Years back, I got rear-ended by a car while stopped at a stop sign. My kids were sipping lemonade. They didn’t bat an eyelid and thankfully were not hurt (or rattled), but I needed physiotherapy for backlash. My son was little when he started imitating me, clutching his back, doing a pretend back stretch saying, “Hai!” When he had to carry a heavy backpack, the stretch came in handy! As I grew older, my regular regimen of yoga and meditation helped keep me symptom free until I went through some personal trauma last year. Guess what got impacted first—my back! (And of course emotional eating and weight gain didn’t help…)
Well, what do you think is the leading cause of disability worldwide? What is the leading cause of pain, missed work, limitations in activity, and the second leading cause of doctor’s visits or hospitalizations?
Lower back pain!
Lower back pain affects more than 540 million people worldwide and it is estimated that up to 80% of American adults will experience back pain at some point in their lives. A growing body of literature suggests that primary care management of low back pain should involve early return to normal activities, selective use of imaging tests, and use of self-care interventions. A popular study in March 2018 asserted that people often get the wrong treatment and guidelines for lower back pain while a majority of cases respond to simple physical and psychological therapies that keep them active and enable them to stay at work.
What is lower back pain and how is it managed?
Lower back pain, or lumbago, refers to spinal and paraspinal symptoms in the lumbosacral region. It can be a disease by itself or a symptom of several musculoskeletal disorders involving the lumbar vertebrae and related soft tissue structures such as muscles, ligaments, nerves, and intervertebral discs.
Symptoms can range from mild to debilitating and can impact our quality of life and work capacity. The pain can be acute, short-term, or chronic (that lasts more than three months); it can be self-limiting with symptoms reducing by themselves. It could be congenital, the result of an injury or infection, a sedentary lifestyle, obesity, lack of exercise or incorrect exercise, muscular overuse or strain, job-related strain, sitting for a long duration, not wearing supportive shoes, poor posture or sleeping posture, bending or lifting incorrectly or linked to nerve or spinal cord ailments like sciatica, fibromyalgia, scoliosis, osteoporosis, disc degeneration, arthritis, or tumors. It could also be caused by non-spine related ailments like urinary tract infections or PID.
The incidence is greater in women than men, it can be linked to the nature of one’s work (i.e., work that requires lifting heavy objects) and is higher in middle aged and older people since it can be a degenerative condition. Physical and emotional stress aggravates lower back pain.
Ways to alleviate back pain in modern medicine involve physiotherapy, medication (NSAIDs, steroids, muscle relaxants, topical ointments), heat (or cold treatment), injections like epidurals and rarely, spinal surgeries for conditions like compression fractures or lumbar disc herniation. Patients also visit acupuncturists, massage therapists and chiropractors and many try practices like yoga, Pilates, core strengthening exercises, Alexander Technique, biofeedback, meditation or tai chi.
The good news about lower back pain is that more often than not it is temporary, it is rarely life threatening and there are many non-intrusive ways to alleviate pain that involve healthy lifestyle changes which are good for overall well being.
How does Ayurveda view lower back pain?
Ayurveda provides holistic solutions to address the root cause of lower back pain, gain long term relief and prevent recurrences.
In Ayurveda, back pain is called Kati Shoola or Kati Graham and considered to be an imbalance or Vikrati of Vata Dosha (the energy principle of air and ether). The Dhatus or tissues impacted are Mamsa (muscle), Asti (bone) or Majja (correlated to nerves or marrow). The pelvic region, lower back and colon are the seat of Vata Dosha. Additionally, whenever we experience pain (and movement is impeded), Vata Dosha is involved.
What is the cause of lower back pain? Is digestion sluggish, agni (digestive and metabolic fire) impaired, is there a buildup of ama (toxins). Is there an underlying disease? The Nidana or cause includes everything that aggravates Vata (esp. the subdosha Apana Vata). Exposure to cold, jagarana (staying up late), Vata aggravating diet, not hydrating enough, controlling natural urges (like urination, defecation, sneezing etc.), excess, less or wrong type of exercise, travel, pregnancy, related health conditions like constipation, colic, obesity, asthma, emaciation, anxiety, fear and grief are all implicated as causative factors.
One has to delve into the nature of pain and what eases the pain through a standard Ayurvedic intake; the Trividhi Pareeksha (three types of assessment, questioning, observing and examination including Nadi Pariksha). Vata pain can be intense, variable and pain with burning and inflammation could have Pitta involvement. Dull, aching, deep pain associated with congestion, obesity, depression, heaviness, numbness and indigestion could be Kapha pain that is aggravated by cold and lack of exercise.
- Nidana Parivarjana. What is your Prakriti (body constitution) and Vikrati; how can you prevent or ease lower back pain with that knowledge? Is it aggravated by your lifestyle; does your work require you to sit for long durations, can you take breaks, get a standing station, can you do strengthening yoga and Abhyanga (self-massage)? Is the back pain related to chronic constipation? Or because of a disease like Sandhigata Vata (osteoarthritis)? Or endometriosis? Nidana Parivarjana involves addressing the root cause.
- Vata pacifying Nutrition and Lifestyle. Balance Vata by keeping to a routine, getting enough sleep, avoiding exertion and with light, regular exercises like postural and strengthening exercises and nature walks. Stay warm and favor warm, easy to digest, unctuous food with the sweet, sour, salty tastes. Avoid dry, cold and processed foods. An Epsom salt bath, adding anti-inflammatory herbs and spices like ginger, turmeric and having turmeric milk can ease discomfort.
- Herbal remedies—addressing the Ama stage (getting rid of toxins that may be present) and Nirama stage (management of back pain after getting rid of ama). There is palliative care (Shamana) and/or cleansing (Shodhana) that can be done and each stage or approach could involve different herbal remedies. Common herbs and formulations include Yogaraja Guggulu, Nirgundi, Gokshura, Maharasnadi Kwath, Panchasakar Churna, Rasnapanchakam Kwath, Dhanwantaram Kwath, Dasamoolarishtam (the regimen is individualized regimen based on overall Vikrati)
- Individualized therapies that depend again on the cause, severity, nature and stage of disease and chronicity. These include Abhyanga (therapeutic massage with oils such as Mahanarayana, Karpooradi, Murivenna, Kottamchukadi or Dhanwantharam oil), Pinda Sweda (fomentation with medicated boluses), Dhanyamla Dhara (continuous pouring of a warm, fermented medicated preparation), Kati Basti (localized unctuous medicated fomentation in the lumbo-sacral region), Pizhichil (pouring warm oil on the body or ‘royal bath’ that involves the benefits of both oleation and sudation), Pichu (application of warm medicated oil-soaked cotton cloth that is replaced periodically and is a palliative therapy) and many other highly effective treatments.
- Panchakarma. Panchakarma is a detailed, individualized detoxification therapy which includes a pre-cleanse and Rasayana or rejuvenation after the treatment. The protocol designed could involve some of the therapies listed above and Snehapana (therapeutic oral ingestion of increasing quantities of medicated ghee as part of Panchakarma), Virechana (medicated purgation) and Basti (medicated enema with herbal formulations). Panchakarma alleviates many chronic conditions, improves immunity, rejuvenates the whole system and strengthens the skeletal and nervine system.
- Yoga (here is an article on yoga asanas and tips for lower back pain) and breathwork like nadi shodhan pranayama(alternate nostril breathing) and abdominal or full yogic breathing which calm Vata are very effective interventions.
- Meditation can help relax tight muscles and reduce stress which could be the cause or aggravating factor in lower back pain; studies have shown meditation (along with simple yoga postures) may work better than pain medication in managing chronic back pain.
As we age and our lifespan has increased, improving the quality of our lifespan is another next frontier. The incidence of back pain could increase with stress, age, injury, postural imbalances, diseases and other risk factors. However, we can beat those odds by educating ourselves, using the ancient science of Ayurveda to prevent and alleviate back pain and gaining a sustainable practice for taking care of our spine.