Managing a love-hate relationship with wheel pose
Wheel was always one of the poses that came easily to me in yoga. Despite my internally rotated hips limiting me in hip openers, I could do wheel and I could go as high as I wanted. However, as my yoga practice progressed through the years, I began to feel a vague whisper at the height of my wheel…something wasn’t quite right.
Soon after this, while at a power yoga retreat in Costa Rica, my instructor trialed an adjustment in which he did a very high cat pose under me to push me a little higher…unfortunately without asking me first about how I was feeling in the pose and whether I was open to the adjustment.
So impressed by the aesthetics of the pose, my fellow yogis asked me: “How did that feel?” I hesitated to be truthful as I didn’t want to put my teacher down, but quite honestly, it felt as if I had been pushed past the point of safety for my body.
Backbends are a key part of yoga practice.
They have many benefits including countering the flattening of lordosis (natural sway curve of the lower back) that slowly happens with prolonged sitting, stimulating the discs of the spine, stretching ligaments and muscles, and on an energetic level, opening the heart, as well as many more. There is, however, a point for some spines where going to end range and accessing the highest point possible may not be wise.
A little too much range of motion
As you are likely aware, the spine is composed of 33 vertebrae that sit in a curved-column. The upper 24 vertebral segments are separated by discs, attached by ligaments (soft-tissue bands) that move and glide on top of each other, while the lower 9 are essentially fused in most adults (the sacrum and coccyx). The 5 vertebrae that sit on top of the sacrum are referred to as the lumbar spine and this is where I will focus the discussion on backbends here.
Bodies that can do yoga, usually end up in yoga
Yoga tends to be self-selecting, especially in the more physically “advanced” yoga styles such as power yoga. In other words, the more flexible one’s body is, the more likely they are to enjoy and gravitate to those classes because the poses are more accessible to them than to others who don’t have that range available in their joints.
Flexible bodies have the genetic make-up to be able to do a wider variety of yoga poses. There is much to be said about dedication to yoga practice, however how far we will get to in many yoga poses will be largely determined by our genetics and body-type.
The other commonality is that flexible bodies, especially females, tend to identify this ability early on in life. Therefore, if we look at the young girls and women training for gymnastics and competitive dance, they will have a greater than average range in their joints. Their joints will go further than most people’s when pushed to the limit.
These body types may present with a weakness at the lower two segments of L4-5 and L5-S1 (the first sacral vertebrae. This manifests as the top vertebrae slipping forward on the bottom one (see diagram) and happens in end-range extension of the lower back, such as deeper backbends like upward facing dog, camel and wheel pose.
This type of instability is termed a “spondylolisthesis” and can present in varying grades. Grade 1-2 being more minimal and grade 3-5 being more severe. The more severe forms can involve a weakening and fracture of the back portion of the vertebrae, called the pars interarticularis.
Explaining the slip
A certain amount of spondylolisthesis is likely congenital and pre-existing in one’s body. As much as 5-6% of the general population has pre-existing spondylolysis, many of whom will be completely pain-free.
However, it is possible that when they begin an activity which stresses this instability through repetitive backbends, they begin to reinforce the looseness in the joint and force it into a forward position where it begins to cause impingement of nerves and stretch ligaments that can bring on feelings of back pain, numbness in the buttocks and legs, and even nausea due to stress on the nervous system and internal organs.
As we age, our joints naturally begin to become less elastic and viscose, the repetitive trauma that our spines have endured through these stresses may start to cause weakness and we may not feel as comfortable going as deep into backbends as we used to.
Common activities involving such repetitive backbends are yoga styles with repetitive vinyasas, gymnastics, and some styles of dance.
Then what?
In my practice as a physiotherapist in downtown Vancouver, an area where there is probably more yoga available than any other city in the world, I often treat young women presenting with lower back pain during and after yoga practice that I believe is due to some of this instability (explained above) and a mild to moderate spondylolesthesis in their lower lumbar spine
Diagnosing a spondylolesthesis
If you are beginning to notice pain, stiffness or numbness in the hours or days following a practice involving deep back bends, or if these poses are causing you pain, there are tests that a skilled orthopaedic physiotherapist can do to assess you.
Most of the time, there will not be a need for imaging or tests unless a more significant slippage or fracture is suspected.
Managing spondylolesthesis: The good news
Most yoga practice can be adapted and modified to care for these instabilities.
Here’s a few ways:
- Practice a posterior pelvic tilt: tucking your tail posteriorly tilts your pelvis and helps to tighten and stabilize the lower few segments of the spine. Starting your backbends with a posterior pelvic tilt can help to protect you from shearing the joints.
- Shift the focus in backbends up into the mid-back (thoracic spine): with all the sitting we do these days at computers and phones, shifting the focus on backbends you’re your upper back can help strengthen of the muscles there, taking some of the pressure off of the lower back.
- Consider shifting to a style of practice that involves less vinyasas or sit a few out during your current classes.
- Work on your abdominal muscles to counter some of the flexibility you have in your lower back. Having a tighter superficial core will allow you to better control your backbends and may help compensate for the increased range that you have in your back. Additionally, switching up your routine to include activities that strengthen your core muscles, such as pilates, may be beneficial. (A series of one-one pilates sessions prior to beginning classes if preferable).
These instabilities and the limitations they bring can be gifts in disguise. Yoga should, at it’s core, be about caring for ourselves and our bodies and developing a relationship where we can listen and understand the messages it is sending us.
As we age, so our practice must change and it is with this approach that we can still have a full, satisfying practice – even without deep back bends.
