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January 1981

Blessing to Yoga

Editorial

The Healing Power of Yoga
Swami Satyananda Saraswati

Yoga Research & Therapy

Yoga Therapy - Ashram Experience
Dr. Swami Shankardevananda Saraswati, MB, BS (Syd)

Slipped Disc and Sciatica
Dr. Swami Karmananda Saraswati MB, BS (Syd)

Scientific Yoga Therapy Response
Swami Niranjan Saraswati

Amaroli
Swami Satyananda Saraswati

No Escape
Swami Kriyamurti Saraswati

Experience in Yoga
K. Arumugam, Coimbatore

Kabir
Swami Gaurishankara Saraswati



Yogic Management of Slipped Disc and Sciatica

Dr. Swami Karmananda Saraswati MB, BS (Syd)

Slipped disc and sciatica are two closely related conditions occurring in the lumbosacral spine. The human spinal column consists of more than 33 individual bones called vertebrae, stacked one on top of the other and surrounded by the thick spinal muscles, the strongest muscles in the body. Lying between the vertebral bodies are cushion-like fibrous pads which act as shock absorbers, protecting the brain, spinal cord and internal organs from damage as we walk, just as the shock absorbers of a car protect the passengers from the shock of a rough, bumpy road. These are the spinal discs. They are filled with a thick jelly-like fluid and are held in position by strong ligaments attached to the bones above and below. Slipped disc occurs when excessive strain is brought to bear upon the lower back region, causing one of these discs to rupture so that the fluid inside herniates and escapes backwards. This injury usually occurs while bending forward with the knees straight to shift a weight from the floor or while shoveling or weeding in the garden. It has also occurred simply when releasing the clutch pedal while driving a car.

This painful experience usually occurs when a person with weak spinal muscles and ligaments applies an excessive strain to the back. It seldom occurs in seasoned labourers or manual workers, but is frequently seen in sedentary workers who are unused to regular exercise. Its incidence would be greatly reduced by daily practice of a few yogic asanas to preserve the strength and flexibility of the spinal muscles and ligaments, and with more widespread knowledge of the correct way to lift a heavy weight from the floor. The crouching position with knees bent protects the vulnerable lower back from excessive strain.

The onset of slipped disc is sudden and immediate. Something is felt to 'go' or 'tear' in the lower back, followed by a sharp, well localized pain which may be agonizing. The individual is left incapacitated- either unable to straighten up at all, or else unable to bend the spine forward again, even slightly, as this gives rise to immediate severe pain. He or she is usually brought to bed or for X-ray examination soon after.

In the next few hours the back pain continues to worsen until it is constant and unremitting. This occurs as the ligaments and tissues around the injured disc become engorged with blood and tissue fluids. The protective covering of the spinal muscles rapidly goes into tight spasm to prevent further painful movement of the area, and the delicate pain fibres supplying the torn disc ligaments become increasingly irritated. The whole area becomes inflamed, hot and swollen and is very tender to touch.

Sciatica refers to a sharp, lightning-like pain which shoots down the back of the leg. It occurs if the herniated material from a ruptured spinal disc in the lower back presses upon the delicate nerve roots emerging from the spinal cord at that level. These nerve roots pass from the spinal column and converge to form the sciatic nerves, which run down the back of each leg. These nerves run right down to the feet, supplying the skin and muscles of the back of the legs. This is why sciatic pain may be experienced in the buttock, in the back of the thigh or in the calf, even though the root problem lies in the lower back region. In response to this pain, the muscles of the back of the leg go into a tight spasm, especially if the sufferer continues to walk, because every step further stretches and irritates the injured nerve roots.

Initial recovery from slipped disc and sciatica

Slipped disc with accompanying sciatica is a painful, incapacitating experience which demands immediate immobilization on a hard bed. Absolute bed rest is necessary while the ruptured disc heals and inflammation subsides. In the acute situation of the first few days, pain relief can be provided by applying alternating hot/cold fomentations over the inflamed area, and adopting a suitable yogic posture such as makarasana which minimizes strain on the lower back region. Aspirin also proves useful in this period. It is important that the spine be kept immobilized as far as possible. No attempt should be made to leave the bed for any reason. For toilet purposes, a bed pan should be available. The patient should rest in a quiet room with minimal disturbance until healing is complete. This commonly requires 10 days or even longer, if the injury is a severe one.

Long term complications and problems

Many slipped disc and sciatica sufferers have a long history of recurrent bouts of crippling incapacity stretching back for many years. Any slight sudden strain, twisting or bending movement is often enough to initiate the whole process once again. As a result they are no longer able to enjoy a full, active life. They often become dependent on analgesic drugs for relief and are frequently forced to take time off from work or household duties in order to rest in bed. Often their employers, family and friends begin to regard their problem as a psychological one, for they are unable to comprehend a life punctuated by continual incapacitating bouts of back pain. Sufferers often develop personality disorders as well - becoming depressed, niggardly and irritable. They are often labeled as 'whiners' or 'complainers' and others avoid their company. Marital, family and social relationships commonly deteriorate as the problem continues to recur.

Surgical procedures

Long term slipped disc sufferers frequently come to surgery for removal of the troublesome disc and permanent fusion of the vertebral joint. Whenever two bone surfaces are permanently opposed to one another they quickly fuse together so that all movement ceases. The surgeon induces this process wilfully by removing the damaged disc and obliterating the intervening joint contents. This procedure which renders the spine permanently stiff and unable to bend, nevertheless provides welcome relief after many years of suffering. Yoga, however offers an effective and far simpler way out of this painful predicament.

Yogic management of slipped disc and sciatica

The following yoga program, when followed diligently, has been found to restore disc health and prevent recurrences of both slipped disc and sciatica. The program is based on the backward bending asanas, which strengthen the posterior ligaments and muscles that hold the damaged disc in place, and promote the circulation of pranic energy to the whole region. They should be practised each day so that spinal stability and function can be restored and a full range of activities can be re-adopted. In this way surgical intervention usually proves unnecessary.

1. In the acute stage of immobilizing pain, a prone (face down) posture on a hard bed should be adopted. Resting in makarasana (crocodile pose) for long periods reduces tension on the disc and nerve roots, providing relief from pain and promoting healing. Sleeping in advasana (reversed corpse posture) or jyestikasana (best posture) is recommended. In sciatica, matsyakridasana (flapping fish posture), with the affected leg drawn up to the chest, to relieve pressure on the damaged nerve roots, will bring relief. These postures should be adopted for relief of pain in the acute situation, so that as much rest as possible can be gained.

2. The following backward bending asanas should be adopted, according to capacity, as healing proceeds and pain diminishes. The first asana attempted should be the simple version of bhujangasana (cobra posture) known as the sphinx posture. Do not strain, and stop if pain develops. Once sphinx is mastered, the following asanas should be adopted gradually, in this order: bhujangasana, ardha shalabhasana, saral dhanurasana, poorna shalabhasana, dhanurasana. Ultimately this program should be practised in full each morning, before any food has been taken. Each asana should be practised a maximum of 5 times, followed by complete relaxation in advasana. The session should conclude with deep relaxation for 15 or 20 minutes, initially in advasana and later shavasana can be adopted. Daily practice should continue indefinitely to avoid recurrence.

3. All forward bending asanas should be absolutely avoided for 4-6 months, as they can precipitate a recurrence of the original condition. They may then be re-introduced gradually, under guidance, after recovery is complete, beginning with shakti bandha series, shashankasana, majariasana and shashank-bhujangasana.

4. During the recovery period, cross-legged sitting postures should not be adopted, as they increase nerve root tension in the lower back. They can be resumed after a few months. Pranayama and meditation in vajrasana are highly recommended.

5. Ajapa japa, movement of breath awareness in the spinal passage from mooladhara chakra in the perineum up to ajna chakra at the top of the spinal column, is very effective in all spinal disorders, including slipped disc and sciatica. Awareness of So-ham should be practised in conjunction with the psychic breath, drawing the breath up from mooladhara to sahasrara with inspiration and the mantra So, and taking the awareness down from ajna to mooladhara with expiration and the mantra Ham. This can be practised in any prone relaxation posture with the spine straight. In the beginning, advasana can be used, followed by shavasana once the supine resting pose can be comfortably adopted. Awareness of the natural abdominal breath can also be added in shavasana. Ajapa japa can be practised as frequently and for as long as desired. It promotes the flow of pranic energy in the spinal column, facilitates healing and brings deep mental and physical relaxation. Finally, the practice should be continued in vajrasana, then in a cross legged posture.
The effects of ajapa japa can be intensified if ujjayi pranayama is practised in the meditative postures with an upright spinal column. The tongue is turned back onto the upper palate (khechari mudra) and the throat region is contracted to produce a gentle snoring sound. This automatically increases the depth and duration of respiration and concentration.

6. Dietary recommendations. In the beginning, a light, semi-solid diet should be taken, commencing with vegetable soup. This will preserve digestive energy which can then be redirected towards the healing process, and also prevents constipation, a major problem for patients confined to bed. As the condition improves, vegetables and rice can be taken and later pulses and whole bread should be added. Avoid heavy and constipating foods such as meat and oily preparations indefinitely. Dairy products and eggs should be reduced during this period, as extra protein is not required. Highly processed and richly spiced foods are best avoided indefinitely as well.

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