If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

By Carol Ardman
WebMD Weight Loss Clinic - Live Events Transcript
Event Date: Wednesday, March 2, 2005

MODERATOR: Welcome to WebMD Live, Dr. Fishman and Carol Ardman. Why yoga for back pain?

FISHMAN: There are very few side effects, it's portable, it's free and there are basically no devices you need to carry with you. Yoga is thousands of years old and there are almost no other means that are as side-effect free. Maybe best of all, unlike medicine, which only takes you up to the state of normal and then says, 'Thank you very much, go about your business,' yoga continues to improve you even when you reach what most of us think of as normal.

In addition, yoga can be individually crafted for you and your problem, unlike medicines, with which all you can do is take more or less, often through the day. But you can't alter the medicine, which is what you do all the time with yoga.

There is even one further advantage: yoga makes you calm. To the extent that pain is not eliminated you are able to bear it better.

MODERATOR: There are many different types of yoga. How do you determine which is the best to do? Is it a matter of personal preference, or are there certain types which are better for certain problems?

FISHMAN: First, there are some that are generally better, they're better for everybody because they are more anatomically sophisticated, and therapeutically better. But when it's someone in pain, we don't want a yoga teacher; we want someone who has experience with the yoga and the illness to combine the two.

My favorite teacher is Mr. Iyengar. I studied in India with him for a year. His anatomy and focus is exactly right. Ananda, Integral yoga and other eclectic brands might be excellent, but I can't talk about them all.

There are two to stay away from if you have back pain. One is Bikram, which is not particularly adapted or focused on individual difficulties. Also, the power yoga such as Ashtanga, where it seems there are dual aims. One is to give a good workout, and the other is to seek the calm so famously reached in the East. But you can't have your heart beat fast and have it beat slowly at the same time, so they're difficult to understand from this point of view.

MODERATOR: Do certain types of yoga help with specific back pain problems?

FISHMAN: Something that arches your back, to improve the opening of the spaces that the nerve roots exist in. A herniated disk will be terrible for you if your disks and vertebrae are slipping.

Our book separates out nine different causes for low back pain, characterizes them so everyone will understand them, then gives postures for each specific one. There is also a difference between acute and chronic pain. This too is best treated according to its category.

ARDMAN: When choosing a type of yoga if you have back pain, it's important to tell your teacher that you have back pain, and discuss it thoroughly to make sure your teacher understands what it is so that you know what you have to avoid.

Also, when choosing a yoga teacher, it's a good idea to make sure that he/she practices yoga seriously at home and has a personal practice. That person will be more able to be responsive to your needs.

MODERATOR: In your book you talk about nine common causes of back pain. Could you please describe them?

FISHMAN:

1. Musculoskeletal pain, which is basically when muscles, joints or ligaments hurt, is the most common cause of back pain. (ARDMAN: That includes muscle spasm.)
2. Nerve pain from a herniated disk in the lumbar spine.
(ARDMAN: That's also called a pinched nerve root or slipped disk.)
3. Arthritis, which is a progressive condition of the joint. It can be any joint along the spine. There are five lumbar vertebrae with three real connections between bones at each level, which means 15 possible places where this can occur.
4. Sacroiliac arrangement, which is a single joint on each side of the body.
5. Pregnancy, where up to 70% of women who are pregnant have back pain. It's a self-curing condition like muscle spasm, but can be very uncomfortable. There is a lot of weight in front of you, your blood volume in the spinal cord itself can compromise it, and your ligaments are loosened from a hormone from the placenta. On top of all this, there's no comfortable way to sleep.
6. Spinal stenosis, where the openings in the spine are narrow. The opening from your brain down the spin is so narrow that the nerves get irritated.
7. Piriformis syndrome, where the sciatic nerve gets compressed by a muscle in the buttock.
8. Being overweight. We have a chapter on weight control. Being overweight makes back pain much worse.
9. After back surgery, usually the pain you went in for is gone, but you have new pain from the surgery. It will go away, but there are yoga exercises you can do to help the pain with weight, balance and strength.

MEMBER QUESTION: My back pain seems to come from stress. Help!

"You should see your doctor if your back hurts for more than three weeks."

FISHMAN: Stress is a common cause of lower back pain, and work by Dr. John Sarno has pioneered a yoga-like method that is very successful by reducing anger and frustration. His books are out there and he teaches courses in New York. Yoga is an alternative method with no proven studies that I've seen regarding back pain, but many proven studies of reducing physiological correlates of stress, such as blood pressure and heart rate.

MEMBER QUESTION: I have a herniated disk that is manageable at this point, but I have to be very careful. I was injured by a personal trainer that had me doing things I should not be doing, which caused the damage. I've noticed that many yoga instructions ask you to do some really big moves that don't appear to be back friendly. How do you find someone you can trust?

FISHMAN: I wish I had a great answer. Yoga was taught in ancient times in only one way -- person to person. The students sought out the teacher and they worked together. The students got to know the ancient yogis. They were usually attached to wealthy families, but didn't care for wealth at all. In exchange, they were able to meditate and did not have to work, and they were really the family's doctor.

Our lives have changed, and we go to classes and read books about yoga, but the same criteria apply. The yogi should be in clean, quiet quarters. As best you can, you should be able to tell that he/she is not as interested in money as much as being interested in helping you. The person should have certification and should be available for questions before, during, or after a session. You might also ask for references just as you would with any other teacher.

ARDMAN: Look for a type of yoga called Vini yoga. It's a therapeutic yoga that is taught one on one. You can ask your teacher if he/she does Vini yoga or knows someone who does, because they may be more trained to help with the back. If you have a herniated disk, you should use a lot of caution when searching for a yoga teacher.

MEMBER QUESTION: I sit at a computer all day. I've done my best to make my work station back-friendly, but it never fails that my mid-back and upper neck ends up in spasm. What sort of yoga can I do for that, and better yet, is there anything I can do while at my desk?

FISHMAN: Posture is the most important thing here. One of the best ways to achieve good posture is through meditation, where you learn to sit straight and love it. Besides that, back bends (some adapted to do standing up if you are at work, against the wall) are helpful when it begins.

ARDMAN: Also -- take frequent breaks, walk around and use a pillow or even a rolled up towel in the small of your back for support while sitting at the computer.

FISHMAN: Your head weighs 14 or 15 pounds. You must support it by your shoulders or your neck is doing a lot of extra work. Imitate the beefeaters at the Tower of London. Keep your head on your shoulders and it will help a great deal. Yoga will help and there are many good photos in the book to help you see the positions.

MEMBER QUESTION: I've been practicing yoga regularly since getting a discectomy four years ago. Physicians have told me it could actually do more harm than good. It does help me with pain management so I would like to continue doing it. Are there any positions I should be avoiding altogether?

FISHMAN: Assuming the discectomy is L4-5 or S1, your biggest risk is in the twisting postures such as matsyendrasana or jathara parivartanasana.

MEMBER QUESTION: Is it OK to do yoga with a video? I live way out and cannot get to a class. Is there any video you recommend?

FISHMAN: If you have pain, you need more than the video can give you. You can use the video after classes or after you have read our book, but I wouldn't go straight to a video if you have pain because nothing they say is sensitive to you and your problem.

MEMBER QUESTION: Would you recommend yoga as a preventative? Gardening season is coming up and I'd like to avoid the usual spring backaches.

FISHMAN: What a good idea. Doing yoga is very much like cultivating small plants. I would practice forward bends especially.

ARDMAN: You should see your doctor if your back hurts for more than three weeks. You should talk to your doctor before practicing any strenuous yoga, and don't substitute yoga for seeing a doctor. Yoga can be tremendously helpful if you have back pain, but if misused it can cause back pain, and that's not a situation anyone wants.

You can be a very advanced yogi or a total beginner who has never done it before, and yoga can help you either way.

MODERATOR: Dr. Fishman, you have used yoga in your practice for 30 years to help patients with back pain. What kind of response do you get from patients when you suggest it?

FISHMAN: It's changed in the last ten years. I used to use yoga postures and sometimes wouldn't even identify them as yoga. But in the last ten years, yoga has become so respected in the general community that I openly embrace it with patients. When I do this now, their eyes light up. They're excited to be using yoga and have no difficulties with it. Ten years ago they might have said something different.

MEMBER QUESTION: I'm six weeks pregnant and I would like to know if stretching and ab exercises are OK for me.

FISHMAN: We have a chapter in our book that is devoted to pregnancy and what is safe. I happened to be with Mr. Iyengar when his oldest daughter was pregnant, and she had back pain. She stood on her head until a few days before delivery. What is dangerous are twists because they pull the ligaments that hold the uterus in place quite asymmetrically. There are other limitations too. See the book.

ARDMAN: The book has warnings on every pose as to whether it is safe when pregnant.

MODERATOR: We are almost out of time. Before we wrap things up for today, do you have any final words for us?

FISHMAN: Yoga has given off many sprouts in the last 3,000 years and many physical therapy and exercise programs contain a good deal of yoga in them. One of the singular advantages of yoga is that you can do it on your own, so it fosters independence rather than dependence. Yoga is not a science, it's a practice. You do it or you don't.

It is a tribute to its first writer Patanjali, who was a physician, and a tribute that it has stayed together as a single practice. But, it is not a means of diagnosing, it is not a science. You need a diagnosis from a physician or a suitable medical person, then you can use yoga.

MODERATOR: Our thanks to Dr. Fishman and Carol Ardman for joining us today. And thanks to you, members, for your great questions. I'm sorry we couldn't get to all of them. For more information, please read Relief is in the Stretch: End Back Pain with Yoga.

QUESTION

Negative emotions are more powerful than positive emotions. See Answer

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