by Sara Curry, Owner of Bikram Yoga Portsmouth

I cannot over-expound on the ability of Bikram Yoga to heal back pain from herniated discs. This yoga gave me back my life. In the depths of my pain, I remember sitting in the car with my husband outside one of our favorite restaurants just crying. I was in so much pain, I couldn't even imagine enduring the suffering of a nice, romantic dinner. Those of you who have experienced pack pain know what it does to your life.

The following is my story and experience. I have included a posture-by-posture list of my personal approach to the practice for back pain-sufferers. I offer the information to help you on your way.

I injured my back in the fall of 2001, shortly after I had started practicing Bikram Yoga. I had spent my youth playing sports, and most recently rugby, running and weight lifting. A lifetime of aggressive and contact sports culminated in two herniated discs in my low back at S1/L5 and L5/L4. They caused acute low back and sciatic pain radiating down to my left knee.

I was in pain constantly, even in my sleep. The pain was so acute some days that my husband had to put my shoes on my feet. It was excruciating to go to work, to rest, to sleep, to walk, to drive.

My doctor told me I had three options: live with the pain, undergo a discectomy or take cortisone shots for the rest of my life.

I had begun my practice at a fantastic studio in Burlington , Vermont under wonderful, supportive teachers Kelley Lyons and Amy Nietzberg. I decided to try Bikram Yoga first.

It was no miracle cure from the start. Classes were hard and uncomfortable. I had set backs regularly. At the time, my job only allowed me to attend 3 to 4 times a week. Some days I didn't think I could go through the pain and challenge of a class, but I always felt better (increased range of motion, better sleep, less pain and an ability to participate in more) after attending.

Over time, I could see slow progress. The miracle happened when I started practicing two times a day. It took me 10 days of doubles to be pain free. I kid you not. PAIN FREE. I could sit without a back support. I could roll over at night. I could put my pants on standing up. I kept it up for two months, resting on Sundays. I have had set backs since then. Under extreme stress or after moving or shoveling snow for hours in the Vermont winter, I have had times where I get sore again. Once, I threw my back out. I have found that the quicker I get back to yoga and the more classes I can take, the faster I recover.

Now, four years out from the initial bad spell, I live a free, active life. I hike, water ski, shovel, stand on my head. There are no yoga poses that I skip or avoid. I haven't thrown out my back in over a year. I am very rarely even sore in my low back.

I recognize that double classes are not possible for all of us. With less frequent practice, the healing (and strengthening) will simply take more time. Be patient with yourself and your students. Be strong and work hard. All you need is your body and this yoga to heal yourself.

Anatomy of Back Pain

Once a herniation, always a herniation. Inter-vertebral discs function to cushion the spine and absorb shock. A herniated disc is essentially a disc with a hole in it. The tough outer membrane of the disc is breached, and the softer, inner membrane extrudes. Pain occurs when the extrusion comes into contact with a nerve. A traumatic accident or years of accumulated abuse and degeneration of the tough outer walls most commonly cause herniated discs. Most people with herniated discs have either tight hamstrings (creating downward pressure on the pelvis) or weak abdominal muscles. Both cause a state of nearly constant forward bending in the low spine.

The spinal nerves are located on the back side of the spine. When a person bends forward, the front of the vertebrae move closer together. This forces the disc toward the back of the spine, and the spinal nerves. Persistent, unsupported forward bending will cause or aggravate back pain from herniated discs. It is essential, especially in the beginning of healing for the student to be very cautious with forward bending. For most people, when their low back hurts, they lean forward and touch their toes. This is exacerbating the back pain. It will sound counterintuitive to most people to backward bend when they are sore, but it is essential to make that philosophy shift. Instead of leaning forward, a back pain-sufferer should try a supported standing backbend (like the set up for camel with the hands on the low spine) throughout the day as needed. That has been the hardest point for me to get my students to understand. I have watched students yank on their toes in the final stretching, skip camel and drop into child's pose between postures. After years, they cannot understand why they are not healing. When they finally understand and embrace the anatomy of their back pain and try the postures the right way, they begin to live without pain.

Back pain sufferers need backward bending to strengthen and relieve pain. In a backbend, the back side of the vertebrae come together, moving the discs (and their extrusions) away from the spinal nerves, thus relieving pain. Pain relief may not be instantaneous because there is often a good deal of swelling in the area and tension in the muscles from experiencing pain. Time will help. In the beginning, do like Bikram says and "kill yourself" in backward bends. That is how you will heal yourself. Second, it is important for those with herniated discs to begin strengthening their abdominal and back muscles. One can never heal or repair a herniated disc. The hole will always be there. The student must develop enough muscle strength to support the lower back and prevent aggravation. That means: SUCK YOUR GUT IN. Throughout the class, draw the abdominal muscles in during all postures except for backward bending. Third, spine twists are the most healing movement for the inter vertebral discs. The rotation of the vertebrae serves to draw the extruded material back into the disc. Any time the low back has been compacted or strained, a spinal twist (like the reclined abdominal twist) will help undo the damage. A student with back pain must work the spine twist in triangle as well as the final spinal.

Here are the four main concepts to work on during class:

• Easy does it in forward bending
• Back bend like crazy
• Suck your gut in
• Spine twist like there is no tomorrow

The following is a list of modifications (from my experience) that may need to be made in the BEGINNING of a student's healing process while there is a lot of inflammation in the lumbar spine and trauma in the muscles. It is important not to become dependant on these modifications. They are temporary changes to help you get through the tough times. As you are able, you will move back to the regular execution of all postures. You'll have your head to your knee in no time!

• Pranayama - Take this opportunity to drag your abdominal muscles in as much as possible. Remember a strong belly means a strong back.
• Half Moon - The side bending is helpful in relieving tension in the muscles around the lumbar spine. Use it to help you feel less uncomfortable.
• Backward bend - Remember to keep those elbows locked so you don't sink into your lower back. Concentrate on lifting your chest as you arch back.
• Hands to Feet - Take it very easy. Try bending your knees to get your hands to the floor. If that is too much, walk your hands down your thighs instead of keeping your arms with your ears. If putting your hands on the floor is too much, bring your hands to your thighs, chin up, suck in your stomach & flatten your back. No rounding when the pain is acute. You should look like an upside down "L" from the side.
• Awkward - Great. Work the backbend in part one like it is your job. Work your abdominal throughout.
• Eagle - No problems. Again, stomach in.
• Standing Head to Knee - This is a challenge in the beginning. If you can reach your foot, slowly straighten your back a little at a time, sucking your abdomen in when you feel sore. If you cannot reach your foot due to pain, stand up straight & lift your thigh as high as it will go. DO NOT GRAB YOUR KNEE OR YOUR THIGH; this will put more pressure on your low back. When ready, contract the abdomen & begin to round forward reaching for your foot until you can grab it. I cannot over-emphasis, DO NOT GRAB YOUR KNEE.
• Standing Bow - Work it as strongly as you can its good for you!
• Balancing Stick - You may not be able to come down to parallel because your arms and torso drag on your lower back fairly intensely. If not, set it up. Step forward and stand rock solid like a statue. Belly in, of course. Over time, start to take it down inch by inch.
• Standing Separate Leg Stretching - This posture may strain the low back in the beginning, but it is important to get a stretch to those tight hamstrings. Try hands to the thighs or hands to the floor in between your feet (depending on your flexibility) with a flat back, stomach in just like suggested in Hands to Feet.
• Triangle - Another good one. Pay attention to your spine twist.
• Standing Separate Leg Head to Knee - Similar to balancing stick, you may only be able to set it up. Step out, arms strong, belly in and turn to the side. Build the strength in your abdominal muscles and in time you will be rounding down with the best of them.
• Tree - Work those abs.
• Toe Stand - Test it out. Sometimes the bend forward hurts in the beginning. It is a great posture to stretch and strengthen, though, so get back to it as soon as possible.
• Savasana - Many students want to bend their knees up in Savasana. Try to not. When you stretch your legs out, if your lower back is achy, dribble your knees up and down like they were basketballs. That should shake out some of the tension in your lower back muscles and relieve the cramping.
• Wind-removing - The only reported problem is picking up the foot. Sometimes the pull on the front of the spine by the muscles doesn't feel good. Do what you need to do to get your leg up. Enjoy how the floor is supporting your whole spine.
• Sit up - None in the beginning. Roll over and push yourself up. Over time, though, try to get back into them. They are not a permanent modification. They will help to strengthen the abs.
• Cobra - Work your hardest even though it may be sore in the beginning. It is good for you.
• Locust - Just do your best. It will help to strengthen your back, but your legs may be too heavy in the beginning. Lock your legs tight. Work them off the floor as you can.
• Full Locust - Go for it!
• Bow - Another good one that may feel like cramping in your low back. Work through it while respecting your limitations (and don't baby yourself).
• Fixed Firm - Tight hip flexors will pull acutely on the low back in this one. That may be uncomfortable, but it is important to get them a good stretch. Do the best you can. Concentrate on lifting your chest once you can get to the floor. That should take some of the pressure and acute bend out of the lumbar spine.
• Half-tortoise - Walk your hands down your thighs to come to the floor (contracting the abdominal muscles). If that is too much, skip it for a while.
• Camel - Sore or not, camel is your friend. Don't be scared. Camel is here to help. Do your best.
• Rabbit - Go easy or skip in the beginning. Like half tortoise, you can walk your hands down your thighs if you need to & then set it up.
• Head to Knee - Try it, but bend your knee a TON, drop your head on your knee. Over time, work your heel out away from your body.
• Final Stretching - Bend your knees if you need to, to get your feet. Chest up, flat back, stomach in. As you develop strength and flexibility, you will be able to bend forward with the rest of the class. ALWAYS SUPPORT YOUR LOWER BACK WITH YOUR ABDOMINALS IN ALL FORWARD BENDS.
• Spine Twist - So, so, so good for you. Twist it out. Use your abs (it is a great strengthener for the obliques) to twist.
• Kapalbhati - This is a great opportunity for you to develop strength in your abdomen. Work it. Enjoy it.
• Keep working at it. You don't have to live in pain anymore.

The author of this story is now a successful yoga studio owner and instructor in New Hampshire . She will be happy to answer any questions on the subject or just share war stories with you. You can find her on the web at: bikramyogaportsmouth.com or Sara@BikramYogaPortsmouth.com