By Dr. Rita Khanna
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.
HOW DOES SLIPPED DISC OCCUR?
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 shovelling or weeding in the garden. It can also occur in a simple function, like 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.
WHAT IS SCIATICA AND HOW DOES IT OCCUR?
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 DISK 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. 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.
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. Yoga, however, offers an effective and far simpler way out of this painful predicament. The Yoga 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 practiced each day, so that spinal stability and function can be restored and a full range of activities can be re-adopted.
Asanas in the initial stage:
In the acute stage of immobilizing pain, a prone (facedown) 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.
Makarasana: Lie in prone position, feet together, hands by the side, palms facing upwards, and forehead touching the floor. Now, spread the legs apart and turn the toes sideways, then stretch the hands forward. Place the right hand under the left armpit, and left hand on the right shoulder, making sure one elbow is under the other. Relax in this position, while breathing normally.
Niralambasana: Lie in a prone position with your forehead on the floor, hands by the side, legs together, and toes pointed outwards. Slowly stretch the arms forward, and bend the elbows, raising the head upwards. Place the chin on the palms, with your fingers touching the cheeks, making sure the elbows are together. Hold this for some time, breathing normally. Then, slowly come back to the original position.
Advasana: Lie on the stomach. Stretch both arms above the head, with the palms facing downwards. The forehead should be resting on the floor. Relax the whole body, while keeping the awareness on the breath. If there is any difficulty in breathing, a pillow can be placed under the chest. Perform it as long as you want.
Jyestikasana: Lie flat on the stomach, with legs straight, and the forehead resting on the floor. Interlock the fingers and place the palms on the back of the head or neck. Allow the elbows to rest on the floor. Relax the whole body, while keeping the awareness on the breath.
Matsyakridasana: Lie on the stomach with the fingers interlocked under the head. Bend the left leg sideways and bring the left knee close to the ribs. The right leg should remain straight. Swivel the arms to the left and rest the left elbow on the left knee. If this is not comfortable, you can adjust the arms position according to your own body condition. Relax in the final pose, and after some time, change sides. This position resembles a flapping fish.
Precautions: No forward bending Asanas
Ujjayi: Sit in Vajrasana or in any comfortable posture. Now, inhale slowly and deeply through the nose, and while exhaling, contract the air passage and exhale slowly with a whispering sound.
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.
Vajrasana: Sit with legs extended forward together, hands by the side of the body, and palms resting on the floor. Now, bend the right leg at the knee and place the foot under the right buttock. Similarly, bend the left leg, placing it under the left buttock. Hands should be resting on the thighs with the back straight. Hold for some time – then, come back to the original position.
Relaxation techniques: Ajapa japa in Makrasana
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 practiced 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 practiced 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 practiced 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 practiced in the Meditative postures, with an upright spinal column.
Asanas for later stage: Bhujangasana, Ardha Shalabhasana, Saral Dhanurasana, Poorna Shalabhasana, Dhanurasana, Tadasana
All these 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 Ardha Bhujangasana, 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 practiced, in full, each morning, before any food has been taken. Each Asana should be practiced 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.
Sphinxasana: Lie flat on the stomach, with the forehead resting on the floor, legs straight, feet together, and the soles of the feet uppermost. Bend the arms, and place the forearms on the floor, with the palms downwards, on each side of the head. The fingertips point forward, but are in line with the crown of the head. The forearms and elbows are close to the body. Relax the whole body. Inhale; raise the head, shoulders, and chest, by bringing the upper arms to the vertical position. The elbows, forearms, and hands should remain on the floor. Relax in this position as long as you want, with normal breathing, and then lower the body while exhaling. This is one round. Practice up to 5 rounds.
Shavasana: Lie down on the back, with the legs together, and hands by the side. Spread the legs apart slowly, keeping the heels inside and toes outside. Keep your hands away from the body, with the palms facing upwards. Close your eyes; loosen and relax all the muscles in the body, and focus on your normal and natural breathing.
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 Shashankasana, Majariasana, Shashank-Bhujangasana and Shavasana.
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.
A FEW MORE PRECAUTIONS
• Before you start a Yoga practice, while suffering from Slip disc and Sciatic pain, consult your health care provider and a qualified Yoga instructor, and make sure you follow their advice diligently.
• When performing the postures, be careful not to overstep your pain boundaries. If you experience pain, back off. You must find the program that best suits your body. Listen to your body.
• Do not sit for long periods, and avoid activities that worsen your pain; especially if you’ve been diagnosed with a herniated disc. When you do sit, always use a lumbar support. In most cases, extensive walking is also not advisable.
• Be sure that you are adequately hydrating yourself with at least eight glasses of water each day.
• The key to prevent Sciatica, and Slip disc, is to prevent any damage to your lower spine. Maintain a good posture while sitting.
• Finally, remember to continue with these poses long after the symptoms have disappeared.
The above Yoga program, when followed diligently, has been found to restore disc health and prevent recurrences of both Slipped disc and Sciatica.
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Courtesy: Dr. Rita Khanna’s Yogashaastra Studio.
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Dr. Rita Khanna
Dr. Rita Khanna is a well-known name in the field of Yoga and Naturopathy. She was initiated into this discipline over 25 years ago by world famous Swami Adyatmananda of Sivananda Ashram in Rishikesh (India).
She believes firmly that Yoga is a scientific process, which helps us to lead a healthy and disease-free life. She is also actively involved in practicing alternative medicines like Naturopathy. Over the years, she has been successfully practicing these therapies and providing succour to several chronic and terminally ill patients through Yoga, Diet and Naturopathy. She is also imparting Yoga Teachers Training.
At present, Dr. Rita Khanna is running a Yoga Studio in Secunderabad (Hyderabad, India).