Staying Safe with Degenerative Disc Disease

by Shari

I thought I would follow up on Baxter’s excellent post about preventing spinal degenerative disc disease Degenerative Disc Disease and Yoga by discussing how you might practice yoga safely after receiving this diagnosis.

To begin, it is important to understand how to influence the health of your spinal discs in your asana practice. The spinal discs acquire their nourishment from movement. In asana we move the spine throughout a range of motion that includes flexion (forward bending), extension (backward bending), rotation (twists), and side bending. Almost all asanas combine these movements. Rotation and side bending always occur together, for example, in Triangle pose (Trikonasana). And flexion poses (forward bends) will often be counterbalanced with extension poses (backbends) and vice versa. A well-rounded asana practice will include all these motions in almost every single pose, even Savasana (Relaxation pose), depending on how you position your legs.

If you have received a diagnosis of degenerative disc disease, this indicates that your spinal discs have become brittle and thin. Because of the inherent changes in their structure, the spinal discs are more prone to injury. The vertebral body is supposed to be the main weight-bearing surface for the spine while the intervertebral disc distributes the weight and acts as a shock absorber for stresses that occur from gravitational loading. But when the disc is compromised, more weight-bearing through the vertebra will be distributed onto other structures. Some of this weight may be transferred onto your facet joints, which are not weight-bearing structures but mobility structures of your vertebral column. And with this increased weight-bearing, your body may then respond by the formation of “more bone” for protection of these structures, which can be come painful bone spurs.

The Spine with Its
Three Curves

So what is a poor yogi to do? Start by returning to your Tadasana (Mountain pose). Because postural habits are one of the most important factors in developing degenerative spinal changes in the discs, learning to stand well both on and off the mat is critical in maintaining spinal health. When you think about it, even though you practice daily for 30 minutes, eat well, get enough sleep, have a good meditation practice, and are happy and healthy, if your posture is compromised, the result as the years go by is spinal compression. Learning to incorporate Tadasana into your everyday activities of driving, sitting, bending, and so on, will go a very long way in lessening the impact of spinal compressive forces. This means keeping a “Tadasana spine” (with all three spinal curves) as you move from your hips, and learning how to bend and reach and twist without causing excessive pressure through your discs and vertebrae.

In addition to maintaining your Tadasana spine, I would also recommend that you use props when either doing your own home practice or attending class. Using a strap, chair, block or wall can be helpful in teaching you what your own body can do without pain. To keep your body safe and healthy, you should ensure that your asana never hurts.

Those of you who practice Iyengar-style hatha yoga will know what I mean when I say “props” but for those of you who practice different styles of yoga this may be a foreign concept. In that case, I recommend that when you practice you at least pay very close attention to how you are moving. Where do you initiate movement from when you go into or out of a pose? Where do you start when you come out of a pose? How do you use your hips? And your legs? Where is the weight and force coming from? Do you quickly move through a motion because it hurts but once past that “bad spot” you are okay? What happens if you don’t go so low or so deep?

In addition, working on core strengthening, using your legs effectively, breathing correctly, and maintaining (or developing) adequate flexibility will all help in keeping your spine safe.

Finally, I suggest examining how you set yourself up in Savasana. Both Nina and Baxter have talked before about different ways to position yourself in Savasana (see Savasana Variations). The version with legs on a chair (be sure the chair is the proper height for your body proportions) puts your spine into a more “neutral position” than when your legs are straight out on the floor. But this isn’t necessarily comfortable for every one. When we lie on our backs, some of us like to feel the small of the back making more contact with the floor while others of us like a bit more arch. That is the thing with all degenerative conditions: one size doesn’t fit all. So a bit of experimentation is important. It’s also a good idea to consider your sleeping positions and the support of your bed. If you aren’t well-rested and comfortable in your bed, then no amount of yoga is going to make you feel better. So take the awareness you bring to Savasana—and all your yoga poses—into your bed with you to set yourself up for a comfortable and healthy sleep.

Degenerative Disk Disease and Yoga

by Baxter

In my ongoing attempts to stay up on the developing information about yoga, aging and health, I look at other online sources of new information. One such resource is the online site called Yoga U, which sends out a periodic newsletter as well as offering special live interactive webinars on a variety of topics and yoga. (I’ll be doing a webinar for them in May on “Yoga and the Digestive System” so stay tuned!) As I was preparing for my Sunday session at Yoga Journal Conference last week “Yoga for Arthritis,” I came across a piece on Yoga U about a recent study that looked at degenerative disc disease. 

Degenerative disc disease is a process of change to the cushion-like discs found between the vertebrae or spinal bones. It most commonly affects the discs in the neck/cervical region and the lumber/lower back region. There is some ongoing debate on whether the deterioration of the discs is a natural part of the aging process (since it is seen in people without symptoms of back or neck pain in gradually increasing percentages as we age) or whether it is directly related to an abnormal condition of change in the discs. It is really part of the general wear and tear arthritic changes we see in other joints, as the discs represent a unique kind of cushion structure that is similar to the cartilage caps found on the ends of other bones in major joints of movement. But it is different from the regular cartilage in other joints in that it is a larger structure, not adherent to the vertebrae above and below it, as well as having a unique structure that distributes the intense force of gravity that travels down the spine in a specialized way.

Spinal Vertebrae and Discs

Despite our uncertainty as to a direct correlation between the presence of degenerative disc disease and back and neck pain, I have LOTS of patients and students who have both situations present together. So if I knew of something to offer them that could decrease the development of degenerative disc disease, I would be hopeful it would also reduce their chances of pain as well. The study discussed on Yoga U,  which was originally published in the European Health Journal, March 2011, compared the spines of long time yoga teachers, via MRI imaging, to those of a matched group who did not do yoga. Lo and behold, the yoga teachers, who had been teaching for at least 10 years, had significantly less degenerative disc disease.

The study, done in Taiwan, looked at yoga teachers that practiced a gentle and slow form of yoga. I found this quite compelling, since much of the yoga we recommend here at YFHA is somewhat gentle, and we always recommend moving mindfully into and out of poses. Those of our readers who practice similarly could benefit from this style of practice in regards to their spinal health. The researchers matched the yoga teachers and the control group for age, sex, general health and all were non-smokers. (Why non-smokers, you might ask? Smoking is considered a risk factor on its own for increased chance of back pain.) Even though yoga teachers had less degenerative disk disease in all areas of the spine compared to the control group, within the teachers themselves there was less degenerative disk disease in the cervical spine versus the lumbar spine. Finally, the researchers concluded that their results suggest that hatha yoga may have slowed the natural aging process in the discs.

They hypothesized that a combination of factors, such as stretching and positioning of the spine, as well as decreased weight-bearing on the spine while practicing yoga, may allow for more nutrients to diffuse or enter the spinal discs. Whatever the reasons, these are surely encouraging results! However, as always with these initial studies, this early evidence warrants further studies with larger groups of people. In the meantime, I am going to continue with my gentle, slow yoga, with the intention that my discs are benefiting every day. Won’t you join me?