How an Active Dad with Slip-Disc Condition, Low-back Pain and Sciatica Avoided Surgery
- Created on Sunday, 01 October 2006 11:06
A 58 years old building contractor finds himself in chronic back pain and constant leg pain. When an osteopath recommends him to undergo a surgery to alleviate the unbearable pain, he decides to go to a yoga instructor instead. His individual yoga practice is divided into three parts; asanas for Lower Back Strength , Core-Strength (Ilio-Psoas), Hamstring stretches, and Poses to bring relief to Sciatica.
The following is the story of Rob, a 58 year old, active dad and building contractor whose busy life is very physical both with his construction work and his skiing, biking, and soccer playing activities. Fifteen years ago, Rob was diligent in attending my weekly yoga classes and it “helped his aches and pains” mostly in his lower back he said, due to his construction job. He was a consistent student for about two years. Then life got too busy for Rob to continue the yoga classes weekly. His home practice was minimal and soon dropped off altogether as his sports activities increased and his physically demanding construction company grew.
Suddenly 2 years ago, he found himself in chronic and excruciating back pain and constant leg pain. It was unbearably painful for him to walk, sit, and even stand, let alone to move vigorously. He could not work or enjoy his sports activities. He went to see a respected osteopath in San Francisco who took X-rays of Rob’s spine. The diagnosis was Spondylosis – or ‘wear-and-tear’ on the discs causing degeneration and shrinkage, Slip Disc Condition in his lumbar vertebrae, and Sciatica, nerve compression in the major Sciatic nerve and referred pain down through the path of the nerves in his legs. The osteopathic physician recommended surgery immediately. His prognosis was to surgically “fuse” Rob’s lumbar vertebrae to his sacrum thereby stabilizing the lower vertebral column and removing the herniated intervertebral disc pressing on roots of the nerves of the lower limbs; and then - hope for a loss of pain due to lack of compression on the Sciatic nerve. Side effects, however, were reduced range of movement in the hip flexors, thigh extension, and knee flexors. Rob envisioned a life limited to very little movement, no more sports, and possibly a career change. The idea of surgically fused lumbar to sacrum was more terrifying to Rob than seeking alternate methods and so he explored further.
He asked his physician to recommend physical therapy before succumbing to surgery. A physical therapist worked with Rob for approximately 6 months. Gentle exercises to stretch the piriformis muscle, deep inside the buttocks, were given with a few inefficient hamstring stretches. The physical therapist only had a half-hour period with Rob monthly, and then sent him off to work on the exercises at home. Rob began to feel a bit better and wanted to explore more options and a deeper approach to stretching and releasing the pain. That’s when he came to see me – about a year and a half ago, and asked to have a private yoga session. “I remember how good I felt when I was taking the weekly yoga class”, he said. “I’d like to feel pain-free again without surgery.”
I asked Rob to bring his X-rays and we looked at them closely. By this time, Rob was very aware of what was going on in his lower spine and knew that he had to stretch his back and build up his Core Strength. This was a good starting point. This is the stage of analysis according to BKS Iyengar - when we gather all information, X-rays and understanding of the area of concern. Next is to work intelligently and with compassion - to bring awareness - to be fully present with where the pain originates.
My approach to working with Rob was to have him lie down on the floor first, allowing the lower back to lengthen on the floor right at the beginning of his yoga practice. That way, he could feel the lower back spreading wide on the floor and the hamstrings could be more efficiently stretched. We used a belt around his toes as he brought one leg up at a time. Conscious of his tight hamstrings, he only stretched as far as he could keep the knee completely straight (where the hamstrings attach at the back of the knee). He used deep breathing to encourage the hamstrings and lower back to relax. In this floor series, he also brought one leg out to the side to stretch the adductor muscle (inner thighs) as well as the full leg twist – this was painful as the piriformis muscle was rigidly resistant. He remembered that in Yoga, we only go so far as we can receive a comfortably challenging stretch and release; and so he did not push himself but remained aware of slow and deep releases in the tightest places. He breathed a breath of gratitude for each marginal letting go of pain.
Next, he practiced the “P.T.” stretch on the floor (Physical Therapists often recommend this stretch for hip and lower back pain). A simple but effective pose for creating space in the hip joints. It also allows the lower vertebrae to relax and lengthen on the floor. Sure enough, his physical therapist had given him this same exercise to practice. He had at this point already experienced some letting go of the tightness deep inside the buttocks. “I’m beginning to enjoy this” he remarked, as we went through a logical progression of yoga poses.
For building Core Strength, Rob’s practice consisted of standing in Tadasana and squeezing a sandbag placed in between his inner thighs to bring awareness to the sartorius muscles. These muscles when engaged helped Rob to stabilize the pelvis and lift his lumbar up out of the pelvis more freely. A series of modified standing forward bends (or more correctly, lengthening of the spine at the same time hip flexing,) followed to bring more awareness to the positioning of the pelvis, broadening of the lower back and hamstring muscles.
Strengthening the lower back in inversion against the pull of gravity formed the apex of the practice for Rob. He remembered well the ‘Half-version of Full Arm Balance’ and we began in Cat Pose and detailed each and every alignment detail in preparation for this powerful asana. Rob used the belt around the elbows to keep the bones of the arms directly bone-over-bone and vertical, and walked up the wall until his back was exactly parallel to the wall, and his legs slightly higher than parallel to the floor (due to hamstring tightness). Exuberance is what he felt as he came down slowly and absorbed the nourishing blood increase to the spinal column and brain.
The deep-in Ilio Psoas muscles were next to being addressed - these muscles are the principal flexors of the thighs and support the vertebral column. They are an extremely important postural set of muscles. Originating at the lower ribs at the front body, they attach along the lumbar spine and travel down vertically and posterior to attach at the head of the femur (thigh bone). A long slow progression of poses to strengthen the Psoas followed with emphasis on the exhalation as the ‘breath of action’. With repetitions, Rob could feel the heat produced in the deep Ilio-Psoas muscles and this brought new awareness to the lower abdomen and back.
Finally, the “prescription pose’ for Sciatica was the ending series in Rob’s practice. A reclining series with Legs up the Wall, (hamstrings), Out – to- the-sides, (adductors) and finally – reclining Baddha Konasana (deep-in rotators) - where the knees are bent out to the sides and heels are pressing equally into each other. Because of the external rotation of the femur head(s) in this pose, the lower back and pelvis relax and spread wide along the floor. Often people suffering from Sciatica find almost instant relief when practicing this reclining Baddha Konasana. I showed Rob a gentle partner stretch (for his wife to assist him) which would allow him to relax completely.
Rob’s individual practice is in 3 parts; asanas for Lower Back Strength , Core-Strength (Ilio-Psoas), Hamstring stretches, and Poses to bring relief to Sciatica. He has consistently practiced his individual series of yoga poses 3-4 times a week for the past 2 years. He no longer needs surgery – the same osteopathic physician has told him his vertebrae and disc health is vastly improved. Rob has virtually no more Sciatica. He is nearly pain-free, but only experiences a bit of fatigue from over–exerting on the job or in sports. His yoga practice always balances out the pain, he says, and he is looking forward to many more years of a fully active life.
To summarize, I believe Mr. Iyengar’s philosophy centers around bringing full self-awareness to the practice of asana. He says that students should be self-aware, not self-conscious. He says also that analysis and intelligence become one in asana practice. In Rob’s case, through analysis then comes understanding. Through understanding comes compassion. Through compassionate self-healing comes freedom and release of pain. With his newfound freedom, Rob gives himself permission to heal himself, little by little.
By Ann Barros, Certified Iyengar Yoga Instructor
Keyword: Health, Jakartadoyoga, Yoga, Yoga Studio, Iyengar, Jakarta, Indonesia