Hip and Back Discomfort Part #1 – The forward-folding connection

In the opening moments of my yoga class, I ask if anyone is experiencing physical pain. A few shy hands go up. Students share and we discuss as a class the discomfort those individuals are having, inquiring if anyone else is having a similar experience. A common theme emerges – back pain.

I begin my prenatal yoga classes by having all the womxn check-in about how they are feeling, both physically and emotionally. Again, a common refrain emerges.

Most of the group is experiencing some degree of hip and low back pain.

The same theme emerges with my postpartum classes, with my private clients, and with my classes for individuals over age 50. Anecdotally, I would say that back discomfort is the most common complaint I hear as a birth worker, bodyworker, and yoga teacher. Statistically, more than 50% of American adults will struggle with back pain at some point during their adult lives. A common prescription for those who are suffering? Go to yoga!

What is the ubiquitous image of American postural yoga?
A forward-fold, or reaching down to touch your toes while standing or seated. Despite the popularity of this posture, I suggest we consider if this common action in yoga classes is really serving the majority of our population, given our epidemic of back stiffness and pain. This inquiry starts with a basic knowledge of our anatomy.

I often teach in my classes that the hips and low back are one entity, rather than as distinct regions of the body. I refer to the hips-low back or the pelvic complex as a grouping of bones and muscles whose anatomy and function need to be considered together. Picture the pelvis as a large bowl. The frontal hip bones are the front rim of the bowl. The sacrum (the large, flat-ish bone that forms the back of the pelvis) and sacroiliac joints (denoted by the two dimples above the buttocks in the low-back) form the back rim of the bowl. The pubic bones and sitz bones together form the bottom of the bowl. A complex array of muscles and connective tissue are layered over and through the pelvic bowl, connecting the spine, to the bones of the pelvis, to the femurs or thigh bones. The way these bones and muscles connect and interact form the foundation of healthy hip and spinal movement. Healthy, or functional, hip and spinal movement determines how we sit, stand, walk, run, carry, etc. Healthy patterns minimize discomfort.

Culturally, we spend a lot of time sitting at desks, driving, texting, reading, and other activities that engender a forward-leaning posture.

This forward-leaning posture tips the pelvis backward, also known as a posterior tilt. Picture the pelvis a the previously mentioned bowl. Imagine the bowl is tipping backward, with its contents spilling out the back. In this posture, the tailbone (the coccyx) tucks under and muscles of the back lengthen as we pitch forward. The more time we spend in this posture, the more natural this feels. Over time, our “neutral” pelvic posture becomes a posteriorly tilted pelvic posture. We think we are sitting or standing up straight, but our pelvis is still tilted back. I see this posture in the vast majority of students with whom I work. When we are unable to return to and sustain a neutral pelvic position, we move with less efficiency, our muscles become conditioned in dysfunctional patterns, and pain is often the result. The summary?

Sitting is bad for our hips and back!

We know this. But what does that have to do with forward-folding in yoga class? I’d argue, quite a bit.

This posterior pelvic tilt and subsequent rounding in the low back in the primary action of a forward-fold.

Try it right now. Stand up and reach for the floor. Your low back rounds and the flesh of your buttock draw down towards the floor. This posture is mimicking the same dysfunctional pattern of sitting, only in an exaggerated form. If we have determined that excess of this posture is a primary component to most back pain, why would we continue to practice that action in a yoga class? I argue that most forward-folding in yoga is only exacerbating our back and hip pain epidemic.

So what now?

I suggest we start with simple and gentle back bending, beginning by laying on the belly and gently lifting the chest away from the floor (think cobra and sphinx pose), as well as laying on the back, draped over a rolled towel or blanket. I also suggest that we spend less time (maybe no time?) forward-folding, in a yoga class or elsewhere.

Of course, these suggestions don’t apply to everyone. Forward-folding is not a dysfunctional action in and of itself, but one of several actions of a healthy spine.

However, in our yoga practice, we are searching for balance, forever seeking the middle ground. If our culture has both literally and figuratively tipped the scales (and our pelvis!) in one direction, I suggest we use our practice to bring us back to back-bending, and equilibrium.