Back Injury Basics

For YOGABODY Teachers & Students

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 Agenda
• Identify the most-common back problems
• Learn what your students (and maybe you) might be dealing with
• Familiarize yourself with back pain and back care terminology
• Understand the risks and rewards of any healing protocol
• Take an honest look at the role of yoga and yoga teaching in the context of
injury

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 Why this Matters
• In just about every class you teach, someone has a back problem
• If not now, you and your students will likely have a back problem at some
point—it’s just a part of life
• There is a true lack of solutions for people in pain
• Most back pain is sub-clinical, meaning no one knows what’s going on, so
students often turn to things like yoga for answers
• Yoga can be an amazing part of a healing protocol for people with back
problems

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 Common Conditions
• Disc Herniation
• Spondylosis
• Spondylolysis
• Spondylolisthesis
• Spinal Stenosis
• Facet Syndrome
• Lordosis / Kyphosis
• Scoliosis
• Tumor, Infections, Disease
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 Disc Herniation
• More of a squish or bulge, but often referred to as a
“slipped disc”
• Disc protrusion is often present before the herniation
• What happens: anulus fibrosus is damaged and the
nucleus pulposus squishes out
• Continuous pain is common
• Might irritate a nerve and radiate
• Could even cause bowel and bladder incontinence if
certain nerves are affected

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 Basic Terminology (makes it easier)
• Spondylo = spine
• Osis = pathalogical condition
• Lysis = break
• Listhesis = slippage
• Spondylosis = generation term for degradation of spine
• Spondylolysis = fracture or break in at pars interarticularis (part of joint)
• Spondylolisthesis = slippage of a vertebra (usually anterior movement)

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 Spondylosis
• This is spinal osteoarthritis (wear and tear conditions)
• Can affect: facet joints, nerves, vertebral bodies
• Caused by: years of constant abnormal pressure, poor posture,
movements dysfunctions, or just getting older
• What happens: degeneration of discs, tear or fracture of disc, nerve
irritation, narrowing of disc space, calcification of soft tissues, spurring
from abnormal pressure

NOTE: spondylosis is extremely common and can be a-symptomatic

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 Spondylolysis
• Bony defect or fracture within the pars
interarticularis
• Typically caused by a stress fracture of the
Facet Joints bone
• Common in adolescents who over-train
• Most common in lumbar region
Sacrum
• Treatment include: surgery, bracing, physical
therapy, or nothing at all
• Can progress to stenosis or spondylolisthesis

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 Spondylolisthesis
• Slipped vertebra
• Forward displacement of vertebra usually in
lumbar region or cervical spine—rare in the
thoracic
• Common Causes: fracture, accident, trauma
• Less Common Causes: birth defect, tumor,
infection
• Body will often try to self-fuse by calcifying
ligaments
• Fusion surgery might be needed

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 Spinal Stenosis
• Spinal canal narrowing, various causes
• Cervical and lumbar spine most-commonly
affected
• Often age related due to wear and tear
• Many causes: ligament thickening, bone spur,
bulging disc, facet joint problem, compression
fracture, cysts
• NOTE: can (but rarely) be caused by genetically
small vertebral canal

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 Facet Syndrome
• Usually in cervical or lumbar at the joints where
vertebrae meet
• Often off-center pain (one side), often worse with
spinal extension
• Causes: capsule tissue get stretched/deformed or
degenerated with age, overuse, whiplash, etc
• Can lead to spondylosis or other problems

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 Lordosis
• Exaggerated lumbar curve
• Can be congenital
• Other causes: heeled shoes, posture, movement patterns
• Makes students more susceptible to problems, but often
a-symptomatic
• Will likely affect yoga practice
• a.k.a. “Dancer’s Back” or “Sway Back”

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 Kyphosis
• Exaggerated cervical and/or thoracic curve
• Can be congenital
• Other causes: Vit D deficiency, injury, illness
• Makes students more susceptible to problems, but
often a-symptomatic
• Will likely affect yoga practice
• Cobb Angle Test used to diagnose with a degree of
severity assigned
• a.k.a. “Text Neck”

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 Scoliosis
• Spine has a sideways curve
• Structural Scoliosis: spine is truly deformed
• Functional Scoliosis: spine is being pulled/pushed into
deformation
• Genetics 38%, environment 62%1
• 3% of population has some scoliosis, women more than
men
• Treatment: braces, surgery, physical therapy, none at all
• Cobb Angle Test used to diagnose with a degree of
severity assigned

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 Radiculopathy
• Radiculopathy = radiating pain
• Nerve-related injury to the spine
• Often the result of another spinal injury that is impacting the nerve
• Often includes compression of a nerve root usually at the exit foramen
• Can coupled with one or more other spinal injuries / conditions
• Symptoms include: pain, weakness, tingling, inability to control certain
parts of the body
• a.k.a. “Nerve Pain” or “Radiating Nerve Pain”

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 Nervous System Role in Back Pain
• Almost all back injuries can irritate nerves
• Radiating pain is often a sign of an
impinged nerve
• Causes: disc digentation, narrowing of
vertebral column, bone spurs, movement
of vertebrae, joint inflammation, and many
other causes

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 Common Medical Solutions
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Steroid injections (cortisone shot)
• Muscle relaxants
• Strange ones: anti-depressants, anti-seizure drugs,
opioids
• Physical Therapy
• Acupuncture, chiropractic care, other bodywork
• Yoga
• Surgery
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 NSAIDs Side Effects
• Cardiovascular problems
• Gastrointestinal bleeding
• Ulcers
• Kidney problems
• Increased blood pressure
• Dulling of your nervous system (antithesis of yoga)
• 100K hospitalizations, 16.5K deaths2
• The Worst: they inhibit cartilage and ligament
production
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 Steroid Injections
• Corticosteroid: often people will say, “I got a cortisone shot.”
• Relieves pain
• Deteriorates cartilage and bone
• Weakens the connective tissues (ligaments) supporting the structure
• “Steroids injections don’t work for everyone and repeated steroid
injections can weaken bones and connective tissues.” – Mayo Clinic

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 How the Spine is Examined
• Most common: not at all
• X-Ray: good for bones/factures, not good for soft tissue view
• CT or CAT (computed tomography): more complete view of soft tissues,
but still not great at seeing discs
• MRI (magnetic resonance imaging): best option for looking at soft tissues,
but can be too pricey (even with insurance) so often not done
• Challenges: most people don’t get an MRI, and when people get x-ray or
CT scans, they are often laying down giving us just one view of the spine

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 Surgery Facts
• Over half a million spinal surgeries in USA alone

• Hundreds of billions of dollars in expenses

internationally

• Post-operation complications are extremely

common

• Failure rate can be as high as 80%

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 Why Surgery is So Common
• Insurance might cover surgery but not therapy
• People often go to a surgeon for back pain advice—the surgeon is
extremely likely to recommend surgery
• Much of main stream back care is about pain removal—this is very
different than rehabilitation or a return to full function
• Many people are unwilling or unable to put in the time to rehabilitate
their body—a quick fix is preferred

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 Common Surgeries
• Diskectomy: part (or all) of a disc are removed
• Spinal Fusion: just as it sounds, vertabrae are fused together
• Laminectomy: surgeon removes part of the lamina to make more room in
the spinal canal
• Foraminotomy: surgical widening of the foramen to make more room for
nerve to pass
• Disc Replacement: removal of natural disc, replaced with prosthetic
• Interlaminar Implant: u-shaped insert that forces space between two
vertebrae

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 Biomechanical Problems Need
Biomechanical Solution
• Strength
• Flexibility
• Balance
• Nutrition
• Yoga, Pilates, Physical Therapy, Smart
Movement

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 Natural Anti-Inflammatory Options
• Omega-3: 1-3 grams daily

• Curcumin: turmeric extract

• Vitamin D: take 2,000-5,000 IU’s / day

• Bromelain: fresh pineapple or pure

food supplement

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 Important to Consider…
• Many back injuries are years in the making
• There is no “right” or “wrong” way to lift objects, just safer and more
stable ways
• Any number of conditions can aggravate the nerves of the spine, this is
often the source of pain
• Back pain could be completely physical (car accident) or completely
mental (stress related)
• Many times, back problems are multi-factorial

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 Injuries to the Spine
• Quadriplegia: All four limbs lose sensation and movement. Usually results
from injury at T1 or above. Quadriplegia also affects the chest muscles and
injuries at C4 or above might require a breathing machine.

• Paraplegia: Loss of sensation and movement in the lower half of the body.
It usually happens as a result of injuries at T1 or below.

• Triplegia: Loss of sensation and movement in 3 limbs, often the results

from incomplete spinal cord injuries (SCI)

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 Common Yoga Injuries
• L4/L5/S1 injuries of all types: extension or flexion combined with a twist is
the greatest risk and/or extension or flexion with poor alignment

• SI Joint Injuries: same as above

• Cervical Spine: rare, but often happen with the use of a wall for
headstand, over-practice in headstand, or with teacher assists made with
the head and neck

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 Common Slang that Confuses
• Slipped disc: could actually be nearly any back condition
• Spondy: could be spondylosis, spondylolysis or spondylolisthesis, very
different conditions
• Pinched Nerve: could be bone-related, muscle-related, or even disc
related
• Threw Out My Back: could mean absolutely anything from nothing to
severe injury
• Muscle Pain: student might just be sore (muscles) for new movements

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 What Happened? Simplified…
• Weakness: poor posterior chain muscles leave spine “on its own” rather
than supported

• Lack of Mobility: tight hip flexors, hamstrings, back, and core muscles
(among others) can lead to irregular torque on the spine

• Muscle Imbalance: over or underdeveloped asymmetrical muscles can

lead to torque on one side

• Injury: snowboard fall, lifting a box, twisting and compressing, etc

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 Practical Stuff
• Don’t physical adjust students in shoulder stand
• Don’t let students use the wall for any headstand variations
• When helping a student in headstand, use “hot potato” hands
• Never physically adjust the head or neck—just don’t
• Help students get out of their lower back and extend their thoracic in
backbends
• Make everyone fill out a waiver of liability before joining class
• On the new student form, ask everyone if they have medical conditions
you should know about

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 What Yoga Can & Cannot Do
• Don’t suggest (or attempt) to treat,
diagnose or cure anyone’s back problem

• Yoga is awesome, we don’t need to make

exaggerated health claims

• Yoga can be the movement, mindfulness

and stress-reducing part

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 Next Steps
• Read and review this lesson multiple times
• Get familiar with the common conditions so
you’ll recognize them
• Become familiar with the common surgeries
so you understand what your students have
experienced
• Always refer to health care professionals
• Be conservative, careful, and cautious
• Focus on: strength, flexibility, balance

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©Yoga Teachers College – All Rights Reserved