scientic study about
the use of yoga therapy for the treatment of chronic lower back pain to date.
The study was funded by the National Institute of Health (NIH) and pub-
lished in the
1
Annals of Internal Medicine in December, 2005. The 12-week
program examined how participants who suffered with non-specic lower
back pain responded to yoga therapy when compared with two control
groups: a conventional exercise program developed by a Physical Therapist
and a third group who was given a self-care book on lower back health to read.
The results were undeniably positive, concluding that this particular approach
to yoga, known as Viniyoga, is a safe and effective treatment for chronic lower
back pain. Viniyoga is a particularly gentle form of yoga with a strong focus
on individual adaptation and breath development. It is extremely accessible
for all body types. This study provides physicians and other western-trained
medical professionals conclusive evidence for recommending Viniyoga
and possibly other therapeutically oriented styles of yoga to their patients.
Robin Rothenberg co-authored the yoga program and worked extensively
with the researchers. She taught all the classes in the original study and is
now training staff for a second, larger scale NIH study, currently underway,
that uses this same Viniyoga protocol. Now she has recreated that program,
so that you have the opportunity to experience the benets of Viniyoga
through The Essential Low Back Program in your own home!
The CDs and accompanying booklet are not intended to replace a medical
evaluation of your particular back condition. If you are experiencing lower
back pain, please consult with a doctor before beginning this or any other
yoga or exercise practice. There are some conditions, such as serious disc
herniation, recent back surgery, severe sciatica, or cancer, for which this
program may not be benecial. The information in this booklet is intended
to facilitate your healing through yoga. If you would like to learn more
about yoga therapy or about how to connect with a yoga therapist in your
area, you can visit the International Association of Yoga Therapys website
at: www.iayt.org.
WELCOME!
1
Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care
book for chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2005;143:849-56.
3
3
The yoga and exercise group met once a week for 90-minute sessions and
were encouraged to practice daily in the interim. The yoga participants
experienced a 78% of the yoga participants had a significant reduction in
pain levels, compared with 63% in the exercise group and 47% in the book
group. The use of medication for pain management decreased most mark-
edly among the yoga participants. In follow-up interviews, the yoga partici-
pants were the only ones who experienced continued improvement in
their condition 26 weeks later. Participants in the other two groups actually
experienced a worsening of symptoms a half-year later. Twice as many of
the participants in the yoga classes said they would denitely recommend
the yoga program to others. The Essential Low Back Program
3
diagram 1 - Spine, Side View
3
diagram 2 - Spine, Back View
LOW BACK ANATOMY 101
The body is an amazing complex of bones, muscles, nerves, and organs that seem to com-
municate magically with one another to create the experience that we call healthy function.
Without direction, the heart knows to beat, the lungs to breathe, and the liver to filter out
toxins. For the most part, we ignore the body as long as its doing what it should, treat-
ing it as if it were the hired help, a servant to the mind. Its only when the body complains,
as it does when injured, stressed, or left unattended for long periods of time that we bring
our focus to it. Even then, were mostly annoyed that it hurts, preventing us from enjoying the
activities we love or getting a good nights rest. The body is then perceived as an obstacle to
the minds fulfillment, rather than a partner in need of some extra T.L.C..
It rarely occurs to us that the body may, in fact, be expressing the unspoken frustrations and
needs of the heart. Culturally, we are attuned to physicality and most of us notice pain
at the physical level long before were able to acknowledge underlying mental or emotional
stressors. Many clients with back pain have discovered that when they changed jobs or
created better boundaries with their children, and/or spouse, their back pain dissipated.
Dr. John Sarno
2
has done extensive research on this mind-body connection, specifically in
relationship to chronic lower back pain. His findings show that theres no direct correlation
between structural anomalies seen on an X-ray and the level of pain in a particular patient.
In other words, there are people with horrific looking degenerative disc disease who are
pain-free, and folks who show insignificant structural changes but cant bend over to tie
their shoes. As we move into the specifics about the physical anatomy, its important to be
aware that the other levels of our consciousness are always at play. To paraphrase many
great wisdom teachings: Healing happens when the body, mind, and heart are aligned.
As you look at diagram 1, note that a healthy spine is shaped in a gentle S-curve. The concavity
at the lumbar and cervical regions is mirrored by the convex structures of the thoracic curve
and the sacrum. These natural curvatures create a shock absorption quality and support our
Homo erectus (upright) stance. If any of these curves are flattened out, exaggerated, or
twisted due to congenital tendencies, such as scoliosis, or as a result of injury or improper
usage, the spinal structure as a whole will be impacted.
Forming the base of the spine are the coccyx (tailbone) and the sacrum (triangular shaped
structure that establishes the center of the pelvic bowl), diagram 2. These are fused structures
that allow for little movement. The five lumbar vertebrae sit above the sacrum and together
form the lumbo-sacral curve, or what we commonly refer to as the lower back. The health
and balance of this curve is largely determined by the tone of the surrounding musculature.
Continuing up the spine are the thoracic vertebrae, which connect to the rib cage; and the
cervical vertebrae, which connect to the base of the skull.
5
2John Sarno, MD, Healing Back Pain, Warner Books, N.Y. 1991
3Diagrams adapted from AVI handouts with the permission of Gary Kraftsow. The Essential Low Back Program
photo 2
Cobra Pose with Leg Lifts
photo 1
Standing Forward Bend
diagram 8 - Erectors
diagram 9
Posterior View
diagram 10
Gluteus Muscles
There are three primary sets of muscles that play a starring
role in the balance of the pelvis and low back. On the
back side are the erectors, the quadratus lumborum, the
glutes, and the hamstrings. On the inside core are the
pelvic oor, the transversus abdominus, the multidi and
the illio-psoas (pronounced, illio-so-as). In addition to
these, the adductors, the abductors (inner and outer thigh
muscles), and hip rotators are important for stabilizing the
pelvic girdle and releasing pressure off the sciatic nerve.
On The Backside:
THE ERECTORS
diagram 8
-

The erectors are the
muscles that run lengthwise along the spinal column.
They do exactly what their name implies hold us erect.
They can be locked long (that is held habitually in an
overstretched position, as with chronic slump) or locked
short (as in the case of lumber lordosis - excessive
low-back arch). Ideally, the erectors are strong and
well-supported by the deep core muscles (the transversus
abdominus and the mutidus), and the skeletal bones
of the legs, pelvis and spine, providing good postural
alignment. Forward bends stretch the erectors, photo 1
and back bends like the Cobra Variations, photo 2
strengthen them.
QUADRATUS LUMBORUM

diagram 9
-

The
quadratus spans either side of the spine across the lumbar
region, below the rib-cage, and connect to the sacrum
at the bottom. Most often when people put their hands
to the small of the back on the sides and complain, Oy,
my back hurts!, their hands are pressing into the qua-
dratus. The quadratus is like the sentry for the low back.
With any sign of strain or torsion in the lumbo-sacral
region, the quadratus lock down in a splinting action to
keep further damage from happening. The challenge
with long-term back problems is that often quadratus
on one or both sides has been on guard for so long, it
has literally forgotten how to relax, which impedes
circulation and circumvents healing. Side Bends and
twists in particular, help stretch the quadratus as do
forward bends like *The Wheel.
*See pg. 24 for a full description of The Essential Low Back
Program's version of The Wheel.
GLUTEUS MUSCLES
diagram 10
-

The glutes or butt
muscles, in conjunction with the hamstring and quad-
riceps (back and front thigh muscles), are responsible
for the mobility and stability of our pelvis. Since their
primary purpose in life is to walk us, they are happiest
when well-used. Sitting or standing for extended periods
of time actually tires them out. When weakened from
disuse, they lose their capacity to provide support for
the pelvis, a set up for potential problems in the hips,
sacrum, and lower back. If excessively tight, they can
put pressure on the sciatic nerve, creating a proverbial
pain in the a--.
MUSCLES of the LO