by Sarah Apple Kingsley, pt, dpt

While working as a physical therapist for many years, the number one complaint that people will come into clinic for is BACK PAIN! It seems like nearly everyone these days (or someone very close to them) can claim to have suffered from episodes of back soreness. Most recurrent episodes stem from the amount of time spent seated in a chair or in the same static positions, usually with poor posture.

When we don’t move for periods of time or move in the same habitual patterns, our muscles and joints become very stiff. Oftentimes it manifests as a global stiffness throughout the body, for which many typical yoga poses and stretches can be very beneficial. Other times one set of muscle groups will become very short and tight while the opposing muscle group will conversely become elongated. In this case, over-stretching the elongated tissues can lead to further pain and injury. This is why core strengthening for back pain is so crucial for a complete recovery. Yes, stretching is wonderful and necessary, but it needs to be coupled with postural training for the body to support the spine in a neutral position, preventing muscles from getting overly stretched or shortened. In order to do this, we need to WORK THE CORE!

Many of the physical therapy exercises we give to our patients in the clinic actually originate from yoga poses. Here are some top examples of core-strengthening yoga poses to support the spine:

1. Bridge Pose – Particularly great for strengthening the gluteals (butt muscles), which have major connections to our deepest abdominal muscles.
   To perform: Begin lying on your back with your knees bent and feet flat on the floor. Root your tailbone towards your heels, engage the gluteals and the lower abdominals as you press into your feet and lift your bottom up into a low bridge position. Focus on staying low to ensure you are activating your gluteals to avoid overactive spinal extensor use.
2. Table Top/Bird Dog – Just being in tabletop (on all fours or quadruped position) is a great way to get in touch with your core as it involves weight-bearing through all the limbs.
   To perform: Come into a hands and knees position with the hands directly under your shoulders and knees directly under your hips or slightly closer in to ensure a neutral pelvis. Pull your low belly up and in and energetically dial your hands out towards your pinkies to secure your shoulder in the socket. You can remain here for 5-10 breaths OR as a progression and very commonly prescribed PT exercise you can try bird dog. Begin first by lifting just one hand up in line with your ear, returning back to start and then reaching the other hand out in front. Then try reaching one leg back behind you, returning to start, and performing with the other side. If you can perform each of these movements separately without ANYTHING else changing in the spine, try lifting one arm out in front of you and the opposite leg back behind you. Return to the starting position and repeat with the opposite arm and leg. A good test is to put a block or dowel on your back to ensure good spinal alignment throughout and best core activation.
3. Plank and Forearm Plank – This pose takes table top/quadruped up a level by lifting the knees, putting an added demand on the core.
   Begin on all fours with your hands directly under your shoulders. Step one foot straight back behind you, followed by the other. Attempt to maintain your body in a straight line, lifting in your low belly and reaching back through your heels, engaging the gluteals as well. Coming down onto your forearms with elbows bent is an alternative that also works the core muscles with an added demand on the forearm and more proximal shoulder stabilizing muscles.
4. Side Plank and Modified Side Plank (with a twist) – This pose works your obliques and side abdominal muscles much more than a regular plank. Think of the plank described above, but tilted on your side. Only one arm is down on the floor directly under the shoulder, the legs are extended with the top foot stacked on top of the other. Pull your shoulder blade back on the ribcage and stay lifted, not sinking. Modified side plank is the same, however with your bottom knee down. This pose puts slightly less demand on the obliques, however it adds demand to your gluteus medius muscle to stabilize. Adding a twist is a way to amp up both poses by reaching your top arm down towards the floor, and then back up towards the ceiling. The rotation action helps to further engage the oblique muscles especially.
5. Boat Pose – Most people think of this pose in yoga immediately when referring to “core work.” Boat pose definitely engages the hip flexors and the rectus abdominus. However, for those with back pain it can be a big strain on the core and failure can lead to more discomfort and pulling in the low back. I recommend a modified variation beginning in an upright sitting position with knees bent and feet down on the floor. Keep your low belly lifted and spine and torso long as you begin to lean your upper torso back towards floor but only as far as you can lean without rounding or lifting your feet from the floor. Then use your core to pull yourself back up to start.
6. Chair Pose with a Twist – This pose involves full body core and gluteal engagement as you perfect your squatting position. Begin with feet shoulder-width apart, toes facing forwards. Hinge back from your hips keeping your spine long into a squat or chair position, knees do not track forwards beyond your toes. Raising your arms up overhead with thumbs pointing up adds further demand to your upper and lower trapezius and gluteals to stabilize. Adding a twist will also engage your obliques by reaching one hand down towards the floor and the other up towards the ceiling, think lifting up more than back. You can also perform a twist with your elbows bent and hands in a prayer position. Exhale as you perform the twist to engage the abdominals, inhale as you return to start.
7. Twisted Crescent or Modified Twisted Crescent – Sticking with our “twisting theme” to activate those obliques, twisted crescent or modified with the knee down also engages the glutes and rotator cuff while giving a stretch to the posterior fascia of the hip that is in front, and an anterior stretch to the hip that is behind. The restrictions in these two areas often contribute to back pain complaints. Begin standing, hinge back from your hips and step your right foot back, lowering the knee directly underneath the hip. Hinge your upper torso forwards to plant your right hand down directly underneath your shoulder. Energetically dial your hand out to the side and pull back slightly to secure the scapula on the ribcage and activate the rotator cuff and serratus anterior. Lean into this shoulder as you reach your left arm up towards the ceiling. Relaxing your ear to shoulder will help release the neck which can often contribute to low back pain. For full twisted crescent you would then lift the back knee, reaching back through the heel to keep the gluteal engaged. Hold for 2-5 breaths and repeat on the other side.

These are just a few examples of some great poses to work the core, strengthen the spine and help improve your back pain complaints. Each LYT class utilizes some or most of these poses and more to help you feel strong, stable and more freedom in your movement!