Yoga for back pain: what helps, and what makes it worse

People arrive at this centre having already tried yoga for their back. Roughly half say it helped a little and then stopped helping. The rest say it made things worse, and stopped.

Both groups usually did the same thing: they joined a general class and did what everyone else was doing.

Back pain is not one problem

The phrase covers several different mechanical situations that want opposite things.

A back that hurts more when you bend forward, when you sit for a long stretch, or first thing in the morning is usually a flexion-sensitive back. Forward folds, seated forward bends and rounded-spine movements tend to aggravate it, and those are exactly the shapes a beginner class is full of.

A back that hurts more when you arch backwards, when you stand for a long time, or when you walk downhill often prefers the opposite. Deep backbends are the thing to be careful with there.

A back that hurts in both directions, or that refers pain down a leg, needs assessment before any programme starts. That is not caution for its own sake. Loading the wrong tissue in that situation costs weeks.

Nobody can tell you which of these you are from a class register. This is the entire argument for assessing before prescribing.

What tends to help

• Breath work, earlier than you would expect. Persistent pain raises muscle tone across the whole trunk. Slow breathing lowers it, and it is available to you on a day when you cannot face movement at all.
• Gentle, repeated movement within a comfortable range. Small and often beats large and occasional. A stiff back responds to being reminded it can move, not to being forced.
• Hip and thoracic mobility. When the hips and the upper back do not move, the lower back moves instead, and it is not built to take that share.
• Deep abdominal and gluteal work. Not crunches. Low-load, controlled work that teaches the trunk to hold position while the limbs move.
• Walking. Unglamorous, well tolerated, and one of the few things that helps almost everybody.

What tends to hurt

• Deep forward folds early on, particularly seated ones with straight legs.
• Loaded twists performed for range rather than control.
• Full wheel, plough and shoulder stand in a beginner body. These are advanced shapes and a class rarely has time to build up to them properly.
• Holding a stretch into pain in the belief that it will loosen. It will guard instead.
• Practising through a flare-up because you have paid for the month.

The rule we give people

If a movement produces pain that is sharp, that travels down a limb, or that is still there the next morning, that movement is not for you today. Discomfort that eases within the session and leaves you no worse the following day is usually fine.

That rule is not a substitute for supervision. It is what you use between sessions.

When to see a doctor first

Get medical assessment before starting any programme if you have numbness or weakness in a leg, any change in bladder or bowel control, unexplained weight loss, a history of cancer, fever alongside the pain, or pain that began with a significant injury or fall.

We will say the same thing at a consultation. Some backs need imaging before they need exercise.

What we actually do here

The first consultation costs ₹300 and takes about half an hour. A physiotherapist looks at how you move, which direction provokes the pain and what is compensating for what. Only then is practice chosen, and it is chosen from the Integrated Approach of Yoga Therapy rather than from a class syllabus.

Because our physiotherapists also hold MSc Yoga degrees, the manual treatment and the practice come from one assessment instead of two.