SpineFitYoga

neck and back pain causes

Neck and Back Pain Causes 

“Back pain should be explained, not explained away.” Michael A Adams, PhD

Intro

Everyday I see people with neck and back pain that’s defined as “non-specific,” meaning no known cause, often with x-rays or MRI results that are normal, yet the person has had pain for years. Or they may be told their pain is due to muscle spasms or a muscle strain, perhaps from lifting something heavy, or even something light, just that one time. But more often than not, neck and back pain comes on gradually over time, often without any apparent cause. Neck and back pain really does seem a mystery to both sufferers and caregivers alike.

Alternatively they may bring in their MRI report describing various combinations of bulged discs, herniated discs, disc degeneration (DD), stenosis, etc. In the latter case, the person is often told their pain is because of the anatomical problems listed in the report. To an extent, some of that might be true. A herniated disc might cause a lot of back pain, but why did the disc herniate? A muscle spasm as a source of pain is less true, but it sure can seem true, and why is the muscle spasming in the first place? Unfortunately most people with spine pain have never been told, and it’s because most clinicians, and even most spine specialists, simply don’t know.

However, since it’s your spine, wouldn’t you want to know the reasons muscles spasm, the reasons discs bulge and herniate, what gives you arthritis, etc. In the following chapter, we’ll be talking about solutions for neck and back pain. These solutions will make so much intuitive sense once you understand the causes. The causes aren’t even that complicated, and in the basic science literature they aren’t even controversial. However, those causes often go against what we have been told by well meaning, and sometimes not so well meaning practitioners for decades, if not centuries, therefore undermine a lot of traditional treatments.

If you are a traditional practitioner, you might not want to hear it, and you might not want your patients to hear it either. Anyway, here are the main reasons for spine degeneration and pain, first explained simply, and again explained in greater detail for those who think it might not be true. Included endnotes are for those who would like to piece together the answers for themselves.

Simply put, what you need to know:

The causes of spine damage are so important because if you only treat symptoms and proximal causes of pain, but do not remove the root cause of injury there is no amount of “feel good treatments” that will ultimately make you better. You can get adjustments, massage, or acupuncture from now until the sacred cows come home, but if you do not stop over-flexing your vertebral discs it will eventually be snap city aka disc herniation. Therefore understanding the causes of spine pain is crucial if you want to heal. Here’s how it works:

1:

Spine flexion, a normal everyday movement, when taken too far, held too long, or done too often, with insufficient recovery is the number one cause of neck and back pain. Examples of spine flexion include:

  • looking down at your phone, laptop or a book
  • looking down at a desk as you write
  • shoulder stand or plow pose in yoga
  • bending forward through your spine to touch your toes, tie your shoes, or do a forward fold
  • sitting slouched, or in too large of a chair, with poor lumbar support
  • squatting so deep that your hips tuck under
  • crunches, sit ups, posterior pelvic tilts
  • bending your knees to your chest

Yes I know that many of these things are supposed to make neck and spine pain better, but they are the same motions and positions that make spine pain worse. That’s actually good news, it’s hope for change.

2:

By overstretching forward into flexion you stretch the collagenous tissues on the back of the spine, causing micro failure, pain, inflammation and “reactive muscle spasms” that activate to protect the spine from further flexion damage. These are often mistaken as the cause of the pain, and stretched out, increasing collagenous damage. The collagen damage is frequently the cause of “acute” or short term neck and back pain. If the cause of the acute pain is not recognized and corrected the pain becomes recurrent, but because it’s caused by such ordinary activity it’s often perceived as random.

3:

While other ordinary everyday spine motions (extension, twisting, and side bending) and stresses (compression) can also be overdone, when combined or alternated with flexion they become particularly damaging, accelerating flexion induced spine injury.

4:

If excessive spine flexion continues, collagenous micro failure becomes macro failure, often in the form of rearward bulged and later herniated discs.

5:

A herniated disc is then deflated and shows up on an x-ray as narrowed or degenerated. The narrowed disc puts the ligaments spanning its distance on slack, resulting in focused spinal instability.

6:

Over time the body attempts to stabilize the loose segment by growing bone spurs and osteophytes that permanently lessen vertebral range of motion, but in doing so the bone formation can further pinch the spinal cord or nerves, causing increased pain, tingling, and lessening muscle strength.

7:

The combination of decreased disc height, disc bulges, herniations, and bone formation narrows the central and/or lateral foramen of the vertebrae impinging spinal nerves or the cord itself in what is called stenosis. If bad enough the stenosis induced nerve impingement can result in chronic pain, muscle weakness, numbness and tingling affecting the arms or legs.

8:

Advanced stenosis can result in permanent pain and disability for which even the best exercise programs, drugs and surgery are powerless to fully correct.

9:

Genetics, body fat, hyper or hypomobility, sleep loss, anxiety, and depression can all play factors leading to central sensitization of pain, and a diagnosis of fibromyalgia, which is very difficult to get rid of.

10:

The above is referred to as the degenerative cascade, but I like to think of it as a path, for which if you are aware of the causes and catch it early enough you can just step off the path.

11:

SpineFitYoga is about teaching and practicing proper spine alignment and building fitness in a spine healthy way so as to best reverse, stop, or mitigate further damage. The quicker you start, the better chance you have of a full recovery.

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All the above in greater detail:

Spine Flexion

What happens most frequently is people overstretch their spines (neck and/or back) in flexion. In doing so, they start to stretch out the collagenous tissues on the back of their spine. These tissues all have sensory nerves that immediately act reflexively to increase muscle contraction of the spine extensors to protect use from overstretching. However, if the stretch is continued, the protective muscle contractions decrease, no longer offering as much support.

As a result, micro failure and inflammation of said collagen tissues occurs. The disrupted collagen attracts inflammatory cells to repair the torn tissues, resulting in pain and reflexively increasing spine extensor muscle spasms (that resist spine flexion) peaking roughly 5-7 hours after the injury. The muscle spasms should and would do a great job of increasing spine stiffness, thus preventing additional spine flexion injury.

Unfortunately, at some point people started overthinking it. Now, when our neck or back starts hurting, we feel for the problem, often feel a muscle spasm: pain and stiffness that arrived at about the same time. We then think the muscle spasm and tightness, rather than protecting us from the pain, is causing the pain, so we stretch harder and try to stretch out said spasm. What’s seductive here is it often actually “works” a little and the spasm will loosen.

However, that spasm was protecting us from the same stretch direction we are probably using to eliminate it. Hence the pain returns, as do the muscle spasms, often worse later. Even if we don’t purposefully stretch the spasm, but continue to stretch it out of habit because of poor spine posture the pain and spasms will still worsen over time. However, because the damage at this point is still just micro failure of the collagen tissues, it will not show up on an x-ray. There was no known “accident” that caused an “injury” so the pain is often diagnosed as “nonspecific” or of unknown cause.

Nonetheless, the injury is real and the mechanism was absolutely specific! It was just a long time coming, usually decades, and when it arrives it is after you have been doing the offending motion, stretch, posture (or all three) many thousands of times – movements as seemingly innocuous as using your neck to look down at your cell phone.

Herniated Discs & Spine Flexion

If the above cycle continues, pain will often come and go. Over time the flexion compressing the front of the disc is pushing it’s gel filled disc center (the nucleus) backward, causing some of the gel to push its way through the torn annulus fibers. Once the nucleus gets far enough, it begins to bulge either straight back, or back to one side, and there is your familiar disc bulge that might show up on an MRI.

At least now your pain is not nonspecific anymore, and you have a visible reason for the pain, but it is still the same flexion force that’s been causing the bulk of your discomfort all along. Flexion, if continued, eventually causes the nuclear gel to breach the outer layers of the annulus and into the vertebral canal or foramen. That’s your full disc herniation, which is often highly inflammatory, highly painful, often irritating nerves that radiate pain and tingling down the arm if the herniation is in the neck, or down the leg if the herniation is in the low back.Picture a jelly donut where you squish the front of it and all the jelly squirts out the back.

That’s an almost perfect analogy of what happens with a herniated disc. Except in real life, though the final breach might have happened all of a sudden, the bulk of the damage happened a little at a time over years, until the last straw finally broke the camel’s back (literally).

The result is likely severe pain, weakness, numbness and tingling going down an arm or leg. If it is your leg, there’s your “sciatica” for which a lesser therapist will blame it on a tight piriformis muscle and tell you to stretch it. While you’re at it, that therapist will tell you to stretch your knees to your chest to really deflate that disc. A large herniation usually shows up readily on an MRI, and the deflated, flattened disc will show up on an x-ray too, so there’s your degenerated disc (DD). Again, the pain is not non-specific. The disc herniation might be a proximal cause of pain but the root cause of pain isn’t the herniated disc. Instead, it’s the spine flexion stretch that you evidently had too much of, which started the cascade of events leading to that herniated disc.

At this point all is not lost, and if the person makes good choices there is still much that can be done.

However, as the ruptured disc deflates, it also flattens, which shortens the space between the above and below vertebral bones. That shortening slackens the ligaments that were connecting the two vertebra and without those ligaments holding as tight, vertebral instability is increased in all directions. The shorter disc also brings the facet joints closer together, so they compress sooner and harder during otherwise normal activities resulting in arthritis, bone spurs and osteophytes.

This begins to show up in the later stages of spine degeneration, which is the body’s best attempt to “re-stabilize” the damaged region. The arthritic changes can be painful in and of themselves, but the combination of lost disc height and increased bone formation narrows the vertebral canal and foramen, producing a condition called stenosis. The narrowing can then pinch the spinal cord or nerves exiting the spinal column.

When stenosis gets bad enough, the person might have severe pain, numbness, tingling, muscle weakness, and difficulty walking. Even standing with a neutral spine can be painful. At this point we are getting to where it might be too late for SpineFitYoga, or much else, to do a lot of good.

The good news is that it takes decades to get to this scenario, but the bad news is many people get here anyway and have no idea how. They blame it on age or bad genetics, which are partial truths at best. However, if we follow the chain of events and recognize what is going on we can see how it all happens from the beginning. From there we can take steps to stop it, and most importantly take steps off the path that causes it, thus allowing the body to heal itself, preferably as early as possible. That’s what SpineFitYoga is all about.

Compressive Stress (excessive):

Compressive, or axial stress, is when the discs are squished or “compressed” from top to bottom. One would think that compressive stress is particularly pathological, with weightlifters snapping up their spines all the time with the extreme loads they lift. But in general, the spine holds up fairly well to compression, at least compression with a neutral spine.

In fact, without compression stresses, the spine will lose bone mineral density and become osteoporotic, and it is because of intermittent compressive stresses that weightlifters and gymnasts have some of the densest and strongest bones. This offers considerable protection to osteopenia and osteoporosis later in life.

Also, compressive stresses, within reason, seem protective of the vertebral discs themselves. So do you want spine compression in your yoga or other exercise program? Yes, yes you do.

However, compressive forces if applied unevenly, suddenly, or too forcefully without your body having had time to adapt and strengthen can and does cause damage, which on an MRI often shows up a Schmorl’s node.

A Schmorl’s node is a type of herniation where instead of the nuclear gel of the central disc working its way posterior as is seen with repeated spine flexion, it breaks through the end plate and travels either upward or downward into the vertebral body above or below.

Schmorl’s nodes most frequently occur where the lumbar and thoracic spine come together. This is likely because of concentrated levels of twisting hit this region as all the above vertebra are buttressed by the rib cage. The twisting tightly winds up half of the annulus fibers of the vertebral discs, thus increasing compressive stress on the nucleus forcing it up or down through whichever end plate is weaker.

The other likely cause of Schmorl’s nodes would be due to sudden and extreme compressive stress. For example, hitting a large bump on a motorcycle or ATV when seated, where rather than soak up the stress through your legs, that sharp compressive stress went direct through the spine. A fall onto one’s tailbone can do the same.

Even for big impacts a neutral spine is protective, allowing the vertebral bodies to absorb more than double the amount of compressive stress before end plate failure. Too much compression combined with flexion can result in vertebral body fractures, particularly if the person has lesser bone density. On the other hand, compressive with extension really loads up the facet joints and can fracture the pars interarticularis which can later result in the condition of spondylolisthesis (an unstable condition where one vertebra slips forward on another).

Workplace vibration often shows up on occupational research as a top risk factor for spine degeneration. The vibration they are talking about is usually road vibration from driving or piloting helicopters, so it perhaps can be thought of as long term repeated micro-compressive stress.Spine damage resulting from vibration has been difficult to sort out from the damage induced by prolonged semi-flexed seating positions that often accompany it. However, recent biomechanics research does show vibration exposure to be an additional factor which can accelerate already established partial herniations, and when combined with with flexion causes disruption and delamination of the annulus collagen fibers resulting outward migration of the nucleus.

So in short, spine compression in and of itself usually is not a problem and to some degree is a solution. However, compression when combined with other motions (flexion, extension, twisting) is where you run into problems. Such that if you are going to do some lifting, you really want to do it with a neutral spine. And if you are going to spend a long time in a position, you really want that position to be neutral. Both of which are what’s taught, and more importantly trained, in SpineFitYoga.

Spine Extension

Spine extension (bending backward) like a sphinx, cobra, backbend asana, or looking overhead, is a little more tricky. If the spine is otherwise healthy, mild to moderate spine extension stretches can be a welcome break from long periods of flexion. I prefer avoiding long periods of flexion from the start, rather than hoping to sort of fix things later. However, to put extension damage into context, I think we need to discuss the continuum from potential help to certain harm.

In the 1980s, Robin McKenzie, a New Zealand physiotherapist and founder of the popular McKenzie method for neck and back pain, theorized that if spine flexion herniated discs posteriorly, then spine extension would push that disc material forward again. There was no research testing whether in fact this worked until 2009, when Scannell and McGill confirmed that after repeated spinal flexion to the point of causing a partial posterior disc herniation, an immediate follow up of repeated spine extension “sometimes” helped to return disc material back to the center. However there were numerous caveats to that study.

First, the extension stretches only worked about half the time. They found that if the flexion damage was enough to where the discs lost more than 30% of their disk height, then the repeated extension didn’t work, the disc was already too damaged.

Also, in order for the disc material to move posterior in the first place, there had to be damage or a tear to some of the posterior annulus fibers allowing the gel of the nucleus to escape backward. Just pushing the nucleus back to the front with extension did not heal that annulus damage which would likely take months in living tissue. It’s like if the barn door opened, and the horses escaped, just throwing them back inside isn’t likely to do much good if you can’t figure out how to close the door.

I corresponded with Dr. McGill after reading his paper and asked if he was now advocating McKenzie stretches as part of his routine. He said not really, saying he thought there was potential that repeated spine extension exercises (like the floppy pushup) would start to damage the facet joints, possibly causing arthritic changes down the road. He then relayed the idea of having the person rest in prone position propped up on elbows (sphinx pose in yoga) or just prone with two fists under the chin for about 10 minutes. The idea being for a sustained extension stretch might still help work the disc material forward, minus the impact to the facet joints induced by repeated end range extension.

McGill’s group of researchers followed up that study with another in 2012. They wondered if spine flexion herniated a disc backward, and extension pushed it forward, if alternating each flexion stretch with an immediate extension stretch would offset and eliminate that damage. Rather than help they found alternating extension with flexion actually made the discs herniate 53% faster.

Apparently the discs act more like a wire coat hanger. Repeatedly bending the wire both back and forth does not negate damage, but is one of the surest ways to get the wire to break. So quickly alternating between a downward and upward facing dog and repeated sun salutations are probably not ideal if you have disc problems.

Reading this research was one of the things that got me to really trust McGill’s group’s research. They weren’t trying to prove anything, rather they were just testing ideas to learn what would happen, and afterwards applying what they learned to solve problems and help people.

Aggressive extension stretches, particularly if painful should always be avoided, with reasons being as follows:

  1. Extension increases compressive stress through the facet joints of the vertebra. If the spine is otherwise healthy, most people do not extend enough during daily activities to be problematic. However, if your job requires looking up repeatedly or for long periods (like a tree trimmer or electrical lineman) extension might become one, especially if the discs have degenerated (likely due to too much flexion) reducing stability and bringing the facet joints closer together, such that even modest extension becomes problematic.
  2. If a disc has bulged or herniated posteriorly, that disc material and ensuing inflammatory response takes up space through which the spinal cord and/or spinal nerves travel. Extension further decreases that space which could cause increased pain, numbness and tingling going down the arms if it’s a neck issue, or legs if there’s a pinch in the low back.
  3. The spine, if beaten up enough with significant DD osteophytes and bone spurs, can also decrease nerve space either by itself or combined with disc material as described above. This can exacerbate nerve compressive and inflammatory pain with neck or back extension. The same changes can also cause decreased blood vessel space causing one to get dizzy when looking up and even lose consciousness.
  4. Even in a healthy spine, aggressive back extension exercises, particularly with impact (as in gymnastics, cheerleading, or American football) can result in stress fractures of the par interarticularis. Those fractures can be painful in and of themselves but with considerable core strength are often trained through without knowing they are present. However, those par fractures, if improperly healed can allow the upper vertebrae to slip forward on the lower (called spondylolisthesis) resulting in pain and disability later in life.

All the above processes make aggressive spine extension stretches something to avoid. If the spine has enough degeneration even mild extension past neutral might do more harm than good.

With severe degeneration and arthritic bone formation, resulting in considerable stenosis, just standing up straight with a neutral spine can impinge nerves. Upper cervical extension can impinge nerves going up into the head causing headaches or can impinge blood vessels to the brain causing loss of balance, loss of consciousness or even a stroke. All of which are good reasons to know the spinal injury process so as to avoid crossing the point of no return, where even with the best of exercise programs recovery is limited.

You can bounce back from a fair amount of spine injury and still lead a normal and pain free life. However, once we start talking about advanced degenerative changes, there’s sometimes less to hope for. So spine flexion/extension range of motion is more about maintaining a balance, but think of it like balance on a tightrope, rather than a teeter totter.

Spine Rotation/Twisting & Torque

Unlike flexion, and to a lesser degree extension, spine twisting and rotational stress is usually not much of a problem in and of itself. The neck especially is meant to rotate so we can look around as needed, while the thoracic and lumbar spine allows for smaller amounts of twisting that is generally not harmful. I’m sure it helps that modern life usually doesn’t park our spines in rotation as often or as long as it does flexion. Still if taken too far, rotation stretches are known to be reliable pain generators, with vertebral failure as follows.

The annulus is made up of concentered layers of collagen fibers alternately crosshatched at roughly 60 degrees. This crosshatching helps to resist overstretching in either direction of rotation. However, rotation stretching tensions every other layer of fibers resulting in two known problems. First, the tension imparted to those fibers in the direction of the stretch increases compressive pressure on the nucleus, increasing the risk for end plate type compression injuries like Schmorl’s nodes as mentioned above. At the same time, while half the annulus layers are being stretched tight, the other half (positioned in the opposite direction) is made more slack. Which if repeated enough, causes delamination or separation of the annular layers, which is an especial problem when rotation is combined with flexion, more than doubling the rate for which discs herniate in comparison to those exposed to flexion alone. Thus if you have back pain those knee to chest flexion stretches lying on your back, followed by rotating your hips side to side are probably not the best idea.

In the neck, both spine flexion and extension interacts with twisting to lessen rotational range of motion. Thus if you have poor cervical posture it’s going to be harder, with regards to both effort and vertebral stress, to turn your neck and look around. This is particularly noticeable in people with neck pain when driving.

Side Bending

Side bending, like rotation, generally doesn’t cause a lot of problems. Few (if any) people herniate a disc entirely to the side and few sports or occupations put you in position to cause such damage, or warrant research attention. However, side bending, when combined with flexion has been shown to determine the direction of herniation. Such that spine flexion forward combined with side bending to the right will push the nucleus in the opposite direction of the bend, causing a herniation to the back left, while spine flexion with side bending left will cause a herniation back right.

Thus spine flexion, because it is so overdone in daily life, is the main driver of the herniation, with lateral bending often steering it one way or the other. For example a recent patient of mine with a disc bulge back/left, worked as a roofer and would tar roofs with a heavy spray gun over his shoulder resulting in forward/right lean.

Miscellaneous factors that seem unrelated, but together really matter:

  • Genetics
  • Insomnia
  • Anxiety
  • Rumination
  • Depression

Unlike weight, there isn’t a lot of reason to think these factors directly and negatively impact the spine itself. However, evidence suggests they can all have considerable impact on resulting “felt pain” as well as how people deal with that pain. If how you deal with that pain is to sit at home, in prolonged spine flexion, watching television, eating highly processed and calorically dense foods, then it will come back around to physically worsened DD. The result would be spine pain, and around the wheel we go, likely picking up a seemingly unrelated discomfort with every turn. We are getting well on our way to what is called central sensitization and a diagnosis of fibromyalgia, which is incredibly difficult to deal with.

Genetics

Knowing how physical factors like bending, twisting and compression, when overdone negatively and reliably affected the discs, I was skeptical that spine degeneration was hereditary. It turns out the geneticists don’t cross mingle with the biomechanists that much either. I figured people from the same family likely had the same bad habits, sat in the same sofas, ate the same foods, played (or didn’t play) the same sports, etc. However, when reading the genetic research they made a really strong case with a number of studies able to link certain genes with DD. Some even estimated the hereditary contribution to DD being as high as 75%. I thought “no way,” as that made it sound as though if spine pain runs in your family you are doomed. It would also seem to imply that environmental factors (flexion, extension, compression, etc.) or the protective effects of exercise, motor control, and diet might not matter much. Yet I was seeing my rehabilitation program directed only at environmental factors work effectively every day. I suppose my results could be a fantastic placebo effect. Yet in the physical forces research discussed earlier, they were not genetically testing any discs. However, they were able to get all of them to give up the ghost one way or the other. At the same time none of the discs (genetically predisposed or not) blew spontaneously on their own. So what gives?

What made sense of it for me, and tied it all together was a study that looked at the combination of genetic and workplace factors. They found that certain genes and environmental stressors worked synergistically to damage the spine. So it wasn’t that environmental stresses don’t matter, it’s that to those with predisposing genetic factors, physical forces matter even more! Such that in the biomechanics tests, the vulnerable discs would perhaps be the ones that failed at the 3,000th instead of the 10,000th flexion repetition. An example of what they found in the workplace was that having a predisposing genotype in an occupation that had low levels of spine bending and twisting, the odds of developing DD were elevated by 76% compared to controls. The control subjects without that gene in a high bending/twisting occupation had their DD risk increased to 332%. However, the high risk genotype when combined with high levels of bending and twisting increased the risk of DD to a whopping 1148%. Interestingly, another paper found that a different DD predisposing gene, when combined with obesity more than doubles disc height loss, of either the gene or the bodyweight alone by the time they were 40-45 years old.

So in the case where there is a genetic predisposition or family history of DD, maintenance of pristine spine mechanics and fitness becomes evermore important. Reasons for optimism include the protective effects of exercise (type not specified) that reduced the risk of DD by more than half. Another study found that after bariatric surgery, those who lost 80 pounds gained back 2mm of disc height. So the take home message is that if you suspect you have poor genes and a family history of neck and back pain, it’s not at all that you are doomed. Rather, you just need to be extra diligent to stay fit and keep your posture and motor control on point.

Insomnia

Insomnia is often experienced when you are in physical pain. Pain has been shown to disrupt sleep, and the resulting sleep loss has been shown to increase felt pain the following day. The fatigue makes you not want to exercise, or get out and see the sun. Neither of these do your spine any good, and both of which tend to degrade future sleep and all three factors (lack of sleep, sun and exercise) put you at increased risk for depression.

Rumination

Rumination is when a person focuses their attention on their distress, thinking about it over and over, but not in a way that comes up with any solutions. Distress might be psychological (i.e. in the case of social anxiety) but with chronic neck and back pain it can become physical. There does appear to be a close link between rumination, anxiety and depression. Some researchers suggest that rumination is the link by which anxiety becomes depression. Such that if you worry about a problem enough, it will bring you down, whereas if you distract yourself and stay busy, psychologically people reliably do better. If however, you’re a bricklayer, who repeatedly bends over picking up heavy loads with a flexed spine 40 hours a week, your good attitude is likely to get tested to its core. Rumination about pain is reportedly worst when trying to go to sleep, or when awakened at night, with either or both the pain and rumination about it making sleep difficult. Sleep loss not only causes increases in felt pain the following day but when sleep loss becomes chronic (as to be expected when one is in chronic pain or chronically ruminating) research has shown a reduction of hippocampal neurogenesis (new nerve cell growth). The end result being an atrophied (shrunken) hippocampus associated with the onset of depression in the short term and even the onset of Alzheimer’s in the long term.

Depression

Depression is comorbid with many pain syndromes to include both chronic neck and back. What makes depression so damaging is that when it kicks in, you lack the desire, energy, and optimism to do anything about it. And depression, being like back pain is multifactorial so there isn’t one thing that reliably fixes it. So one needs to arouse what feels like a herculean effort to lessen symptoms exactly when they don’t feel like doing anything. Antidepressant medications are only sometimes beneficial but many have the side effect of “substantial weight gain,” so fine there.

I actually think that’s where typical Hatha Yoga helps the most in people with neck and back pain. It’s the mindfulness, along with self-control, community, optimism and a positive outlook that makes people in pain feel better. It’s hard to ruminate about pain if you are fully engaged in a yoga sequence and trying not to lose your balance. For some, the good is enough to offset the bad of perhaps too many spine flexion stretches, sometimes combined with rotation and often cycled with extension. So my intention with the SpineFitYoga sequences was to unpack the various components of yoga, maximizing what’s best and minimizing what isn’t, while blending the modern science with what Satchidananda said was originally a “science of the mind.” Fascinatingly, nowhere in Patanjali’s Yoga Sutras did he necessitate or even recommend spine stretching. Rather he defined an asana as “a steady comfortable posture.”. Commenting about Patanjali, Satchidananda wrote:

“Sri Patanjali was the epitome of acceptance of all methods and a broad mindedness of approach. He did not limit his instructions to one particular technique, to members of any particular religion or philosophy, or in any other way.”

So it’s with that openness and acceptance that I hope people will welcome my efforts to synthesize wisdoms from all cultures and ages with efforts to help people pursue or continue yoga that might be in pain. In the pursuit of doing yoga, I hope to help those with neck and back pain who otherwise don’t have access to good care. And of course make people healthier and happier by spreading mindfulness of yoga and Karmic yoga. If anyone achieves the state of samadhi, in savasana following my sequence I definitely want to hear about it.

Concluding Remarks

The causes of spine damage are so important because if you only treat symptoms and proximal causes do not remove the root cause there is no amount of “feel good treatments” that will ultimately make you better. You can get adjustments, massage or acupuncture from now until the sacred cows come home, but if you do not stop over-flexing your vertebral discs it will eventually lead to snap city aka herniation. Therefore understanding the causes of spine pain is crucial if you want to heal.

Spine pain is not a classification, it’s a continuum. If you look at spine pain with an accurate understanding of the degenerative process you can see where different movements might be more or less irritating, and some might think that less irritation is relatively relieving even though it’s furthering the degenerative process. SpineFitYoga seeks to minimize irritating movements to optimally allow spine healing by balancing fitness, awareness, and coordination, not just knowing, but doing.