If you are at a loss of how to relieve your back pain, this case study is for you. It shows that a positive approach, the right exercise and yoga therapy can improve even complicated back problems such as spondylolisthesis and stenosis. Jill’s back and leg discomfort and road to recovery exemplify how we can learn to manage and relieve back pain, and why it is important to keep searching for the right approach. The cause of Jill’s discomfort is complicated: presenting as scoliosis and sciatic pain, it is caused by foraminal stenosis and made complex by spondylolisthesis. I’ll explain the terminology later. Suffice to say that these different conditions require different approaches from yoga therapy. In fact, what would benefit stenosis is likely to aggravate spondylolisthesis. This case study about yoga therapy for spondylolisthesis and foraminal stenosis explains how to approach this complicated cause of back pain.
Certain kinds of back pain are complicated because they are the result of several underlying conditions. The right approach may not be immediately apparent. This was the case when Jill came to me for yoga therapy. In her early 50s, Jill had experienced a persistent back discomfort causing “aching and twinges in the lower back on the right side and numbness, tingling and cramping in the right shin and foot”.
The MRI report, dating from 2013, mentions:
- moderate scoliosis
- spondylolisthesis at L5/S1
- a loss of height of the L5/S1 intervertebral disc causing foraminal stenosis and compression of the right L5 nerve root.
The L5 and S1 point to the exact vertebrae involved: L5 is the lowest lumbar disc and S1 the top of the sacrum. More recently, Jill developed a problem with her left hip, which won’t open fully, probably due to osteoarthritis. The scoliosis is probably a contributing factor for both the back condition and the hip osteoarthritis.
Jill experienced her symptoms mostly at night, when she felt dull discomfort and twinges in her back with tingling in the leg. She said that most disconcerting about the sciatic pain was it’s unpredictability. She had tried physiotherapy, osteopathy and acupuncture, none of which gave her complete relief. Despite years of unresolved pain, Jill remained positive and did physiotherapy stretches at home, 2 hours of Pilates per week, and swimming once a week. She had practised Hatha yoga in the past, but was advised to stop because of the sciatic pain. One of the reasons to try yoga therapy was that she missed doing yoga.
Jill’s experience of her back problems demonstrates that MRI reports don’t have the last word and it is possible that people feel much less pain than the MRI report would warrant and vice versa. The reasons for this are not clear, but what does seem important is a positive approach and remaining as active as possible.
So what are spondylolisthesis and stenosis?
In spondylolisthesis a fracture in the spine causes one vertebra to slide forward, or more rarely backward. If the disc slips forward, as in Jill’s case, one has to avoid back bends, as this may push the disc further forward.
Stenosis means “narrowing”. Foraminal stenosis is a narrowing of the space between the vertebrae, more specifically the spaces through which nerves exit or enter the spinal cord. The narrowing of this space can result in pressure on the nerves and nerve pain. In most but not all cases, back bends are beneficial for this condition.
This is when the yoga therapist has to take a deep breath … and proceed with caution.
Yoga Therapy for Spondylolisthesis and Foraminal Stenosis
As stated before, yoga therapy was not the only therapy Jill tried. She also benefited from her other activities, such as Pilates and physiotherapy exercises. Nevertheless, there was a marked improvement during the time that Jill included yoga therapy in her exercise regime. I like to think that it empowered Jill to help herself. The following were important aspects of the yoga therapy approach:
Avoiding the movements that can aggravate the pain
It may seem common sense that an essential part of pain reduction is avoiding movements that can aggravate the pain. However, it is not always clear in daily life what these movements are, especially when a nerve impingement is usually felt with a delay of an hour or even a day.
For the time being, Jill has to avoid forward bends, back bends and twists. She became increasingly aware of these movements in her daily life, and how she could improve e.g. the way she picked something of the floor. She also removed these movements from her Pilates workout. It is likely that she will always have to avoid strong back bends and strong forward bends. Other habits such as sitting up straight and lifting a certain way will have to remain habits for life as well.
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Including movements that will soothe and strengthen
-Poses that mobilise and relax the body but are neutral for the spine, such as arm and shoulder exercises, neck stretches, holding one leg in a supine position.
-Poses that gently round the back, such as child’s pose.
-Exercises that strengthen the core. To find out about core strengthening that is safe for back pain, do visit my video sessions here.
-Exercises that release and strengthen the gluts.
-A very gentle back bend, called cobra pose, keeping the lower back extended.
-Hip circles lying down, on all fours or standing to mobilise and lubricate the hip joints.
-For the scoliosis, side plank on the convex side. Jill was able to do the full version, moving into the pose from plank, but easier versions with one knee down can work too.
-Relaxation and moving with the breath, for a sense of wellbeing and calm.
In yoga therapy, it is important that students listen to their own body, whatever the teacher says. This is important for an area in which specialists sometimes give contradictory advice. Jill did her homework on most days and over the weeks it became clear to her which movements were beneficial. She applied the increased awareness to yoga movements as well as physiotherapy stretches. One physiotherapy exercise in particular had been prescribed for hip flexibility but it hurt her back, so it was better left out.
Before the 4th yoga session, the sensations in Jill’s back and leg became “far less troublesome” and she wasn’t even aware of the leg sensations all the time. By the 5th yoga session, Jill’s back felt “normal” and the leg sensations were only slightly there. Some sudden movements would still hurt, but when they did, Jill knew to go back to the basic poses: being careful and including basic stretches for a few days would reduce the pain again. Jill is now also enjoying Zumba classes. In her own words:
“I now feel more confident about deciding which other activities I can try because I am reassured that I should be able to recover if I feel any adverse effects. So I feel generally less constrained. Also, it feels good to be able to return to yoga, albeit in a limited way, because it did feel like a bit of a loss when I had to stop. It is gentler and inherently therapeutic and so complements the other body work I do.”
Yoga therapy for spondylolisthesis and foraminal stenosis has given Jill:
-A clear indication of which movements to avoid in yoga, physiotherapy, Pilates and daily life. Significantly, this is making the sciatica more predictable for her.
-Knowledge of which movements are beneficial in her daily practice.
-A way to relax when her back and leg feel sore, using the breath and relaxation.