Causes of chronic back pain and the truth about healing

How do you speak to your body? Do your conscious thoughts toward your body match your unconscious thoughts? Every time you get a compliment and reply, "Thanks," is your body able to absorb that positive attention, or does your inner dialogue feed negative talk into the tissues and cells of your body?

I haven't written since August because, quite frankly, I was swimming through so much personal change, pain, and ultimately, growth, that I wasn't sure I'd be able to keep my head up. But here I am, fully breathing and more full of life and love than ever. Why? Because I'm starting to actually pay attention to the conscious and subconscious thoughts that fill my mind and body.

A couple weekends ago, I was blessed with the opportunity to participate in a weekend workshop with Aadil Palkhivala, founder of Purna Yoga. Aadil has studied back injury, pain and dysfunction for over 30 years, much of that time with B.K.S. Iyengar. I, obviously, was very interested in what he had to share with the group. I have been practicing his low back series and hip series almost daily for over four months now, and while they help me to feel better in the short term, the spinal dysfunction I have been experiencing hadn't gone away. Aadil showed us exercises to relieve back pain and open the hips and heart, but his main message was this (paraphrasing):

Chronic back pain is an emotional issue, not a physical one. Until you deal with emotional causes of the trauma, you will not heal, no matter how many physical therapists you see and how diligently you perform your exercises. The exercises are a band aid; the real healing work must be done with the mind and the emotions.

Well, . . . crap, I thought. It's one thing to make time for exercises, yoga and physical therapy appointments. It's another issue entirely to dive into the dark recesses of my mind and figure out what I've stored there. I could only imagine that behind the pain symptoms must lay more emotional pain. As I've said before, the truth about healing is that it's painful, both physical and emotionally. Aadil continued (again, I'm paraphrasing):

To simplify for our purposes, we have two main types of muscles, striated and smooth.

Striated muscle are those large muscles close to the skin, like the biceps and quadriceps. We can contract and relax these muscles with our will. Smooth muscles are deep within the body, like the muscles around the vertebral column. These muscles cannot be contracted or relaxed at will; they only respond to subconscious thought. The two main subconscious thoughts that cause our smooth muscles to contract are fear or insecurity, and a feeling of uncontrollability.

Further, these muscles are incredibly strong. Aadil treated a patient recovering from two shattered vertebrae. When Aadil asked how the vertebrae became shattered, the man replied, "I had a seizure, and my muscles crushed them."

After two and a half days of thinking about my unconscious mind, and being instructed to look inside and ask, "Why am I here? What is my purpose? What am I afraid of?", I was ready to retreat into a cocoon of mystery novels and T.V. romance dramas. But as luck would have it, I wasn't afforded that luxury and instead went to work gathering equipment and food for a retreat I was holding in Sequoia National Forest (more on the retreat later). In the frenzied days that followed, by back tightened more, making walking, sitting, and even sleeping risky activities. But as soon as we reached the healing cover of the forest trees, I put on my happy face, introduced myself to a group of eager clients and got on with the retreat.

In between my retreat activities, I had time and a safe space to look inside and start to notice the underlying chatter in my head. And not just the chatter, but also the tendencies of my mind. I started noticing fear-driven patterns of thought, and continued to monitor when those arose and why. One evening, after a particularly trying day, I laid in child's pose to try to release my spasming low back muscles. For the first few inhales, I guided my breath and mind into the tight area and took a look around, as if to familiarize myself with it, and on exhale retreated, leaving just parts of my energy there, as if I was asking for permission to be friends with the muscle. Next, my inhales focused on gentle questions: What are you holding on to? Will you let me help you to release it? And my exhales worked to release energy and relax the muscle. During this process, a friend put two fingers on the muscle very gently, which allowed me to better tune into the location and feel another level of the muscle's stress.

I continued talking to the muscle in this way, like a small child, and letting go every exhale. Somewhere in the process, I was overwhelmed by an intense sadness that released from the area, but I continued to breath even as the tears came. After about 15 minutes of this process, the muscle released. My hips reached my heels for the first time in several months, and I slept better that night in my tent than I had in ages.

The muscle have stayed relaxed, with my breath and my coaxing, for over two weeks, which is where I am now, building a relationship with my body that is built on love and trust rather than fear or will. Through the breath -- which truly is the bridge between body and mind -- I'll continue to build a relationship with the muscles, bones, and systems that support me, peeling back layers of pain and fear, and teaching my mind to have a loving relationship with my body.

What are you cultivating?

A few weeks ago, I was lucky enough to spend three afternoons with Robert Birnberg, yoga teacher and scholar of yoga texts. Robert taught me many things during his lectures, but something that really stuck with me was about joy. We are all seeking to have more sustained joy in our lives. In fact, we do everything that we do because we believe it will bring us more sustained joy. Yoga can do many things for us, but above all, it should bring us joy. How many times do you find yourself caught up in the alignment of the posture, or the tone of the instructor's voice, or the smell of the person next to you rather than paying attention to what you're cultivating throughout your yoga practice?

Most of us tend to rush through our lives with little regard for what affect our actions are having on our well being. We eat breakfast in our car, or at our computer along with our morning emails. We rush from one meeting or client to the next, scheduling friends and family into our calendars so that we remember to save time for them. Then we rush from dinner to yoga class, speeding through a vinyasa flow, and finally bring home a dinner prepared by someone else in a hurry. From there, we may eat in front of the television, exhausted from rushing and too revved up from the pace of the day to enjoy our food or those we're eating with.

Where is the joy?

These things may bring a sense of accomplishment, true; or create a standard to which we hold ourselves to daily. I have often based my sense of worth around how efficient I was in dealing with my day--how many tasks I accomplished, how many appointments I squeezed in, and how many postures I could fit into my asana practice. The problem with this type of standard, especially in yoga, is that it is not sustainable in the long run. The yoga sutras tell us that one important aspect of a yoga practice is that it is sustainable. How long can we expect to keep our hurried pace? Five years? Ten or Twenty? And when we realize that we can no longer go as fast, as long or as hard, how will we measure our self worth?

We live in a fast-paced world; we can't find a time machine back to 1950 or "the good old days," nor am I saying that we should. But we can learn to slow down enough to pay attention. We can take the time between or even during our activities--or in yoga, in our postures--to figure out and understand what we're cultivating in each activity, meeting, or obligation. If we start to notice that all we're cultivating at work is stress or boredom, then we may want to reevaluate our career choice and use yoga tools to find the confidence we need to make a change. If we notice that all we are cultivating in our yoga practice is the same frantic pace of the day, we may we need a different yoga class, a better instructor, or, most probably, to look at ourselves more deeply to try to understand why we can't find rest, healing or joy from our yoga.

Try this with your next yoga practice: Sit or stand quietly and let your mind settle on your breath. When the mind feels calm, think of something that brings you joy. You'll know you have the right thing because you'll have a big, sappy smile on your face. Don't judge what brings you joy--it could be a loved one, chocolate, watching your dog play, whatever. Feel the joy radiate from your heart center, and use your ujjayi breath to move the feeling into the rest of your body, until it's radiating from your core into every space of your body and even out into your aura. Begin your asana practice with this feeling in the body. Several times throughout your practice, come to stillness for just a moment with the hands at heart center: Feel the joy. Come back to the feeling of joy several times, and again at the end of your practice.

You can use this exercise with other emotions or states of being you would like to have more of, such as abundance, healing, love and compassion. Next time you step on your yoga mat, as yourself: "What am I cultivating?"

Twisted

Two weeks ago, I started working with an additional physical therapist, one who works with the mechanics of the spine. While her fingers were placed along the bony protrusions of the sacrum and vertabrae (the spinous processes) I stood and sat, arched and slouched. Diagnosis one: My pelvis is twisted to the left.

No kidding?!?!! That was interesting to learn and even more interesting to realize that I hadn't noticed it before. I had always had a much easier time twisting my torso to the left than to the right, which makes sense because when the pelvis is turned toward the left, it increases the range of motion in that direction. Twisting my torso to the right (to set up for Parsva Bakasana, for example) has always been more challenging. But range of motion wasn't the only place I could experience my twisted pelvis: when I stand with my toes on the same line, my right thigh is about 3/4 of an inch in front of my left thigh.

If that wasn't strange enough, let's move up the spine. The sacrum joins the pelvis at the sacroiliac joint. So while the sacrum may sometimes feel like a solid, unmoving protrusion of the pelvis, it is actually a joint that can tilt in four different directions: anterior right, anterior left, posterior right, posterior left. Because of the twist in the pelvis, my sacrum was twisted back the other way and anterior. When I stood with my feet hips-distance apart, toes lined up, and rolled my spine forward into a forward bend, my torso would get about half way to my toes and then sharply veer to the left. Talk about party tricks.

To reverse the twist in the pelvis, I started working to strengthen my right piriformis muscle (the muscle stretched in half-pigeon pose). When I went back a week later, my pelvis was still twisted, but my sacrum was now twisted anterior in the other direction. Which means that my sacrum is hyper mobile. Imagine someone with hyper mobile elbows or knees for example -- when they straighten their arm or leg all the way, it starts to bend the other direction (hyper extension; sometimes called double jointed). This, in a nut-shell, is hyper mobility, and all hyper mobility can put a lot of strain on the joint in question.

So what is the answer? Well, as yoga teaches, the answer is balance. When a very flexible person does yoga asanas, their challenge is to find their strength. For example, I've seen people with flexible backs and shoulders dumping into their armpits or shoulders during downward facing dog. Instead, they should try to create a long, straight spine, keep the ribs tucked into the body and find the strength in the core, shoulders, and legs. I've also seen students who are very flexible in the hips. During a lunge, it's easier for them to collapse into the hips, but rather, they should find the strength in the legs and lower abdomen by keeping the back thigh lifted and uddiyana bandha pulled in. For people with a hyper-mobile sacrum, like me, I have to learn to not compensate in my low back for areas in my body that are tight. For example, my shoulders are tight. When I raise my arms overhead in tadasana, I can't bring them all the way overhead while keeping my shoulders away from my ears . . . unless I arch my back and stick out my front ribs to compensate. I'm learning not to do that and like movements anymore.

I'm learning through my injury that, just as some people follow the idea of a perfect body or a perfect life, I had been following the idea of a perfect posture, one that mimicked pictures in the books. What I've learned is that my body is not ready for all versions of all postures, and that there is no such thing as one perfect posture. A better posture is one that is appropriate for the student and her or his body on that day. As the practice grows, so will the student and her or his body. As we say in yoga, practice makes practice. Practice doesn't, in yoga, make perfect.

Yoga and my girl parts: the great debate

I'll never forget that bitter-sweet day when my body decided it was time to step over the threshold into womanhood. It was Thanksgiving weekend, and I was at my grandmother's house with my 30-odd cousins and 18 aunts and uncles. I was thirteen. I'd had an awful, cramping stomachache most of the day. That evening, I was wrestling on the living room floor with my cousins and and realized that something down there didn't feel right. Later that night, I told my mom. She gave me a handful of plastic and said, "Welcome to the real world."

That was 1994. I was taught by my mother and the other women around me to treat my time of the month as an inconvenience to be recognized but hidden; it was not something to keep me out of my activities or hinder my involvement in sports. In fact, as I grew older and began participating in male-dominated sports, I came to think of my accomplishments while on my cycle as making me a super-woman. Hell, I thought, if I can keep up with these eight men post-holing up a mountain to ski down while on my period, what can't I do? My period was like my chance each month to do a little more, just to prove to myself that it wasn't anything that could hold me back.

So it's no surprise that when I read yoga text after text explaining the rules of yoga while menstruating -- rules that limit what postures are appropriate, especially invertions -- I regarded the information as outdated, anti-feminist and insulting. I never followed the guidelines. Many yoga teachers and western doctors would back me up on this -- why take women back centuries because of something they can't control? One of my yoga instructors has spoken to several physicians about this issue and came to the conclusion that there is no medical reason for women to stop doing inversions during their cycle if they feel good.

However, because of the hormones associated with menstruation, several researchers are noticing a pattern in the timing of injuries in women. Several European researchers have found that women may injure themselves more frequently at certain times during their menstrual cycle. During menstruation, the female body does change, largely due to increased hormones in the body. At the most basic level, these hormones can soften and weaken muscles and ligaments, especially around joints, a process which prepares the body for potential pregnancy. During this time, a woman's body may be more prone to injury. Most noticably, studies found more ACL tears (a ligiment surrounding the knee) during this time.

So what is right for your body and your practice? It's up for each woman to decide for herself. I am not the type of instructor to ask menstruating women not to turn upside down in class, because I prefer inverted poses during my cycle. However, I believe that the decision requires an honest assessment of how a woman is feeling. So often in our culture, women feel pressured to perform in sports at a rate equal to men. But during a woman's cycle, her body is physically different from a man's, with differences in hormones that could make her more prone to injury. Having a relationship with your body to assess your physical well-being, each day, is important.

Usually, I feel okay during my period. I still crave my handstands, but can't hold them for as long. My shoulders want to roll in instead of out, and my structure feels a bit wobbly. This month, I was completely wiped out on day one of my cycle. I was able to teach through my cramps, and took a gentle, Happy Back class that felt okay until I strapped up a yoga wall harness that pressed against my cramping belly. By three o'clock in the afternoon, I was spent. Instead of mowing the yard and cleaning the house as planned, I took an assessment of what my body needed and instead decided on a hot bath and nap. The water soothed my aching joints, low back and cramping belly, and when my head hit the pillow, I fell instantly to sleep.

Life at 75 Percent: Fighting the Ego

Ah, glorious inversions! I just came home from a fabulous weekend of practicing and practice-teaching inversions with my new, beautiful group of yoga teacher trainers. It's been less than a month since I started my 300 hour, professional teacher training through YogaWorks and Prana Yoga Center in La Jolla, and I am loving every minute of it. Well, almost. The group is wonderfully small, inquisitive, open and compassionate and I feel so fortunate to be working with these beautiful individuals. The YogaWorks instructors have been fantastic -- full of energy and information, and excited to help us learn how to be better teachers. The only problem I've been having is with myself -- finding my limits and practicing ahimsa, or non-violence, with my practice.

I am so grateful to be working with a physical therapist who intimately understands yoga (check out www.embodyyogatherapy.com). Additionally, she seems to understand exactly the type of person I am, including my tendency to push my body just over its limits -- time and time again. I asked her directly this week what my limits should be. I knew we'd be practicing inversions this weekend and I really wanted to get upside down, but safely. I She said, "Anna, first of all, don't do anything that hurts or feels uncomfortable. Second, do everything at 75% of what you would normally do. So if your brain tells you that you can do five handstands, do three. If you think you can hold for another five breaths, hold for three." Basically, override the ambitious part of the ego and have compassion with my healing body.

Ironically, the lead instructor and I were dealing with the same struggle. I'm trying to safely recover from injury, and she was pregnant. She wanted to demonstrate and do each inversion, and so did I, but both of us had to rein in the ego, look at the larger picture, and find compassion.

I did it. I mean, I practiced at 75%. Or I thought I did. I'm feeling a little compression and discomfort in my low back; not pain, just discomfort. But I did less, and that feels like a good start. Next time, I think I'll take it down to 60% of what I think I can do.

This weekend I learned a lot of really helpful and solid information about how to teach inversions safely. I learned how to tell if a student isn't ready for certain inversions and why, and how to work with that student to become ready. I learned new ways of spotting students upside down and a fantastic line of preparatory poses to build strength and courage before an inversion.

But the biggest thing I learned this weekend was something that our instructor said when we were in meditation: our yoga practice is meant to heal, invigorate, and relax us. It is not meant to harm us. When we are working past the edge, or moving incorrectly, or not listening to the body, we are not practicing yoga anymore. Yoga is a union of mind, body and spirit. If we are injuring ourselves, or no longer incorporating ahimsa in our practice, we are not doing ourselves any good. Yoga is meant to be a lifestyle; that is, something that we can practice our entire lives. If we can't figure out how to listen to the body now, how will we safely practice into old age?

When the body is healing, do less. What I've come to realize is that even if my ego is as strong as ever, my body is not as strong right now. That's okay. If I take it one day at a time, at 60 to 75% of normal, then slowly, my strength will build and I will find the healing aspect of yoga and be able to practice past my 60th and even 75th birthdays.

Revitilization

It's been a long time since I've written. And not because I didn't have plenty to say, but I decided to follow the old saying, "If you can't say something nice, don't say anything at all." It wasn't that I had a mouthful of hateful words to spout, but more that I've been in such a personal transition that nothing made sense, even to myself. So, I guess more appropriately, I was following, "If you can't say anything that makes any sense, don't bother moving your tongue (or typing the keys)."

This transition has been difficult and sat at times, and inspiring and energizing at others. This "transition" I'm speaking about has several components; an injury (or re-injury); a shift in my teaching schedule; a desire to teach, practice, and understand yoga differently than I have been; and a bucket of new yoga information. And while I said this has been sometimes difficult, I also realize that the transition has been divinely inspired; each shift or piece of new information presented itself at the perfect time, whether I realized it at the time or not. All of it I created through manifestations, even the uncomfortable pieces, as a way to teach myself the lessons I want to learn and to grow into what I want to become.

For the next few days, I'll fill you in on what I've been learning the past month, starting with how injury has effected me. For the rest of the month, I'll keep you posted the new, incredible journey I'm taking. I hope you'll stick around.

Yoga is Everywhere

I've written before about hidden limits or boundaries that we attach to ourselves. Some of these limits are helpful, like the limit that says, "I shouldn't walk across a street that contains a moving vehicle." Other limits are not so helpful, and these limits are often times invisible to us.

I recently uncovered a limit that I had in my space. This limit said that the only yoga asana that I should practice was a rigorous type of Astanga or vinyasa that gave my body a noticeable workout. Last July, when an injury occurred on my body, I didn't try any types of more gentle yoga to increase healing. Instead, I went out of the yoga world and into the medical world until I was ready to jump back into a vinyasa class. Today I realize that in doing that, I missed out on so many of benefits that yoga has to offer.

This time, I am not going outside of yoga to heal. I was recently inspired to attend a Happy Back Class at Prana Yoga in La Jolla. It was fabulous! Not only was is safe for people with injury, it focused on common postures (we worked mostly standing asanas for that class) and how specifically to use the leg and belly muscles to release the back and keep it free in the posture. The class included aid from the yoga wall with straps to hold onto in standing postures, and a sling to hang from in downward facing dog and child's pose. Hanging in traction is one of my new favorite things! I've been trying to stretch my back like that for months without having the physical ability to do it; with the wall, it's easy! And as for thinking I wouldn't get enough exercise -- my legs are so sore! Our instructor's mantra to us was that we have strong legs that can hold us up; our back doesn't have to do all that work. I realized that I had been stabilizing my postures with a tailbone tuck that caused clenching in the glutes and the back; learning to stabilize myself only with my legs and low belly was very challenging, and left me more sore than I have been in months!

I am so inspired. My ego is embarrassed that I let myself go so long believing that vinyasa was the only type of yoga for me. I fully admit that I was so wrong. Today, I am taking the Happy Back Class again because I want to learn more. I want to learn how to have a practice free of pain and discomfort and free from putting my back at risk through poor alignment and weakness. I'm also taking a restorative class this evening that will focus on spinal alignment and deep relaxation. As I look towards these different and varying types of yoga, I am inspired and excited to learn as much as I can. I've realized in the past few weeks that although I love vinyasa, it's not for everyone all the time. There are people with chronic injury or recovering injury who need yoga also, and I want to be an instructor who can tailor a practice to help those people recover, to take the worry or panic from their mind, and show them, like I was shown Wednesday, that they are strong and they can train their body in a healthy way.

Namaste.