In the last article on back health, Back on Track I, we discussed lumbar disc injury in relationship to low back posture and yoga poses. However, as noted in the last article, this is just one of many low back dysfunctions. There are numerous back health conditions to familiarize yourself with. In this post we will examine the individual presenting with hyperextension of the lumbar spine or hyperlordosis, essentially the opposite of the flattened lumbar spine covered in Back on Track I .
To imagine what hyperlordosis looks like, think of a pregnant woman who carries all her weight (baby) in her abdomen. It’s easy to visualize how as her tummy grows, the weight of her belly pulls her spine forward, arching her low back deeper. Of course, not only pregnant women present with this posture; look around and you will see many other examples of individuals standing with this hyperlordotic posture.
You might be wondering what causes this posture? As in the case of a pregnant woman, it is easy to conceptualize the heavy weight of the abdomen pulling the spine forward and down with gravity. However, this posture is not dependent on a certain body type; it can simply be the product of genetics and habit over time as our bodies holding pattern becomes ingrained and memorized like a go to blue print. Old injury can also dictate how a postural pattern emerges. The human body has a remarkable way of figuring out the path of least resistance; unconsiously our bodies are moving away from the pain.
Tight hip flexors and weak abdominals can also co-concur with this posture. The iliopsoas muscles, otherwise known as the hip flexors, are often tight or shortened in people with hyperlordosis. The iliopsoas is a name for the two hip flexor muscles, the iliacus and the psoas. The iliacus attachment starts at the inside wall of the pelvis while the psoas attaches along the length of the lumbar spine on the transverse processes. Both muscles come together and share a common tendon of insertion at the top anterior aspect of the femur (thigh) bone. Biomechanically, when this muscle contracts it creates flexion at the hip joint. When this muscle becomes chronically shortened, it heightens the “flexed” posture at the hip joint by pulling at its attachment points – pulling the lumbar spine into greater lordosis and creating an anterior tilt of the pelvis. This can also be heightened by lax or weak lower abdominals.
Whatever the cause of this postural imbalance, the concern is how the imbalance affects the health of the individual. A potential hazard of hyperlordiosis, other than the regular aches and pains of tightened postural muscles alongside the spine, is back pain from the structures of the spine as a result of being strained chronically outside of their healthful alignment. Some individuals will experience pinching of the facet joints, the two small joints where the bony edges of two vertebrae meet one another at the posterior aspect of the spine. When facet joints, or any bony structures, are compressed it can lead to arthritic symptoms/conditions of the spine from the wear and tear of asymmetrical force distribution. This can be especially true when a person with this condition continually places further compression of the spine during deep back bends in yoga.
Yoga poses involving forward folds and hip extensions, however, can offer an opportunity to undo the low back stresses and strains of this posture type. The forward bends open the spaces of the lumbar vertebrae and lengthen the tightened postural muscles along the sides of the spine, which can be very relieving to a hyperlordotic back. And poses that extend the hip will stretch the iliospoas which can also be very beneficial for correcting this posture when shortened hip flexors are involved.
Of course each student’s anatomy and postural tensions are unique so care must be taken to ensure the forward bends and hip extensions are targeting the area you wish to affect. In the forward bends, it is important to ensure the bending doesn’t just occur at structures above and below. For example a person with tight muscles along the lumbar portion of the spine might overcompensate by over-bending the area of the spine above, the thoracic spine. Or, when stretching the hip into extension, the person with tight hip flexors will need to caution against the lumbar spine being pulled into deeper extension from the pull of the psoas muscle.
A simple exercise to help teach isolation into the lumbar spine is to have him or her stand with their back body against a wall or lying flat on the floor. Have him or her perform a gentle pelvic tilt (a posterior rotation of the pelvis), which promotes flattening of the lumbar spine towards the wall or floor. It is helpful in this exercise that the individual utilize lower abdominal muscles to activate the motion rather than solely clenching the gluteals (buttocks). It is also important in this exercise that the rest of the body remain still and relaxed to promote the isolation of movement at the pelvis/low back. Lastly, it is helpful to encourage lengthening the spine, a gentle self-traction, with this motion.
Next, apply the pelvic tilt motion to the forward bends and hip extension asanas to maximize their benefit. Examples of forward bends are Paschimottanasana (seated forward bend), Uttanasana (standing forward bend), Malasana (garland pose), Anada Balasana (happy baby pose). Examples of hip extension poses are Low Lunge, High Lunge, and Virabhadrasana I (Warrior I). Cueing suggestions might be “activate through the lower abdominals, drawing the navel towards the spine”, or “attempt to flatten the lumbar spine and draw the tailbone towards the ground”.
It is important to realize that when teaching yoga to a group of individuals, each person will have his or her own unique anatomy and considerations for back health. In Back on Track I a flattened lumbar spine was considered, while in this article on over-extended lumbar spine was discussed. By contrasting the two extremes, my hope was to highlight that what might be helpful cues for one individual may be the exact opposite for another individual. Since this can be the case, my recommendation is to get to know your students and overtime assist them with their individual needs and precautions to maximize health in their yoga practice.