Back Care and Some Background
Updated: Apr 27, 2021
I was born with a congenital back condition called spondylolisthesis, which is a deformation of the lower back in which the 5th lumbar vertebra has slipped forward of the 1st sacral bone, causing a pronounced lordosis or forward curving of the lower back. In my case this only became apparent when I was 15 years old, and was experiencing chronic lower back pain particularly after sports involving throwing a ball. I would sometimes find myself in such acute pain that I was lying on my back unable to move. The X-Rays also revealed that there was a rotation at L5 and I had developed a scoliosis or lateral S shape in my spine.
Physiotherapy was recommended and I was told that if I grew anymore that I would most likely have to wear a corset-like brace to support my spine. The physiotherapy approach at the time was to focus on strengthening the abdominal muscles to provide support for the front of the spine to compensate for the weakness and fragility in my back muscles. This offered some relief but the problem was that the exercises focussed on the superficial abdominal muscles rather than the deep abdominal muscles so they were just creating a compression in the front to match the compression in my back. So there was little improvement in my mobility and I was still susceptible to injury with certain movements.
Luckily my mother was into Hatha yoga at the time and introduced me to this approach. Though I could not do all the postures, I became more flexible and stronger, and never had to wear a brace in spite of growing several more inches. My condition improved instead of getting worse. I eventually became a massage therapist, bodyworker and yoga teacher. Over the years my spine became more aligned and my structure was more balanced. As long as I kept up my routine and did not subject my back to extreme back bends, I enjoyed a life free of back pain.
Now, if there is one key thing that I learned in my journey, it is the crucial role of the psoas muscle in supporting and maintaining healthy function in the spine. You remember that I mentioned earlier that the physiotherapy exercise I did when I was a teenager focussed on my superficial abdominal muscles, which are basically the rectus abdominus (“six-pack”) and the muscles of the waist (obliques and transverse muscles). In those days sit-ups were big and then because some people were hurting their back with these movements a variation called crunches were introduced. These are safer and more efficient but even these need to be learned properly in order to engage the psoas muscles.
So what are the psoas muscles? They are your deepest abdominal muscles and actually originate from your back, attaching at the transverse processes and sides of your five lumbar vertebrae and the last thoracic vertebra above the lumbar.
They merge with their close neighbors the illiacus muscles which originate on the crests of each side of your pelvis and both run down through your groin to attach at the top inside of your thigh bones. So they are crucial not only in their location at the core of your body but they also connect the top of your body or torso with your lower body or legs. They are primarily known as hip flexors (such as when you raise your leg straight in front of you or sit up from a supine position), but they also participate in adduction of your legs (pulling towards the midline) and even lateral flexion of the trunk (with unilateral contraction).
The psoas muscles are also the muscles we use for undulating movements. It is no accident that our spines are shaped like an S. This design allows the impact of each step we take to reverberate in a wave -like motion through the spine. Our feet also have arches that give them a similar shape for the same reason. Ideally the two cooperate to provide both shock absorption and more effective propulsion. In order for this to happen, the psoas muscles, which are located between, must be properly performing their primary function of flexing the hips. Unfortunately shoes and spending a lot of time sitting in chairs have caused a lot of us to forget how to use these muscles and this has had negative repercussions on our backs, necks and all the joints that have to compensate for our lack of mobility in the core structures of our body. Add to that the cumulative effect of gravity compressing the spine and the loss of fluid in the disc cushions between the vertebrae as we age, and there is no danger that massage therapists, bodyworkers, osteopaths and chiropractors will be out of business ! And it’s not just so that we can be free of back pain! The spine not only provides structural support. It also houses the central nervous system, so the vitality and harmonious function of our entire organism depends on the integrity of our spine.
The good news is that yoga has always emphasized core movement and current exercise culture has also woken up to the importance of whole body exercise which requires activation of the core as opposed to focusing on developing individual muscles. We have also learned that flexibility is an important factor in strength. I developed a back care program that incorporates these concepts as well as an important third factor: range of motion. This particular sequence is the culmination of over 40 years of research and practice on my own body and those of hundreds of clients I have treated for lower back problems. As they create more space between the vertebrae and balance in the supporting tissues they are particularly effective for anyone suffering from spondylolisthesis, disc compression, degeneration or herniation, and sciatica due to compression of the sciatic nerves emanating from the spine. However, they are safe and effectively relieve pain and heal most lower back discomfort.