A Long-Term Prevention Strategy

Once Christopher Morey was a little farther down the road to recovery, he booked a few private lessons with Roger Eischens, a yoga instructor from Madison, Wisconsin, who helped him refine his yoga postures with an eye toward long-term prevention of problems. Eischens, who has extensive training in Iyengar yoga, found that despite Morey’s tremendous flexibility he had subtle muscular imbalances between his left and right side that were predisposing him to back problems. In Morey’s case, the imbalance had to do with the way he used his shins, but Eischens stresses that the underlying problems vary from patient to patient and require a skilled eye to diagnose. He recommends trying to find a yoga teacher or yoga therapist with years of experience.

Eischens says his approach is to “start away from the problem.” In the case of lower back pain, he begins by looking the feet and the shoulder blades to see if misalignment and the failure to use muscles in some areas are leading to strain in others. He was able to adjust Morey’s yoga postures to “stimulate under-stimulated muscles” in his legs and trunk.

Galen Cranz, an Alexander Technique teacher and Professor at the University of California at Berkeley, believes if we are going to avoid back problems we also “must focus on changing the unconscious habits of daily life.” People often assume a C-shaped slump of their backs when they sit, for example, without any awareness of doing so. Cranz whose own spinal curvature (scoliosis) sparked her interest in the Alexander technique believes it to be “the greatest single system for treating biomechanical problems.”

Like yoga, the Alexander technique can be used both to get over an acute episode of back pain and to prevent problems in the future. Its comprehensive analysis of posture and movement allows you to not only sit and stand better but “to brush your teeth and open doors in better ways.” Cranz, who has also studied Iyengar yoga believes the benefits of the two systems can be synergistic.

Much back pain, of course, can be traced to sedentary lifestyles. A lack of exercise leads to deconditioning of both back and abdominal muscles which support the spine. Regular aerobic exercise--particularly less traumatic activities like walking, biking and swimming--and exercises aimed specifically at strengthening the abdominal muscles such as stomach cruches are known to decrease the likelihood of developing back strain. Poor lifting technique can also cause problems. Sitting itself puts enormous strain on the lumbar spine, particularly if one sits in the slumped posture so typical of modern life.

Cranz, who is also the author of The Chair: Rethinking Culture, Body, and Design, thinks that most chairs are poorly designed for spinal health--particularly for women under five foot six inches. She suggests sitting, whenever possible, with the feet flat on the floor and the sit bones (the bony prominence in each buttocks) higher than the knees. This position allows the lumbar spine to maintain its normal, healthy inward curve. Ideally the angle between the legs and the trunk should be around 120 degrees but anything greater than 90 degrees is helpful. People whose jobs provide chairs that don’t accommodate this can try placing a large book or a thin cushion on the seat of the chair to raise the level of the hips and another book on the floor if their feet don’t reach the ground. Or she suggests scooting forward to perch on the edge of the chair keeping your spine straight and a healthy angle at the hip (this may not sound inviting but is a surprisingly comfortable position).

Ergonomically designed chairs may not solve the problem, however, if they are so comfortable that we don’t move once we’re in them. “There’s no such thing as one perfect posture,” Cranz maintains. Frequent changes of position are natural and healthy. She suggests that workers take frequent breaks and set up their offices that they have to get up to file or answer the phone. If you’re at home or your workplace allows it, try sitting on the floor for a while. For spinal health, Cranz also recommends once a day spending 15 minutes lying on your back with your knees bent, feet flat on the floor and head supported on a book or folded blanket.

It may also be helpful to look at emotional factors. Recent studies have found that job stress and life dissatisfaction both increase the risk of developing back pain. Some authorities, notably Dr. John Sarno, the author of Healing Back Pain: The Mind-Body Connection, believe that almost all back pain has emotional causes. While Sarno has focused on something other conventional doctors have ignored, some experts worry that blaming everything on emotions is too simplistic. Eischens, for one, advises to “be leery of anyone who tells you just to straighten out your emotions.” You’ve got to look at your body too.

Christopher Morey continues to do yoga daily to keep his back strong and supple and it’s really paid off. Not only has he had no problems from the herniated disk but his usual low back pain is completely gone. Now two years after narrowly escaping back surgery, Morey is even able to chop wood without any discomfort. “Back pain is a manifestation of an imbalance in the body,” he says. “Whether you get surgery or not, you’ve still got that imbalance. And you’ve got to take steps to address it.”

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