What are the Forward Bending Guidelines for a Herniated Disc?
For a herniated disc, modifications include forward pelvic tilt. It was my understanding that the pelvis should be rolled back to straighten the lumbar spine to alleviate pain in that area. Please clarify this for me.
Answer from Justine
There is a running joke in the Yoga therapy world that every question can be answered with ‘It depends.’ Used to drive me crazy when Gary Kraftsow would answer that way…..but I can’t tell you how often it comes out of my mouth when I mentor my Yoga therapy students!!
With a forward bend (standing or otherwise), the pelvis should be tilted forward so that the sacrum is moving in the same direction as the lumbar spine – otherwise there is a hinge point in the lumbar spine which puts added, undue stress on the anterior portion of the intervertebral discs, adding to the posterior pressure on the disc – which could cause a bulge or cause an already bulged disc to herniate. (Note: seated forward bends are riskiest to the lumbar spine, as the hips are fixed so any brunt of the movement will go into the body) Generally speaking, lumbar discs tend to bulge posterolaterally (to the back, slightly to the side of the spinal cord) which is why we don’t want that undue pressure on the anterior portion of the disc. (I have a disc that bulges straight back to the cord – rare, because the ligamentum flavum is strong and usually prevents that slippage. Lucky me!)
However, if a disc bulges forward (usually from an bad accident or a crazy, wild, extreme Yoga back bend, unfortunately – I’ve only worked with one like that in my career) then that pelvis rolling back to lengthen the back to lengthen the lumbar would be more appropriate when standing to release posterior pressure on the discs and bring the nucleus of the disc more centrally aligned, rather than pushing forward. Regardless, the safest forward bend for disc damage of any kind in the lumbar spine is apanasana, where the spine is completely supported by the floor.
As far as tucking, or rolling back the pelvis – it depends! If someone is standing in tadasana, and has an overly lordotic lumbar curve (sway back if you will), then rolling the pelvis back will help to elongate the lumbar curve and bring the spine more into balance. However, a standing forward bend would still necessitate the forward movement of the pelvis to keep the spine from hinging. I find tucking the pelvis more structurally beneficial to people with severe lumbar osteoarthritis or spinal stenosis, as it lengthens and slightly opens the posterior aspect of the vertebrae, allowing more room for the nerves as they exit the spinal column.
The hamstrings can be a major culprit it pulling the pelvis into posterior rotation in a forward bend, which is why it is safer to bend the knees if there are tight hamstrings (I instruct everyone to bend their knees, at least for the first few forward bends, to take the hamstrings out of the equation and stretch the musculature of the low back. Stretching the hamstrings while supine, with the back completely supported by the floor, is a safer option).
Keep in mind, I also work with pretty severe injuries and tend to always go for the safest common denominator!
Below is one of my favorite poses for low back pain.