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Sunday, April 17, 2011

Parsvakonasana


(parsh-voh-tahn-AHS-anna)
parsva = side, flank
ut = intense
tan = to stretch or extend (compare the Latin verb tendere, “to stretch or extend”)
Step by Step

Stand in Tadasana . With an exhalation, step or lightly jump your feet 3½ to 4 feet apart. Rest your hands on your hips. Turn your left foot in 45 to 60 degrees to the right and your right foot out to the right 90 degrees. Align the right heel with the left heel. Firm your thighs and turn your right thigh outward, so that the center of the right knee cap is in line with the center of the right ankle.

Exhale and rotate your torso to the right, squaring the front of your pelvis as much as possible with the front edge of your mat. As the left hip point turns forward, press the head of the left femur back to ground the back heel. Press your outer thighs inward, as if squeezing a block between your thighs. Firm your scapulas against your back torso, lengthen your coccyx toward the floor, and arch your upper torso back slightly.

With another exhalation, lean the torso forward from the groins over the right leg. Stop when the torso is parallel to the floor. Press your fingertips to the floor on either side of the right foot. If it isn’t possible for you to touch the floor, support your hands on a pair of blocks or the seat of a folding chair. Press the thighs back and lengthen the torso forward, lifting through the top of the sternum.

In this pose the front-leg hip tends to lift up toward the shoulder and swing out to the side, which shortens the front-leg side. Be sure to soften the front-leg hip toward the earth and away from the same-side shoulder while you continue squeezing the outer thighs. Press the base of the big toe and the inner heel of the front foot firmly into the floor, then lift the inner groin of the front leg deep into the pelvis.

Hold your torso and head parallel to the floor for a few breaths. Then, if you have the flexibility, bring the front torso closer to the top of the thigh, but don’t round forward from the waist to do this. Eventually the long front torso will rest down on the thigh. Hold your maximum position for 15 to 30 seconds, then come up with an inhalation by pressing actively through the back heel and dragging the coccyx first down and then into the pelvis. Then go to the left side.



Anatomical Focus
Brain
Hamstrings
Shoulders
Wrists
Spine

Therapeutic Applications
Flat feet

Benefits
Calms the brain
Stretches the spine, shoulders and wrists (in the full pose), hips, and hamstrings
Strengthens the legs
Stimulates the abdominal organs
Improves posture and sense of balance
Improves digestion

Contraindications and Cautions
If you have a back injury or high blood pressure, avoid the full forward bend; instead do Ardha Parsvottanasana (pronounced are-dah = half). Perform steps 1 and 2 as described above, a couple of feet from and facing a wall. With an exhalation lower your torso parallel to the floor and reach your hands out to the wall. Press your palms actively into the wall (preferably with your elbows fully extended), keeping your front torso longer than your back.


Beginner's Tip

Variations
As mentioned above, the full version of this pose is performed with the hands behind the back in Anjali Mudra, a hand position sometimes called Pristanjali Mudra (prish-TOHN-jolly; prishta = “the back, the rear of anything”), or sometimes Paschima Namaskar (posh-EE-mah nam-AHS-car; pashima = “west”; namaskar = “to greet or salute”).

Stand in Tadasana with the hands in Anjali Mudra in front of the heart. Bend your knees slightly and round your back, hunching your shoulders. Exhale, inwardly rotate your arms and sweep them around behind your back. Press the palms together with the thumbs resting on your sacrum, so the fingers point toward the floor. First turn the wrists so the fingers point toward the sacrum, then continue turning until the fingers point toward your head. Your pinkies will now press against your back torso. Slide your hands up your back, lifting and opening your chest as you do. If you can, position the hands between the scapulas, with the pinkies pressing firmly against the spine. Keep the palms spreading together as much as possible. Roll the front shoulders up and back, and lengthen down from the back armpits through the elbows toward the floor. Now follow the instructions for the pose.


Modifications and Props
If you find your back heel lifting as you bend into this pose, practice with your back heel pressed to a wall. The heel’s contact with the wall will help you keep it grounded. Another way to work with a lifting heel is to raise it on a sandbag.


Partnering
A partner can help you anchor the heads of the thighs, which in turn will help you ground the heels and lengthen the spine. Take the feet apart and turn the torso. Have your partner stand behind you and loop a strap over your groins, just in the creases where the thighs join the pelvis. Then bend forward into the pose. Your partner should pull firmly on the strap, dragging the groins deeper into the pelvis. From this action, press actively into the back heel and lengthen the spine over the front thigh.


Preparatory Poses
Adho Mukha Svanasana
Anjali Mudra
Baddha Konasana
Gomukhasana (especially the arm position)
Prasarita Padottanasana
Supta Baddha Konasana
Uttanasana
Utthita Parsvakonasana
Utthita Trikonasana
Vrksasana

Follow-Up Poses
Parsvottanasana is a good standing pose preparation for seated forward bends and twists. Other follow-ups include:

Dandasana
Pincha Mayurasana
Prasarita Padottanasana
Salabhasana
Salamba Sarvangasana
Salamba Sirsasana
Utkatasana
Virabhadrasana I

Deepen The Pose
There are really two ways to position the torso over the front thigh in this pose. Beginners should align the midline of the torso over the inner side of the front thigh. Advanced students should rotate the torso and bring its midline down over the midline of the front thigh.

Upward Plank or Purvottanasana


Step by Step

Sit in Dandasana (Staff Pose) with your hands several inches behind your hips and your fingers pointing forward. Bend your knees and place your feet on the floor, big toes turned inward, heels at least a foot away from your buttocks.

Exhale, press your inner feet and hands down against the floor, and lift your hips until you come into a reverse tabletop position, torso and thighs approximately parallel to the floor, shins and arms approximately perpendicular.

Without losing the height of your hips, straighten your legs one at a time. Lift your hips still higher without hardening your buttocks. Press your shoulder blades against your back torso to support the lift of your chest.

Without compressing the back of your neck, slowly drop your head back.

Hold for 30 seconds, then sit back down in Dandasana with an exhale.



Anatomical Focus
Wrists

Therapeutic Applications
Fatigue

Benefits
Strengthens the arms, wrists and legs
Stretches the shoulders, chest, and front ankles

Contraindications and Cautions
Wrist injury
With a neck injury, support the head on a wall or chair seat

Beginner's Tip
Practice with a chair support: Sit near the front edge of the seat and wrap your hands around the back edge. Inhale to lift your pelvis, then extend each leg with an inhale.

Preparatory Poses
Gomukhasana (arms only)
Supta Virasana
Setu Bandha Sarvangasana
Dhanurasana

Follow-Up Poses
Paschimottanasana
Adho Mukha Svanasana

Tuesday, April 12, 2011

Stretch and Science

In recent years, biomedical research has begun to investigate and appreciate what yogis have known for centuries: Stretching keeps us limber, youthful, and healthy.
By Fernando Pagés Ruiz

If you're already practicing yoga, you don't need exercise scientists and physiologists to convince you of the benefits of stretching. Instead, you'd probably like them to tell you if there's anything in their flexibility research that can help you go deeper in your asanas. For example, when you fold into a forward bend and are brought up short by the tightness in the back of your legs, can science tell you what's going on? And can that knowledge help you go deeper?

The answer to both questions is "Yes." A knowledge of physiology can help you visualize the inner workings of your body and focus on the specific mechanisms that help you stretch. You can optimize your efforts if you know whether the tightness in your legs is due to poor skeletal alignment, stiff connective tissues, or nerve reflexes designed to keep you from hurting yourself. And if you know whether any uncomfortable sensations you feel are warnings that you're about to do damage, or whether they're just notices that you're entering exciting new territory, you can make an intelligent choice between pushing on or backing off—and avoid injuries.

In addition, new scientific research may even have the potential to extend the wisdom of yoga. If we understand more clearly the complex physiology involved in yogic practices, we may be able refine our techniques for opening our bodies.

Why Stretch?

Of course, yoga does far more than keep us limber. It releases tensions from our bodies and minds, allowing us to drop more deeply into meditation. In yoga, "flexibility" is an attitude that invests and transforms the mind as well as the body.

But in Western, physiological terms, "flexibility" is just the ability to move muscles and joints through their complete range. It's an ability we're born with, but that most of us lose. "Our lives are restricted and sedentary," explains Dr. Thomas Green, a chiropractor in Lincoln, Nebraska, "so our bodies get lazy, muscles atrophy, and our joints settle into a limited range."

Back when we were hunter-gatherers, we got the daily exercise we needed to keep our bodies flexible and healthy. But modern, sedentary life is not the only culprit that constricts muscles and joints. Even if you're active, your body will dehydrate and stiffen with age. By the time you become an adult, your tissues have lost about 15 percent of their moisture content, becoming less supple and more prone to injury. Your muscle fibers have begun to adhere to each other, developing cellular cross-links that prevent parallel fibers from moving independently. Slowly our elastic fibers get bound up with collagenous connective tissue and become more and more unyielding. This normal aging of tissues is distressingly similar to the process that turns animal hides into leather. Unless we stretch, we dry up and tan! Stretching slows this process of dehydration by stimulating the production of tissue lubricants. It pulls the interwoven cellular cross-links apart and helps muscles rebuild with healthy parallel cellular structure.


Remember the cheesy '70s sci-fi flick in which Raquel Welch and her miniaturized submarine crew get injected into someone's bloodstream? To really grasp how Western physiology can benefit asana practice, we need to go on our own internal odyssey, diving deep into the body to examine how muscles work.

Muscles are organs—biological units built from various specialized tissues that are integrated to perform a single function. (Physiologists divide muscles into three types: the smooth muscles of the viscera; the specialized cardiac muscles of the heart; and the striated muscles of the skeleton—but in this article we'll focus only on skeletal muscles, those familiar pulleys that move the bony levers of our bodies.)

The specific function of muscles, of course, is movement which is produced by muscle fibers, bundles of specialized cells that change shape by contracting or relaxing. Muscle groups operate in concert, alternately contracting and stretching in precise, coordinated sequences to produce the wide range of movements of which our bodies are capable.

In skeletal movements, the working muscles—the ones that contract to move your bones—are called the "agonists." The opposing groups of muscles—the ones that must release and elongate to allow movement—are called the "antagonists." Almost every movement of the skeleton involves the coordinated action of agonist and antagonist muscle groups: They're the yang and yin of our movement anatomy.

But although stretching—the lengthening of antagonist muscles—is half the equation in skeletal movement, most exercise physiologists believe that increasing the elasticity of healthy muscle fiber is not an important factor in improving flexibility. According to Michael Alter, author of Science of Flexibility (Human Kinetics, 1998), current research demonstrates that individual muscle fibers can be stretched to approximately 150 percent of their resting length before tearing. This extendibility enables muscles to move through a wide range of motion, sufficient for most stretches—even the most difficult asanas.

If your muscle fibers don't limit your ability to stretch, what does? There are two major schools of scientific thought on what actually most limits flexibility and what should be done to improve it. The first school focuses not on stretching muscle fiber itself but on increasing the elasticity of connective tissues, the cells that bind muscle fibers together, encapsulate them, and network them with other organs; the second addresses the "stretch reflex" and other functions of the autonomic (involuntary) nervous system. Yoga works on both. That's why it's such an effective method for increasing flexibility.

Your Internal Knitting

Connective tissues include a variety of cell groups that specialize in binding our anatomy into a cohesive whole. It is the most abundant tissue in the body, forming an intricate mesh that connects all our body parts and compartmentalizes them into discrete bundles of anatomical structure—bones, muscles, organs, etc. Almost every yoga asana exercises and improves the cellular quality of this varied and vital tissue, which transmits movement and provides our muscles with lubricants and healing agents. But in the study of flexibility we are concerned with only three types of connective tissue: tendons, ligaments, and muscle fascia. Let's explore each of them briefly.Tendons transmit force by connecting bones to muscle. They are relatively stiff. If they weren't, fine motor coordination like playing piano or performing eye surgery would be impossible. While tendons have enormous tensile strength, they have very little tolerance to stretching. Beyond a 4 percent stretch, tendons can tear or lengthen beyond their ability to recoil, leaving us with lax and less responsive muscle-to-bone connections.

Ligaments can safely stretch a bit more than tendons—but not much. Ligaments bind bone to bone inside joint capsules. They play a useful role in limiting flexibility, and it is generally recommended that you avoid stretching them. Stretching ligaments can destabilize joints, compromising their efficiency and increasing your likelihood of injury. That's why you should flex your knees slightly—rather than hyperextending them—in Paschimottanasana (Seated Forward Bend), releasing tension on posterior knee ligaments (and also on the ligaments of the lower spine).

Muscle fascia is the third connective tissue that affects flexibility, and by far the most important. Fascia makes up as much as 30 percent of a muscle's total mass, and, according to studies cited in Science of Flexibility, it accounts for approximately 41 percent of a muscle's total resistance to movement. Fascia is the stuff that separates individual muscle fibers and bundles them into working units, providing structure and transmitting force.

Many of the benefits derived from stretching—joint lubrication, improved healing, better circulation, and enhanced mobility—are related to the healthy stimulation of fascia. Of all the structural components of your body which limit your flexibility, it is the only one that you can stretch safely. Anatomist David Coulter, author of Anatomy of Hatha Yoga, reflects this in his description of the asanas as "a careful tending to your internal knitting."

Now let's apply this physiology lesson to a basic but very powerful posture: Paschimottanasana. We'll begin with the anatomy of the asana.

The name of this pose combines three words: "Paschima," the Sanskrit word for "west"; "uttana," which means "intense stretch"; and "asana," or "posture." Since yogis traditionally practiced facing east toward the sun, "west" refers to the entire back of the human body.

This seated forward bend stretches a muscle chain that begins at the Achilles tendon, extends up the back of the legs and pelvis, then continues up along the spine to end at the base of your head. According to yoga lore, this asana rejuvenates the vertebral column and tones the internal organs, massaging the heart, kidneys, and abdomen.

Imagine you're lying on your back in yoga class, getting ready to fold up and over into Paschimottanasana. Your arms are relatively relaxed, palms on your thighs. Your head is resting comfortably on the floor; your cervical spine is soft, but awake. The instructor asks you to lift your trunk slowly, reaching out through your tailbone and up through the crown of your head, being careful not to overarch and strain your lower back as you move up and forward. She suggests that you picture an imaginary string attached to your chest, gently pulling you out and up—opening anahata chakra, the heart center—as you rotate through the hips into a seated position.

The image your teacher is using is not just poetic, it's also anatomically accurate. The primary muscles at work during this first phase of a forward bend are the rectus abdominis that run along the front of your trunk. Attached to your ribs just below your heart and anchored to your pubic bone, these muscles are the anatomical string that literally pulls you forward from the heart chakra.

The secondary muscles working to pull your torso up run through your pelvis and along the front of your legs: the psoas, linking torso and legs, the quadriceps on the front of your thighs, and the muscles adjacent to your shin bones.

In Paschimottanasana, the muscles running from heart to toe along the front of your body are the agonists. They're the muscles that contract to pull you forward. Along the back of your torso and legs are the opposing, or complementary, groups of muscles, which must elongate and release before you can move forward.

By now, you've stretched forward and settled into the pose completely, backing off slightly from your maximum stretch and breathing deeply and steadily. Your mind focuses on the subtle (or perhaps not so subtle) messages from your body. You feel a pleasant pull along the full length of your hamstrings. Your pelvis is tilted forward, your spinal column is lengthening, and you perceive a gentle increase in the spaces between each of your vertebrae.

Your instructor is quiet now, not pushing you to stretch further but allowing you to go deeper into the posture at your own pace. You're getting to know the posture and getting comfortable with it. Perhaps you even feel like a timelessly serene statue as you hold Paschimottanasana for several minutes.

In this kind of practice, you're maintaining the posture long enough to affect the plastic quality of your connective tissues. Prolonged stretches like this can produce healthful, permanent changes in the quality of the fascia that binds your muscles. Julie Gudmestad, a physical therapist and certified Iyengar instructor, uses prolonged asanas with patients at her clinic in Portland, Oregon. "If they hold the poses for shorter periods, people get a nice sense of release," Gudmestad explains, "but they aren't necessarily going to get the structural changes that add up to a permanent increase in flexibility."

According to Gudmestad, stretches should be held 90 to 120 seconds to change the "ground substance" of connective tissue. Ground substance is the nonfibrous, gel-like binding agent in which fibrous connective tissues like collagen and elastin are embedded. Ground substance stabilizes and lubricates connective tissue. And it is commonly believed that restrictions in this substance can limit flexibility, especially as we age.

By combining precise postural alignment with the use of props, Gudmestad positions her patients to relax into asanas so they can remain long enough to make lasting change. "We make sure people aren't in pain," Gudmestad says, "so they can breathe and hold a stretch longer."

Reciprocal Inhibition

Along with stretching connective tissue, much of the work we do in yoga aims to enlist the neurological mechanisms that allow our muscles to release and extend. One such mechanism is "reciprocal inhibition." Whenever one set of muscles (the agonists) contracts, this built-in feature of the autonomic nervous system causes the opposing muscles (the antagonists) to release. Yogis have been using this mechanism for millennia to facilitate stretching.

To experience reciprocal inhibition firsthand, sit down in front of a table and gently press the edge of your hand, karate-chop style, onto the tabletop. If you touch the back of your upper arm—your triceps muscle—you'll notice that it's firmly engaged. If you touch the opposing muscles, the biceps (the big muscles on the front of your upper arm), they should feel relaxed.

In Paschimottanasana the same mechanism is at play. Your hamstrings are released when you engage their opposing muscle group, the quadriceps.

David Sheer, an orthopedic manual therapist in Nashville, Tennessee, uses the principle of reciprocal inhibition to help patients safely improve their range of motion. If you went to Sheer to improve your hamstring flexibility, he would work the quadriceps, developing strength in the front thigh to help relax the hamstrings. Then, when the hamstrings have achieved their maximum range for the day, Sheer would strengthen them with weight-bearing, isometric, or isotonic exercises.

At the Yoga Room of Nashville, Betty Larson, a certified Iyengar instructor, uses the principles of reciprocal inhibition to help yoga students release their hamstrings in Paschimottanasana.

"I remind my students to contract their quads," says Larson, "lifting up the entire length of the front of the leg, so the back of the leg is loosened." Larson also includes backbends in her classes to strengthen her students' hamstrings and backs. She feels it's extremely important to develop strength in the muscles you are stretching. Like many teachers, Larson is using ancient yogic techniques that apply physiological principles only recently understood by modern science.

According to Sheer, she's doing the right thing. He claims the best type of flexibility combines improved range of motion with improved strength. "It's useful flexibility," says Sheer. "If you only increase your passive flexibility without developing the strength to control it, you make yourself more vulnerable to a serious joint injury."

Let's return to your Paschimottanasana. Imagine that this time, as you pivot from your pelvis and reach your trunk forward, your hamstrings are unusually tight. You can't seem to move as deeply into the pose as you would like, and the harder you try, the tighter your hamstrings feel. Then your instructor reminds you to continue breathing and relax every muscle that's not actively engaged in sustaining the pose.

You give up trying to match your personal best. You relax into the posture, without judgment, and slowly your hamstrings begin to release.

Why are you able to gradually bring your head toward your shins once you stop straining? According to science—and many ancient yogis—what was limiting your flexibility most wasn't your body, it was your mind—or, at least, your nervous system.

The Stretch Reflex

According to physiologists who view the nervous system as the major obstacle to increased flexibility, the key to overcoming one's limitations lies in another built-in feature of our neurology: the stretch reflex. Scientists who study flexibility think that the small, progressive steps that allow us to go a little deeper during the course of one session—and that dramatically improve our flexibility over a life of yoga practice—are in large part the result of retraining this reflex.

To get an understanding of the stretch reflex, picture yourself walking in a winter landscape. Suddenly you step on a patch of ice, and your feet start to splay apart. Immediately your muscles fire into action, tensing to draw your legs back together and regain control. What just happened in your nerves and muscles?

Every muscle fiber has a network of sensors called muscle spindles. They run perpendicular to the muscle fibers, sensing how far and fast the fibers are elongating. As muscle fibers extend, stress on these muscle spindles increases.

When this stress comes too fast, or goes too far, muscle spindles fire an urgent neurological "SOS," activating a reflex loop that triggers an immediate, protective contraction.

That's what happens when the doctor thumps with a small rubber mallet on the tendon just below your kneecap, stretching your quadriceps abruptly. This rapid stretch stimulates the muscle spindles in your quadriceps, signaling the spinal cord. An instant later the neurological loop ends with a brief contraction of your quadriceps, producing the well known "knee jerk reaction."

That's how the stretch reflex protects your muscles. And that's why most experts caution against bouncing while stretching. Bouncing in and out of a stretch causes the rapid stimulation of muscle spindles that triggers reflexive tightening, and can increase your chances of injury.

Slow, static stretching also triggers the stretch reflex, but not as abruptly. When you fold forward into Paschimottanasana, the muscle spindles in your hamstrings begin to call for resistance, producing tension in the very muscles you're trying to extend. That's why improving flexibility through static stretching takes a long time. The improvement comes through slow conditioning of your muscle spindles, training them to tolerate more tension before applying the neuro-brakes.

Proprioceptive Neuromuscular Facilitation...What?

Among the recent developments in Western flexibility training are neurological techniques that retrain the stretch reflex, promoting quick, dramatic gains in flexibility. One of these techniques is called—take a deep breath—proprioceptive neuromuscular facilitation. (Fortunately, it's usually just called PNF).
To apply PNF principles to Paschimottanasana, try this: While bending forward, just short of your maximum stretch, engage your hamstrings in an isometric contraction—as if you were trying to draw your heels down through the floor—lasting approximately five to 10 seconds. Then release this action, and see if you can move a little deeper into the forward bend.

The PNF method manipulates the stretch reflex by having you contract a muscle while it's at near-maximum length. When you engage your hamstrings, you actually ease the pressure on your muscle spindles, and they send signals that it's safe for the muscle to release further. In a seeming paradox, contracting the muscle actually allows it to lengthen. If you engage and then release your muscle fibers in this way, you will probably discover more comfort in a stretch that was near your maximum just seconds before. Now you're ready to open a little more, taking advantage of a momentary lull in neural activity, deepening the stretch. Your nervous system adjusts, affording you greater range of motion.

"PNF is as close as we've come to scientific stretching," physical therapist Michael Leslie says. Leslie uses combinations of modified PNF techniques to help members of the San Francisco Ballet improve their flexibility. "In my experience it can take weeks of static training to achieve the gains possible in one session of PNF," Leslie says.

As of yet, yoga has not focused systematically on PNF-type techniques. But vinyasa practices that emphasize careful sequencing of asanas and/or repetition of asanas—moving in and out of the same posture several times—tend to promote neurological conditioning.

Gray Kraftsow, founder of the American Viniyoga Institute and one of the most highly respected teachers in the Viniyoga lineage of T.K.V. Desikachar, likens Viniyoga to PNF. "Alternating between contracting and stretching is what changes the muscle," Kraftsow says. "Muscles relax and stretch further after contracting."

Prana & Flexibility

Kraftsow also emphasizes the importance of the breath in any kind of neurological work, pointing out that breathing is a link between our consciousness and our autonomic nervous system. "It's this quality of breathing," Kraftsow says, "that qualifies it as a primary tool in any science of self development."

Pranayama, or breath control, is the fourth limb in a yogi's path toward samadhi. One of the most important yogic practices, it helps the yogi gain control over the movement of prana (life energy) throughout the body. But whether viewed through esoteric yoga physiology or the scientific physiology of the West, the connection between relaxation, stretching, and breathing is well established. Physiologists describe this mechanical and neurological correlation of movement and breath as an instance of synkinesis, the involuntary movement of one part of the body that occurs with the movement of another part.

While you are holding Paschimottanasana, breathing deeply and steadily, you may notice an ebb and flow to your stretching that mirrors the tide of your breath. As you inhale, your muscles tighten slightly, reducing the stretch. As you exhale, slowly and completely, your abdomen moves back toward your spine, the muscles in your lower back seem to grow longer, and you can drop your chest toward your thighs.
It's obvious that exhalation deflates the lungs and lifts your diaphragm into the chest, thereby creating space in the abdominal cavity and making it easier to bend the lumbar spine forward. (Inhalation does the opposite, filling the abdominal cavity like an inflating balloon, making it difficult to fold your spine forward completely.) But you may not realize that exhalation also actually relaxes the muscles of your back and tilts your pelvis forward.

In Paschimottanasana, the musculature of the lower back is in passive tension. According to research cited in Science of Flexibility, every inhalation is accompanied by an active contraction of the lower back—a contraction in direct opposition to the desired forward bend. Then exhalation releases the lower back muscles, facilitating the stretch. If you place your palms on your back, just above the hips, and breathe deeply, you can feel the erector spinae on either side of your spinal column engage as you inhale and release as you exhale. If you pay close attention, you'll also notice that each inhalation engages the muscles around the coccyx, at the very tip of your spine, drawing the pelvis back slightly. Each exhalation relaxes these muscles and frees your pelvis, allowing it to rotate around the hip joints.

As your lungs empty and the diaphragm lifts into your chest, your back muscles release and you are able to fold into your ultimate stretch. Once there, you may experience a pleasant, seemingly eternal moment of inner peace, the pacifying of the nervous system traditionally considered one of the benefits of forward bends.

At this point, you may feel especially in touch with the spiritual element of yoga. But Western science also offers a material explanation for this experience. According to Alter's Science of Flexibility, during an exhalation the diaphragm pushes up against the heart, slowing down the heart rate. Blood pressure decreases, as does stress on the rib cage, abdominal walls, and intercostal muscles. Relaxation ensues, and your tolerance to stretching is enhanced—as well as your sense of well-being.

Short Cuts to Flexibility?

But not every moment in yoga is peaceful. At the extreme end of hatha yoga achievement, practitioners can experience breakthroughs that may involve a degree of pain, fear, and risk. (After all, hatha does mean "forceful.") You may have seen the photograph in Light on Yoga of B.K.S. Iyengar poised in Mayurasana (Peacock Pose) on the back of a student in Paschimottanasana, forcing her to fold more deeply. Or perhaps you've watched a teacher stand on the thighs of a student in Baddha Konasana (Bound Angle Pose). Such methods might appear dangerous or even cruel to an outsider, but in the hands of an experienced instructor they can be remarkably effective—and they bear a striking resemblance to cutting-edge techniques in Western flexibility training that focus on reconditioning neurological mechanisms.

As I researched this article, a friend told me about a time he accidentally engaged one of these mechanisms and experienced a surprising breakthrough after years of trying to master Hanumanasana (a pose better known in the West as "the splits"). One day, as my friend attempted the posture—left leg forward and right leg back, hands lightly supporting him on the floor—he stretched his legs farther apart than usual, allowing almost the full weight of his torso to rest down through his hips. Suddenly he felt an intense warmth in his pelvic region and a rapid, unexpected release that brought both his sitting bones to the floor. My friend had triggered a physiological reaction rarely encountered while stretching, a neurological "circuit breaker" that opposes and overrides the stretch reflex. While the stretch reflex tenses muscle tissue, this other reflex—technically, it's known as the "inverse myotatic (stretch) reflex"—completely releases muscular tension to protect the tendons.

How does it work? At the ends of every muscle, where fascia and tendons interweave, there are sensory bodies that monitor load. These are the Golgi tendon organs (GTOs). They react when either a muscular contraction or a stretch places too much stress on a tendon.

The huge, state-sponsored sports apparatus of the former Soviet Union developed a neurological flexibility training method based largely on manipulating this GTO reflex. "You already have all the muscle length you need," argues Russian flexibility expert Pavel Tsatsouline, "enough for full splits and most of the difficult asanas. But controlling flexibility requires control of an autonomic function." Tsatsouline makes the point by lifting his leg up on a chair back. "If you can do this," he says, "you've already got enough stretch to do the splits." According to Tsatsouline, it's not muscle or connective tissue that's stopping you. "Great flexibility," asserts Tsatsouline, "can be achieved by flicking a few switches in your spinal cord."

But exploiting the GTO mechanism to enhance flexibility entails certain risks, because muscles must be fully extended and under extreme tension to trigger a GTO reflex. Implementing enhanced methods of flexibility training—like the Russian system or advanced yoga techniques—requires an experienced teacher who can make sure your skeleton is correctly aligned and that your body is strong enough to handle the stresses involved. If you don't know what you're doing, it's easy to get hurt.

If used correctly, though, these methods can be extremely effective. Tsatsouline claims he can teach even stiff middle-aged men, with no prior flexibility training, how to do the splits in about six months.

Applied Physiology

By now you may be asking yourself, "What do these Western stretching techniques have to do with yoga?"

On the one hand, of course, stretching is an important component of building the yoga-deha, the yogic body that allows the practitioner to channel ever more prana. That's one reason why the major hatha yoga schools base their practice on the classic asanas, a series of postures that illustrate and encourage the ideal range of human movement.

But any good teacher will also tell you that yoga isn't just about stretching. "Yoga is a discipline that teaches us new ways of experiencing the world," Judith Lasater, Ph.D. and physical therapist, explains, "so that we can give up the attachments to our suffering." According to Lasater, there are only two asanas: conscious or unconscious. In other words, what distinguishes a particular position as an asana is our focus, not simply the outer conformation of the body.

It's certainly possible to get so caught up in pursuit of physical perfection that we lose sight of the "goal" of asana practice—the state of samadhi. At the same time, though, exploring the limits of the body's flexibility can be a perfect vehicle for developing the one-pointed concentration needed for the "inner limbs" of classical yoga.
And there is certainly nothing inherently contradictory about using the analytical insights of Western science to inform and enhance the empirical insights of millennia of asana practice. In fact, yoga teacher B.K.S. Iyengar, perhaps the most influential figure in the Western assimilation of hatha yoga, has always encouraged scientific inquiry, advocating the application of strict physiological principles to the cultivation of a refined asana practice.

Some yogis are already embracing this synthesis enthusiastically. At the Meridian Stretching Center in Boston, Massachusetts, Bob Cooley is developing and testing a computer program that can diagnose flexibility deficiencies and prescribe asanas. New clients at Cooley's stretching center are asked to assume 16 different yoga postures as Cooley records specific anatomical landmarks on their bodies with a digitizing wand, similar to the ones used in computer-aided drafting. These body-point readings are computed to make comparisons between the client and models of both maximum and average human flexibility. The computer program generates a report that benchmarks and guides the client's progress, spelling out any areas needing improvement and recommending specific asanas.

Cooley uses an amalgamation of what he sees as the best points of Eastern and Western knowledge, combining the classic yoga asana with techniques similar to PNF. (An eclectic experimenter, Cooley incorporates Western psychotherapeutic insights, the Enneagram, and Chinese meridian theory in his approach to yoga.).

If you're a yoga purist, you may not like the idea of a yoga potpourri that mixes new-fangled scientific insights with time-honed yoga practices. But "new and improved" has always been one of America's national mantras, and blending the best from Eastern experience-based wisdom and Western analytical science may be a principal contribution our country makes to the evolution of yoga.

Resources

Anatomy of Movement by Blandine Calais-Germain (Eastland Press, 1993).

Thursday, April 7, 2011

Yoga may heal Sciatica

By Matthew Solan


One day 25 years ago Candy Doran, an avid cyclist and competitive runner, bent over to pump a bike tire and was struck by lightning. Not literally, but that's how she describes the searing pain that shot through her lower back and leg and made her collapse to the ground in agony. The pain quickly subsided, and she resumed her routine of training for half marathons and vigorous cycling competitions like the California Death Ride, for which she biked through five mountain passes in a single day. Over the years, the pain would return, sometimes not as severe; sometimes she just had trouble getting comfortable while seated. It always went away and didn't interfere with her regular activities, so she just "ran and cycled through the pain," she says. When it was gone, it was forgotten. Eventually, after hearing her running and cycling buddies complain about sciatica and reading about the condition in fitness magazines, she put two and two together and realized that she too was suffering from inflammation of the sciatic nerve.

When she tried to address her pain, the results were discouraging. A chiropractor and physical therapist weren't helpful. So she consulted her running magazines and tried the back exercises they recommended. Her hope was that strengthening the muscles of the lumbar area would lessen the frequency or severity of the attacks. But it didn't, and at times the exercises made matters worse.

It wasn't until a knee operation ended her running career a few years ago that she became determined to control her sciatica. "I was physically deteriorating and I knew I needed to preserve what I had left," says Doran, who still cycles about 100 miles each weekend around San Francisco. "And I knew I had to go outside my Western experience of physical therapy to do it."

She found solace at the Iyengar Yoga Institute and with her teacher, Kathy Alef. For the past four years, her twice-weekly practice has taught her to stretch correctly, concentrate on proper alignment, and focus on her overall physical needs. This has been a departure from her physical therapy exercises, which she says are often designed just for specific areas. Now she fights the entire fire instead of individual flames. "Yoga has taught me to pay attention to how my body moves and how it relates to my sciatica," Doran says.

For the first time in decades, Doran's sciatica is almost nonexistent. Besides an occasional flare-up, the equivalent of a 24-hour cold, she is practically pain free. Best of all, at 55, she's able to stay active at an age when most people have to slow down. "Now when my sciatica does occur, I know what to do to ease the pain—stretch and strengthen like crazy."

Of All the Nerve

The sciatic nerves are the body's two largest nerves. They are about as thick as your pinkie and emanate from the lower lumbar spine. They thread through the buttocks down the back of each leg to the soles of the feet and big toes. Pain strikes when a root that helps form one of the sciatic nerves, or when the nerve fibers, become pinched or irritated. You can feel it anywhere along the nerve's branch: low back, buttocks, leg, calf, or foot. It can be felt down one leg or both.


Sciatic pains are like snowflakes: no two are ever the same, and their severity can change throughout an attack. The pain can feel like a dull soreness, numbness, or tingling, or more like an electric shock, throbbing heat, or stabbing pain. It can begin as an annoying ache that makes it uncomfortable to sit, or turn into a variety of intense, and at times debilitating, sensations that make it nearly impossible to walk or stand. An episode can last anywhere from a few hours to several weeks. Some are frequent and consistent—you can almost set your watch by them—while others may arrive out of the blue after a long hiatus.

A common culprit for sciatic pain is a herniated disk (sometimes referred to as a ruptured disk, pinched nerve, or slipped disk). "Your disks can get fatigued like a wire hanger being constantly bent back and forth. Eventually, a disk may weaken and perhaps break," says Loren M. Fishman, M.D., the coauthor with Carol Ardman of Relief Is in the Stretch: End Low Back Pain Through Yoga. "Or a vertebra can slip forward and the nerve fibers may become compressed that way, much like a kink in a garden hose." This can happen due to an injury or trauma, long bouts of physical activity (as is the case with many athletic people who suffer from sciatica), or simply from years of constant bending or sitting for long stretches. It's possible to ignite pain with the simplest movement, much like what happened with Doran. "People may aggravate their sciatica with a sneeze or reaching for a box of cereal," Fishman says.

Yet sciatica is not always related to back issues. "You can have back pain without having sciatica, and you can suffer from sciatica without back pain," Fishman says. For instance, osteoarthritis can narrow the opening through which the nerve roots exit the lower spine, injuring the fibers that make up the sciatic nerve. Another cause is piriformis syndrome, in which the piriformis muscle in the buttock compresses the sciatic nerve. "It's commonly caused by overuse and oversitting, and is seen in people with sedentary jobs like bus drivers and office workers," Fishman says.

Sciatica may seem like a pain to treat, but Fishman says more than half of all sufferers can soothe and reduce flare-ups by combining some form of exercise, in particular yoga, to strengthen the back and help relieve the pressure on the nerve root, with the judicious use of nonsteroidal anti-inflammatory drugs such as ibuprofen, aspirin, or naproxen. Many people have also relied on other complementary approaches to manage attacks. (See "Sciatica Strategies,") Of course, more intense pain may need stronger medications to ease the inflammation, such as oral steroids or epidural injections, and severe or recalcitrant cases may even require surgery to remove the portion of the disk that irritates the nerve root. But a yoga mat and a clear plan may be all that a sciatica sufferer needs.

Managed Care

Can you "cure" your sciatica with yoga? The answer is yes and maybe. "It's wrong to say that your sciatica can never be relieved," Fishman says. But it's also unfair to blindly believe that if you simply put in the time and effort, your pain will disappear forever, says certified Iyengar yoga teacher Anna Delury. That's why she recommends a management-style approach, with the intention to keep your pain at bay, which is more realistic and won't set you up for disappointment.



"You definitely can use the Iyengar method to bring your sciatica under control and make flare-ups less and less common," says Delury, who has trained with B.K.S. Iyengar since the early 1980s and now teaches yoga in her home studio in Los Angeles. "But it is also possible to cure your sciatica with yoga." She speaks from experience. Delury suffered from sciatica for years—the result of a series of childhood falls and an active, sports-oriented youth. It wasn't until she fully embraced Iyengar Yoga, however, that her sciatica withered and eventually vanished. She has been pain free now for 11 years.

Delury emphasizes that managing your sciatica with yoga is not something you can accomplish in a few weeks, or even months. "Everyone is different, but it may take, on average, six months to one year to be able to control your sciatica," she says. "The reason is that it takes longer for nerve and spinal-related problems to heal from injury. It can be painful at times, and you may have setbacks along the way, but you'll also feel relief too."

Sciatica Action Plan

There are different approaches to using yoga to manage your sciatica. It depends on your yoga experience and the severity of your pain. "I've found that 80 to 85 percent of the time, sciatica sufferers benefit from this sequence," she says. Since everyone's sciatica is different, Delury has her students follow a three-tier approach, based on Iyengar's teaching, while doing each pose. They are like individual check marks so students can gauge what they need to focus on, how deep they should go into a pose, and how long they should hold it. Here's a look at the steps and how they are connected.

Step 1 Pacify the pain. Take pressure off the sciatic nerve and rest the lumbar spine by using a variety of props common in the Iyengar tradition: straps, belts, blocks, chairs, bolsters, and walls. "Props provide traction, which releases any pain or discomfort, and they also help educate the body and mind about what it's supposed to feel like," Delury says.

Step 2 Understand proper alignment. When the lights flicker in your home, the likely culprit is a loose wire in the wall. You have to go into the wall to examine the structure and evaluate the problem. The same philosophy applies to your sciatica. You need to investigate where your wires are messed up. Your pelvis and spine work together to ensure proper alignment. Misalignment can cause pressure on the sciatic nerve. Using props helps the body understand proper alignment.

Step 3 Build muscle strength to maintain alignment. To build strength, increase the repetitions of the poses, or hold them longer, or both. You can do this while you learn to align your pelvis and spine in step 2. But you may need to just focus on your alignment first—anywhere from six months to a year—before you are ready to build strength.

Baseline Formula

When you use yoga to manage your sciatica, Delury advises that you cut back on all other activities at first. This means taking a break from strenuous physical activities like skiing or running, or even your usual intense yoga practice. "You have to go to the baseline," Delury says. In her case, she gave up running, dancing, and even sit-ups. "All I did was focus on the sequence given to me by Mr. Iyengar for a year," she says.

This is sometimes more difficult to endure than the sciatic pain itself. It's a big psychological hurdle for active people, especially serious yoga practitioners. But it's necessary, Delury says. The reason is twofold: First, any strenuous activities may inadvertently aggravate your sciatica and cause a setback, and second, you need to break any bad habits you may have picked up in how you move and bend, so you can learn proper alignment.

If you find this complete abandonment too difficult, Delury suggests that you take a trial-and-error approach. If possible, eliminate your most extreme activity first, like marathon running or cycling, or a "lopsided" sport like golf or tennis that emphasizes one side of the body, and monitor how your sciatica reacts.

"Sometimes just eliminating the most intense activity is enough. If it's not, and you find your sciatica still flares up, cut back on another activity, and then another, until your sciatica is OK," she advises. Even if you have to stop doing all sports, you can still stay active with gentle walking, Delury says, while you focus on your sciatica yoga routine.

That's what Toby Brusseau, 27, did. In 2003, he fell 15 feet onto a bed of rocks while climbing in Malibu Creek in Southern California. It caused a herniated disk that triggered painful bouts of sciatica, sometimes so intense that the mere pressure of the keys in his pants pocket was too much to bear.

He took up Delury's yoga sequence, with some modifications to fit his experience level and sciatica. He stopped all other physical activities for several months and focused on just the yoga, sometimes practicing several times a day. This regimen meant he could do no rock climbing, cross-country running, weight lifting, skiing, or mountain biking. Brusseau even stopped going to his regular group yoga class. He admits it was hard to suddenly slow to a crawl like that, but after just one month he noticed a difference and within 10 months felt 100 percent cured.

When the pain began to subside, however, he didn't take it as a sign to throw a harness around the nearest boulder and hoist himself up. He literally took small steps. He began with walks, and when that didn't aggravate his sciatica, he began to run again in his old confines of Fryman Canyon near Hollywood. He began with flat surfaces and worked up to steep hills. When that was OK, he added another of his previous adventures but always gauged how his sciatica reacted. Eventually he made it back to rock climbing.

Brusseau's experience may be unusual, but he's an example of what may be accomplished with diligence and a plan. "So many people are looking for the quick fix for their sciatica, like a steroid shot, so they can get back to their life, but I wanted to feel my way through it," he says. "I wanted to test myself and my yoga to see if it could work—and it did."

Pain Strategies
When a sciatica attack hits, there are several ways to naturally soothe flare-ups or prolonged bouts of pain.


Acupressure In this massage technique, the therapist applies pressure with her fingertips or knuckles. There are about 30 to 40 acupressure points. The goal is to release physical tension to the painful area, relax tight muscles, and increase blood circulation. It's possible to learn how to identify the points and massage them yourself when a flare-up occurs.

Acupuncture In traditional Chinese medicine, sciatica, like other physical pain, is considered a chi (energy) stagnation, says Javaharian Mohammad, L.Ac., of the Pacific College of Oriental Medicine in San Diego. Acupuncture treatments use thin needles to stimulate points in the lower back to help unblock chi and ease pain.

Herbs Many herbalists use St. John's wort flowering tops for mild painful conditions, including sciatica and muscle inflammation, says herbalist Karta Purkh Singh Khalsa. Turmeric is another widely used herb. Its anti-inflammatory effects are most likely due to its active ingredient, curcumin, which gives turmeric its yellow color and may be as effective as cortisone in fighting acute inflammation. Or try a strong tea made from gotu kola (one ounce of dry herb steeped in one pint of water), which can help heal chronic conditions if taken daily for several days or weeks, Khalsa says. (Check with a naturopath before taking these or any other herbs.)

Leg stretches Place the foot of the painful leg up on a box, chair, or stair, while standing, suggests Loren Fishman, M.D. "Lifting the leg stretches spastic muscles in the leg, buttock, and lower back," he says. If both legs hurt, lie on your back, bend your knees, and bring them to your chest. "Make sure your movements are slow and careful," Fishman counsels. For unbearable pain, do the poses while in a warm shower, and let the water cover as much of your body as possible: shoulders, back, and leg; or chest, abdomen, and leg.

Ice Old-fashioned ice therapy numbs sore tissue and can slow inflammation. Apply an ice pack or ice wrapped in a towel (never place ice directly on the skin) to the area around your lumbar spine or wherever the pain is most intense

Can Yoga Cause Sciatica ?

Sometimes your yoga practice can be the culprit of your sciatic pain. This happens, says Anna Delury, when yogis develop bad habits in poses. "They overly rotate their back leg or twist their feet or square their hips too much, like in Warrior I," she says. This can cause pressure on the lumbar spine and may irritate the sciatic nerves. Her suggestion: In standing poses keep your feet flat on the floor, each knee facing in the direction of your toes, and let your hips move naturally. Unfortunately, people misunderstand directions from their teacher about where they should place their hips, which often results in squaring them too much, she says. "The hips should receive the movement, not initiate it. Don't force your body into a movement or position it's not ready for." —M.S.

Your Yoga Experience

1. Everybody wins! Yoga class is kind of like a soccer tournament for kindergartners. You're not supposed to keep score and everybody gets a trophy--even the kid who pouted the entire second half. If you show up to yoga class and make some attempt at breathing, moving, and being aware you'll benefit--even if you fall out of Tree Pose or get your right and left feet mixed up.

2. Failing is an important part of the learning process. This practice is designed to frustrate you. That's how you learn to relax in frustrating situations. You're supposed to fall down! If the postures were always easy you'd never learn anything!

3. It's not about the poses. It's a lot more interesting to notice how your mind, breath, and energy level reacts to the pose. Those reactions will eventually give you amazing insights into who you are, your strengths and weaknesses as a person, and what you can do to make your situation better.

4. You are the only one who cares what you look like in Downward Facing Dog. Think about it: When you are in Down Dog are you thinking about what the person beside of you looks like in her new pants? Most people are more preoccupied with straightening their legs, lengthening their spines, or--depending on how hot the room is--just trying not to slip and fall on their faces.

5. Sometimes you'll have to go it alone. Yoga teachers are great resources--but they don't know everything either. Since yoga is a very individual practice, it's different for everyone. Your teacher can only tell you what works for him or her--and that might be completely different from what will work for you. There are many lessons you'll have to figure out on your own. So you'll have to learn to trust your own intuition and pay attention to cues from your body, mind, and spirit.

Asana for Sciatica

The course of yoga you choose for sciatica depends on the cause of your condition.
By YJ Staff

Before turning to yoga, you should meet with a doctor to determine what's causing your sciatica. Sciatica is defined as pain caused by irritation or pressure anywhere along the sciatic nerve. The nerve extends from the sacrum, between layers of the deep buttock muscles, and then into the deep muscles of the back of the thigh.

Mary Pullig Schatz, M.D., offers the following information about sciatica in her book, Back Care Basics: A Doctor's Gentle Yoga Program for Back and Neck Pain Relief (Rodmell Press, 1992):

"Characteristically, this pain starts in the buttock and extends down the rear of the thigh and lower leg to the sole of the foot, and along the outer side of the lower leg to the top of the foot. Pain may also be felt in the lower back.

"A primary cause of sciatica is a herniated or bulging lower lumbar intervertebral disc that compresses one of the nerve roots before it joins the sciatic nerve. Sometimes irritation of a branch of the sciatic nerve in the leg can be so severe as to set up a reflex pain reaction involving the entire length of the nerve. For example, if the nerve is pinched or irritated near the knee, you may feel the pain in the hip and buttock.

"Another cause of sciatica is piriformis syndrome. The piriformis muscle extends from the side of the sacrum to the top of the thigh bone at the hip joint, passing over the sciatic nerve en route. When a short or tight piriformis is stretched, it can compress and irritate the sciatic nerve. People who habitually stand with their toes turned out often develop piriformis syndrome, as do runners and cyclists, who overuse and understretch the piriformis muscle.

"In order to work therapeutically with sciatica, you must deal with its basic cause." Regularly performing sets of certain asanas can help to relieve some types of sciatic pain. Here are some suggestions from Schatz.

If the sciatica is from a bulging disc, focus on improving posture and body mechanics in daily activities. Yoga practice should be modified so that the pain is neither created nor intensified. Good poses to work with are Tadasana (Mountain Pose), Adho Mukha Svanasana (Downward-Facing Dog) and its modification, Push the Wall Pose, as well as Virabhadrasana II (Warrior II Pose). Do several sets, holding each pose for a moment.

If a tight piriformis muscle is the problem, then it must be gently stretched. Schatz suggests Piriformis Stretch, a seated pose that resembles the leg position of Matsyendrasana (Lord of the Fishes Pose), but without the torso twist. Parivrtta Trikonasana (Revolved Triangle Pose) with the support of a table or countertop can also help. Do not overstretch or more spasm can result. These poses can help relieve both piriformis spasm and piriformis-related sciatica. Remember to always speak with a physician before beginning any type of physical exercise.

Nerve Pain and Herniated Disc

Definition
By Mayo Clinic staff

Herniated disk

A herniated disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine.

A spinal disk is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the softer "jelly" pushes out through a crack in the tougher exterior.

A herniated disk can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. On the other hand, many people experience no symptoms from a herniated disk. Most people who have a herniated disk don't need surgery to correct the problem.


Symptoms
By Mayo Clinic staff
You can have a herniated disk without knowing it — herniated disks sometimes show up on spinal images of people who have no symptoms of a disk problem. But some herniated disks can be painful. The location of your symptoms may vary, depending on where the herniated disk is located along your spine. Most herniated disks occur in your lower back (lumbar spine), although they can also occur in your neck (cervical spine).

The most common signs and symptoms of a herniated disk are:

Arm or leg pain. If your herniated disk is in your lower back, you'll typically feel the most intense pain in your buttocks, thigh and leg below the knee. It may also involve part of the foot. If your herniated disk is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions.
Numbness or tingling. People who have a herniated disk often experience numbness or tingling in the body part served by the affected nerves.
Weakness. Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or impair your ability to lift or hold items.
When to see a doctor
Seek medical attention if your neck or back pain travels down your arm or leg, or if it's accompanied by numbness, tingling or weakness.

Causes
By Mayo Clinic staff
Disk herniation is most often the result of a gradual, aging-related wear and tear called disk degeneration. As you age, your spinal disks lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist.

Most people can't pinpoint the exact cause of their herniated disk. Sometimes, using your back muscles instead of your leg and thigh muscles to lift large, heavy objects can lead to a herniated disk, as can twisting and turning while lifting. Rarely, a traumatic event such as a fall or a blow to the back can cause a herniated disk.

Risk factors
By Mayo Clinic staff
Factors that increase your risk of a herniated disk may include:

Age. Herniated disks are most common in middle age, especially between 35 and 45, due to aging-related degeneration of the disks.
Weight. Excess body weight causes extra stress on the disks in your lower back.
Occupation. People with physically demanding jobs have a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting also may increase your risk of a herniated disk

Complications
By Mayo Clinic staff
Your spinal cord doesn't extend into the lower portion of your spinal canal. Just below your waist, the spinal cord separates into a group of long nerve roots (cauda equina) that resemble a horse's tail. Rarely, disk herniation can compress the entire cauda equina. Emergency surgery may be required to avoid permanent weakness or paralysis.

Seek emergency medical attention if you have:

Worsening symptoms. Pain, numbness or weakness may increase to the point that you can't perform your usual daily activities.
Bladder or bowel dysfunction. People who have the cauda equina syndrome may become incontinent or have difficulty urinating even with a full bladder.
Saddle anesthesia. This progressive loss of sensation affects the areas that would touch a saddle — the inner thighs, back of legs and the area around the rectu



Preparing for your appointment
By Mayo Clinic staff
You're likely to initially bring your symptoms to the attention of your family doctor. He or she may refer you to a doctor specializing in physical medicine and rehabilitation, orthopedic surgery, neurology or neurosurgery.

What you can do
Before your appointment, write a list that answers the following questions:

When did you first begin experiencing symptoms?
Were you lifting, pushing or pulling anything at the time you first felt symptoms? Were you twisting your back?
Has the pain kept you from participating in activities you wanted to do?
Do you have any pain that travels into your arms or legs?
Do you feel any weakness or numbness in your arms or legs?
Have you noticed any changes in your bowel or bladder habits?
Does coughing, sneezing or straining for a bowel movement worsen your leg pain?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Is the pain interfering with sleep or work?
What medications or supplements do you take?
What to expect from your doctor
During the physical exam, your doctor may ask you to lie flat so that he or she can move your legs into various positions to help determine the cause of your pain. Your doctor may also perform a neurological exam, to check your:

Reflexes
Muscle strength
Walking ability
Ability to feel light touches, pinpricks or vibration


Tests and diagnosis
By Mayo Clinic staff
MRI of herniated disk
In most cases of herniated disk, a physical exam and a medical history are all that's needed to make a diagnosis. If your doctor suspects another condition or needs to see which nerves are affected, he or she may order one or more of the following tests.

Imaging tests

X-rays. Plain X-rays don't detect herniated disks, but they may be performed to rule out other causes of back pain, such as an infection, tumor, spinal alignment issues or a broken bone.
Computerized tomography (CT scan). A CT scanner takes a series of X-rays from many different directions and then combines them to create cross-sectional images of your spinal column and the structures around it.
Magnetic resonance imaging (MRI). Radio waves and a strong magnetic field are used to create images of your body's internal structures. This test can be used to confirm the location of the herniated disk and to see which nerves are affected.
Myelogram. A dye is injected into the spinal fluid, and then X-rays are taken. This test can show pressure on your spinal cord or nerves due to multiple herniated disks or other conditions.
Nerve tests
Electromyograms and nerve conduction studies measure how well electrical impulses are moving along nerve tissue. This can help pinpoint the location of the nerve damage.


Treatments and drugs
By Mayo Clinic staff
Conservative treatment — mainly avoiding painful positions and following a planned exercise and pain-medication regimen — relieves symptoms in nine out of 10 people with a herniated disk. Many people get better in a month or two with conservative treatment. Imaging studies show that the protruding or displaced portion of the disk shrinks over time, corresponding to the improvement in symptoms.

Medications

Over-the-counter pain medications. If your pain is mild to moderate, your doctor may tell you to take an over-the-counter pain medication, such as ibuprofen (Advil, Motrin, others), acetaminophen (Tylenol, others) or naproxen (Aleve, others). Many of these drugs carry a risk of gastrointestinal bleeding, and large doses of acetaminophen may damage the liver.
Narcotics. If your pain doesn't improve with over-the-counter medications, your doctor may prescribe narcotics, such as codeine or a hydrocodone-acetaminophen combination (Vicodin, Lortab, others), for a short time. Sedation, nausea, confusion and constipation are possible side effects from these drugs. Decrease or eliminate your Tylenol use if these combination medications are prescribed.
Nerve pain medications. Drugs such as gabapentin (Neurontin), pregabalin (Lyrica), duloxetine (Cymbalta), tramadol (Ultram, Ryzolt) and amitriptyline often help relieve nerve-damage pain. Because these drugs have a milder set of side effects than do narcotic medications, they're increasingly being used as first-line prescription medications for people who have herniated disks.
Muscle relaxers. Muscle relaxants such as diazepam (Valium) or cyclobenzaprine (Flexeril, Amrix) also may be prescribed if you have back or limb spasms. Sedation and dizziness are common side effects of these medications.
Cortisone injections. Inflammation-suppressing corticosteroids may be given by injection directly into the area around the spinal nerves, using spinal imaging to more safely guide the needle.
Therapy
Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk. As the pain improves, physical therapy can advance you to a rehabilitation program of core strength and stability to maximize your back health and help protect against future injury.

A physical therapist may also recommend:

Heat or ice
Traction
Ultrasound
Electrical stimulation
Short-term bracing for the neck or lower back
Surgery
A very small number of people with herniated disks eventually need surgery. Your doctor may suggest surgery if:

Conservative treatment fails to improve your symptoms after six weeks
A disk fragment lodges in your spinal canal, pressing on a nerve and resulting in progressive weakness
You're having significant trouble performing basic activities such as standing or walking
In many cases, surgeons can remove just the protruding portion of the disk. Rarely, however, the entire disk must be removed. In these cases, the vertebrae may need to be fused together with metal hardware to provide spinal stability. Or your surgeon may suggest the implantation of an artificial disk.



Lifestyle and home remedies
By Mayo Clinic staff
Take pain relievers. Over-the-counter medications — such as ibuprofen (Advil, Motrin, others), acetaminophen (Tylenol, others) or naproxen (Aleve, others) — may help reduce the pain associated with a herniated disk.
Use heat or cold. Initially, cold packs can be used to relieve pain and inflammation. After a few days, you may switch to gentle heat to give relief and comfort.
Avoid too much bedrest. Too much bedrest can lead to stiff joints and weak muscles — which can complicate your recovery. Instead, rest in a position of comfort for 30 minutes, and then go for a short walk or do some work. Try to avoid activities that worsen your pain during the healing process.

Coping and support
By Mayo Clinic staff
Pain affects more than just your physical well-being. If you have to deal with recurring herniated disks or other back problems, your psychological and emotional health also are vulnerable. These tips may help you cope with pain related to a herniated disk:

Acknowledge the pain. Some people try to pretend their chronic pain doesn't exist. In the process, they may actually make it worse. You may have more success in coping if you affirm that your pain isn't imaginary and make necessary adjustments to accommodate it.
Manage stress. Stress magnifies pain. Try doing deep-breathing exercises and practicing other relaxation techniques when your stress level begins to rise.
Identify pain triggers. Certain activities or behaviors may worsen your pain. If you identify these triggers, you can avoid or limit them.
See a counselor. Talking with a mental health counselor helps you recognize and rethink unrealistic expectations and beliefs about yourself. Even if you can't change your chronic pain, you can change the way you feel about it.


Prevention
By Mayo Clinic staff
To help prevent a herniated disk:

Exercise. Core-muscle strengthening helps stabilize and support the spine. Check with your doctor before resuming high-impact activities such as jogging or tennis.
Maintain good posture. Good posture reduces the pressure on your spine and disks. Keep your back straight and aligned, particularly when sitting for longer periods. Lift heavy objects properly, making your legs — not your back — do most of the work.
Maintain a healthy weight. Excess weight puts more pressure on the spine and disks, making them more susceptible to herniation