular Understanding Of Back Pain Is Disc Herniation As A Frequent Cause But To A Much Greater Extent Ligament Injury Forms The Underlying Basis
Caring Medical research: Our paper “A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain,” published in the journal Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders made these observations supported by accompanying citations:
- In approximately 90% of patients, low back pain is mechanical in nature, typically originating from overuse, straining, lifting, or bending that results in ligament sprains, muscle pulls, or disk herniation.
- The popular understanding of back pain is disc herniation as a frequent cause, but to a much greater extent, ligament injury forms the underlying basis.
- Ligaments hold the disc in place, and with ligament weakness, the disc is more likely to herniate.
- Low back pain patients who remain symptomatic despite tailored physiotherapy are believed to possess deficient ligament strength in the rear elements of the sacroiliac joint, resulting in insufficient stability to permit effective muscle recruiting strategies.
Pilates Works When There Are Strong Ligaments Pilates Will Not Help When Ligament Instability Prevents Muscles From Getting Needed Resistance
Pilates is an exercise program that concentrates on the deep stabilizer muscles of the core. Pilates, like physical therapy, like core stabilizing exercises, can only work when the ligaments of the spine can support the exercise activity and provide resistance so the muscles strengthen.
It is very rare to see research that says one form of exercise works and another does not. They either all work or they all don’t work. Studies supporting one form of exercise over another support this idea.
Here is the last paragraph from an August 2017 study in the Journal of Exercise Rehabilitation:
“On the basis of the present study it can be concluded that lumbar stabilization exercise, dynamic strengthening exercise, and Pilates are beneficial in the treatment of chronic nonspecific low back pain for reduction of pain, improvement in functional ability, increase range of motion and improve core strength.
However, when compared, lumbar stabilization proved to be a more effective form of exercise than Pilates and dynamic strengthening for chronic low back pain.”
They all worked. One a little better than the others in this one group.
Yoga Works When There Are Strong Ligaments Yoga Will Not Help When Ligament Instability Prevents Muscles From Getting Needed Resistance
Some patients with lower back pain have seen great results with yoga. Some patients have seen poor, none, or worse, results that caused greater injury to the low back. Why do some get benefits and others didn’t? How do some hurt themselves worse? The answer is ligaments.
Let’s first paint a picture by way of a comparison between yoga and physical therapy and the ligament problem.
- If ligament damage and weakness are the problems, a patient trying yoga and physical therapy will find in most cases, neither will help.
- If the patient’s ligaments are still strong enough and can provide the spinal and core muscles resistance, the spine will be stable enough for yoga and physical therapy to work and provide great relief.
Research that was published in the July 2017 edition of the Annals of Internal Medicine helps us shed some light on realistic expectations for Yoga and Physical Therapy.
Coming from some of the best research universities in the United States, doctors from Boston University School of Medicine, Harvard Medical School, the University of Pittsburgh School of Health and Rehabilitation Sciences, and the University of Washington found:
The portions of the above in quotations come from the Annals of Internal Medicine, patient information recap of the study.
Theres No Substitute For Getting To Know Your Own Body In Order To Take Control Of Your Own Health
If low back pain impedes your daily activities , by all means, seek help. Enlist the services of a medical provider or physical therapist who can give you an outside perspective and offer to help as best they know how. But, as every expert in their own respective field agreed, you’re in charge of taking care of you. If you’re invited to a HIIT class after work and you know burpees or running on a treadmill hurt your back, don’t go. If you know that sitting every day is only making low back pain worse, change your schedule so you can get up more. Make choices that get you out of that forward-folding, hip-flexed, hunched position.
“We’re sitting all the time – in planes, cars, at our desks,” Bomkamp said. “Our glutes are weak, our hip flexors are tight, it’s changing our pelvic position.”
And if weakness and instability is a major cause of low back pain, then we have to be smart about our workouts to strengthen and stabilize the muscles that are weak. That’s not to say that yoga is bad for your back, but you have to know what kind of injury you’re dealing with so you can decide which poses in yoga are going to help you get stronger in the ways you need. If you have that knowledge, you can pay attention to those poses and make them the primary focus of your workout.
Ultimately, you’re the boss of your own health.
For Your Best Yoga Practice First Fix The Structural Issue With Chiropractic Care
Remember the old motto on cereal boxes and TV ads? Such-and-such Cereal: Part of this complete nutritious breakfast!
Well, yoga really can be part of your complete healthcare plan… IF you also get a modest amount of exercises, eat well, and see a good Gonstead chiropractor to resolve the alignment issues that are most likely causing your back pain in the first place.
Above all, a Gonstead chiropractor will help you identify the of your pain. Additionally, he or she can recommend stretches and yoga positions that will help ease the tension, bring relief, and help you heal the right way. So if you want to kick pain for good and get back to living the life you want, do yoga the right way and visit the right chiropractor.
How Long Does It Take To Heal Lower Back Pain With Yoga My Personal Timeline
Just like most things in life that are worth having, it is going to take a lot of hard work and persistence to find relief from your chronic low back pain. Yoga is not a quick fix for your pain, but it is the most natural way to relieve lower back pain. Starting a regular yoga practice will slowly release years of aches and pains caused by any number of conditions in your body and is proven to heal chronic lower back pain overtime. So how long does it take to heal lower back pain with yoga?
Physical Therapy Will Not Make Gains Without Strengthened Repaired Ligaments
- Except for the lower back, muscles do little to stabilize the joints since their job is to move the joints.
- Large muscles are necessary for the lower back due to the enormous forces that are transmitted to support the body’s weight; thus, the core musculature is an important part of maintaining spinal stability, but is not the most important part—strong ligaments are.
- Ligament laxity is what causes spinal instability throughout the spine and neck, and Prolotherapy treatment for back pain is the primary treatment for restoring spinal stability, with core strengthening exercise playing a secondary role.
- An injury to one section of the spine affects other sections but the action of the erector spinae muscles is also a contributing factor. The vertebral joints in the spine are very close together and when one is loose, it causes increased forces on the next vertebral level, as well as a contraction of the erector spinae muscle, which then pulls on the vulnerable segment, causing it to become unstable as well.
- To be curative, the treatment for chronic diffuse spinal pain must be a comprehensive regimen of tightening all the “screws” on all the loose “hinges”. This is why Prolotherapy to the spine can involve multiple areas and many injections. If you do not comprehensively treat all the loose ligaments with Prolotherapy, the pain will likely recur.
There Are Still Controversies About The Effects Of Yoga At Different Follow
A September 2020 analysis of published research built on this theme of why yoga did not help some patients. Publishing in the journal Public Library of Science One, researchers gave this analysis of the benefits of yoga and why some do not get the benefits. Here are the learning points of this analysis:
- “Chronic low back pain is a common and often disabling musculoskeletal condition. Yoga has been proven to be an effective therapy for chronic low back pain. However, there are still controversies about the effects of yoga at different follow-up periods and compared with other physical therapy exercises.”
- This study evaluated the effects of yoga for patients with chronic low back pain on pain, disability, and quality of life.
- Yoga could significantly reduce pain at 4 to 8 weeks, 3 months, 6 to 7 months and was not significant in 12 months compared with non-exercise.
- Yoga was better than non-exercise on disability at 4 to 8 weeks, 3 months, 6 months, 12 months.
- There was no significant difference on pain, disability compared with the physical therapy exercise group. Furthermore, it suggested that there was a non-significant difference in physical and mental quality of life between yoga and any other interventions.
Back Mechanic: Yoga And Stretching Can Make Back Pain Worse Some Times
Posted November 5, 2016
As you would expect, we serve many people at our clinic with lower back pain. Many come with a history of sitting too much and not getting enough exercise. But ironically, just as many, maybe even more, despite or because of extensive and consistent strength training and/or stretching, complain of low back pain and intolerance to sitting. Why is this?
There can be many reasons. Here is one typical problem we see where regular stretching is not therapeutic and can make things worse. There is a natural curve in the lumbar region of the spine . When our back is in this normal curved state it is called the “neutral position”. Many modern jobs demand people sit all day causing the lower back to be chronically and excessively bent forward in an “unnatural way”, out of neutral position. Also, some physical jobs demand a person to bend forward for long periods of time or in repeated lifting sequences. This can cause the lower back to be over-loaded in a “flexed” or bent forward position. Many with back pain regularly stretch their back muscles routinely at work, at home or in yoga classes, because it feels great and relieves the pain. But, If you are doing this type of back flexion stretching, it may be re-stressing your already over-loaded and over-sensitive vertebral discs and joints.
- Gord gives an acupuncture treatment to Kari and answers her questions
- cupping and massage and really help your connective tissue
- ATP clients share their turning point stories
What Are We Seeing In This Image The Complexity Of The Back Muscles
This illustration reveals the complexity of the back muscles. Back muscles and core muscles are a primary focus of physical therapy. Spinal instability, caused by spinal ligament laxity can cause vertebrae to move out of their natural positions and cause bulging and herniation. Even a single maligned vertebrae can impact and cause dysfunction throughout the spine and core muscle groups. This will make physical therapy ineffective.
Make Sure You Are Entering Into The Poses Correctly To Avoid Injury
Find your bookmarks in your Independent Premium section, under my profile
In addition to relaxation, a yoga class can provide various health benefits such as increased flexibility and strength – but only when the poses are done correctly.
The popular workout can cause more harm than good if you don’t know what you are doing – a risk that is commonly overlooked as you transition from pose to pose.
To educate yogis on the various injuries that can occur while doing yoga and how to avoid them, chiropractor Michael C Remy outlined the five most injury-prone positions.
An Upward Forward Bend Releases Tight Hamstring And Back Muscles
Sometimes called a forward fold, the upward forward bend stretches the hamstrings and back muscles while providing a release for tight, tense shoulders.
Try it: Stand straight with feet shoulder-width apart and your knees loose, not locked. While you exhale, hinge at your waist and bend forward, reaching toward the floor. Don’t worry if you can’t reach all the way to the floor at first; just stop wherever your hamstrings feel a comfortable stretch. Repeat the pose five to seven times. On the last bend hold the position for 5 to 10 breaths.
How Can You Incorporate Cobra Pose Into Your Yoga Practice
Cobra pose is probably most often practiced as part of Sun Salutations , where you transition from Plank pose into Bhujangasana and, subsequently, into Downward-Facing Dog . It can also be practiced as an alternative to Upward-Facing Dog in further Sun Salutation variations.
Cobra can be an alternative to Upward-Facing Dog. Try it in Melayne and Cameron Shayne’s Budokon Yoga.
If you’re new to yoga, approach this asana by opting for the low Cobra variation, also called Baby Cobra, since this requires less flexibility in the spine, while the high Cobra option is appropriate for more advanced students.
You can also practice Sphinx pose as an easier variation of Cobra pose.
However, you should always take it slowly and never push your body into a deeper backbend. In case you feel discomfort or even pain in your back or neck, lift your chest only as high as you can without feeling pain.
If your spine is very stiff, or if you’re pregnant, try practicing Cobra pose standing up rather than on the floor. Face a wall in front of you and place your hands against the wall. Hug your elbows into your rig cage. As you start pressing against the wall, apply the same alignment as described above, i.e. keep your elbows slightly bent and bring the bottom sides of your shoulder blades together. Then lift your collar bones up and forward.
Learn how to do Cobra pose with Desirée Rumbaugh and Andrew Rivin’s Transformational Home Practice on TINT.
Triangle Pose Lengthens Torso Muscles To Build Strength
Triangle pose is great for strengthening the back and legs and can help lengthen your muscles along the sides of your torso while stretching the muscle fibers along your outer hip .
Try it: Start standing straight with your feet together. Next, lunge your left foot back three to four feet, and point your left foot out at a 45-degree angle. Turn your chest to the side and open up the pose by stretching your right arm toward the ground and the left arm toward the ceiling, keeping both your right and left legs straight. You may not be able to touch the ground with your right arm at first, so don’t overstretch — only bend as far as you can while maintaining a straight back. Hold the position for 5 to 10 breaths, then switch to the other side, and repeat as needed.
These Poses Could Make You Put Down The Pain Relievers
Achy back? Give yoga a go. Numerous studies have shown the power of the ancient practice, which emphasizes stretching, strength, and flexibility, to relieve back soreness and improve function.
According to research published in July 2017 in the Annals of Internal Medicine, yoga may even help reduce the need for pain medication. At the start of the three-month study, in which one group was assigned to physical therapy for their back pain, a second to yoga, and a third to reading about pain management strategies, 70 percent of the subjects were taking medication. By the end, however, while the number of people taking medication in the reading group stayed the same, only 50 percent of the yoga and physical therapy subjects were still taking it.
Researchers are also starting to discover how yoga’s effects on the brain may contribute to decreased pain. In a study conducted by the National Institutes of Health and published in May 2015 in Frontiers in Human Neuroscience, scientists found that there were significant differences between the brains of those with chronic pain and the brains of regular yoga practitioners. Those with chronic pain had less of the kind of brain tissue in the regions that help us tolerate pain, but those who did yoga had more — which suggests that yoga may be not just physically but neurologically protective.
Without Strong Ligaments Physical Therapy Cannot Work
The entire content of this article is nicely summed up in these few words. “insufficient stability to permit effective muscle recruiting strategies.” Without the ligaments, physical therapy cannot work.
The next bullet point, from the same research, gives the solution:
- Experimental studies have found Prolotherapy effective in stimulating the production of collagen fibers, thus strengthening ligaments.
In a separate study we published in the Journal of Prolotherapy, we published these findings:
- We looked at 145 patients, who had been in pain an average of four years and ten months, and were treated quarterly with dextrose Prolotherapy.
- This included a subset of 55 patients who were told by their medical doctor that there were no other treatment options for their pain and a subset of 26 patients who were told by their doctor that surgery was their only option.
- Patients were contacted an average of 12 months following their last Prolotherapy session and asked questions regarding their levels of pain, physical and psychological symptoms, and activities of daily living, before and after their last Prolotherapy treatment.
- In these 145 low backs, 89% experienced more than 50% pain relief with Prolotherapy;
- more than 80% showed improvements in walking and exercise ability, anxiety, depression, and overall disability;
- 75% percent were able to completely stop taking pain medications.
These patients were treated every three months on average.
Use Caution With These Poses When You Have Back Pain
Some poses can give you relief if done right. When you attempt the below, good form is imperative.
Above all, if you have lower back pain, it’s important to do downward dog correctly . If the spine is not stable during downward dog, hip and lower back pain are practically guaranteed. A herniated disc is even possible. Spine stability in this pose means the spinal column is neutral – not arched, not rounded. Straight. Don’t shrug your shoulders, and keep your head and neck neutral.
In a basic forward bend, the temptation is to touch the floor at all costs, but a round back is a back at risk. Starting in mountain pose, keep your back straight as you hinge forward, and keep your pelvis level with the floor.
Triangle pose can feel amazing… if it’s really a triangle. If you look like the letter C or a squirrel trying to hide a nut in its own tail, you’re going to hurt yourself. To achieve the correct geometry, first get your front foot facing forward, parallel with the long edges of the mat. Your back foot should be perpendicular to the front foot, and in a straight line heel-to-arch. Hips, pelvis, and core should be parallel to the ground. Your neck should be in a straight line with your spinal column and needs to be steady.
Another position that’s easy to overdo is camel pose. Make sure your shoulders and neck are gently stretched before moving into the pose, and don’t let your neck collapse as you tilt backwards.
Child’s Pose Elongates Your Back And Relieves Stress
It may look like you’re resting, but Child’s pose is an active stretch that helps elongate the back. It’s also a great de-stressor before bed at the end of a long, exhausting day.
Try it: Start on all fours with your arms stretched out straight in front of you, then sit back so your glutes come to rest just above — but not touching — your heels. Hold the position for 5 to 10 breaths, and repeat as many times as needed for a good, soothing stretch.
The Difference Between A Good And Great Chiropractor
I believed that I’d be pain-free for the rest of my life. I took all of his advice, and after about 2 months, my lower back pain returned. I became depressed. Motta had told me that a lot of chiropractors don’t know what they’re doing, and said not see one. But now that I was in pain again, I needed help.
I tried physical therapy, and it reduced my pain, but didn’t get rid of it.
I had visited probably 10 different chiropractors in my lifetime and had only been impressed with one . The others seemed to be good, but never made a big difference in how I felt.
I asked around for recommendations for a good chiropractor, and my wife had heard about Dr. Rose in Ann Arbor Michigan. I went to see him, expecting to do the normal evaluations of x-rays, standing with both feet on two different scales to see how I balanced my weight, my health history, etc. Usually, there’s 1 evaluation that takes 45 minutes or so.
With Dr. Rose, we had 4 sessions that were an hour to an hour and a half! In addition to all of the normal protocols, he had me move my head, arms, and torso to find out the limits of my range of motion in several planes, and where I felt pain, and how much pain I felt during each movement.
He asked me what I do for my job, and I showed him some of the movements I do in Jiu-Jitsu. He asked how I lift weights, how I stretch, and how I work on my computer.
Build Your Yoga For Lower Back Pain Routine Safely
Even if the practice of yoga is ancient, research on the benefits of yoga for lower back pain is still in its infancy. Because of this, it is important to begin your practice under the supervision of your doctor and with a qualified yoga teacher.
Yoga teachers are not regulated in the U.S., but teachers registered with the Yoga Alliance as either RYT-200 or RYT-500 have met a standard set of rigorous training guidelines. An “E” indicates that they are experienced teachers, and most Yoga Alliance-certified teachers also list any specialties they may hold .
Start slowly, and again, listen to your body. Some soreness after activity is to be expected with any new exercise program, but sharp, stabbing or shooting pain is an indication that something is not right. Approaching yoga for lower back pain in a gentle, restorative way can help you learn to find relief from pain while improving your flexibility and stress levels.
You can start with a few poses each day or find a video or online class that guides you through a sequence of yoga for lower back pain. Whichever works best for you depends on your condition and treatment plan, so talk to your doctor before starting.