Hamstring Stretches for Back Pain

 

Back pain can be caused by many things, such as lifting something that is too heavy, an awkward posture, physical trauma or poor fitness/physical inactivity. In our last article we looked at yoga poses which mobilise the spine and can, when performed regularly, alleviate back pain.

 

However, back pain, especially lower back pain, can also be caused by tightness in the hips and the hamstrings and, so, alternative yoga postures are needed to address pain associated with these areas. This article will look at the hamstrings and their relationship to back pain.

 

The Hamstrings (Hamme = back of leg, Stringere = to draw together)

 

 

The hamstrings are actually three muscles (Semimembranosus, Semitendinosus and the Biceps Femoris) which run through the back of the thighs. The hamstrings originate at the Ischial Tuberosity (the sit bone) and insert into the tibia and fibia just below the back of the knee. The hamstrings are prime movers of knee flexion (the front leg position in Warrior II) and hip extension (the position of the hips in Full Wheel) and are also involved in the medial rotation of the lower leg (turning in) and the lateral rotation of the lower leg (turning out).

 

Becca in Virabhadrasana II (Warrior II). The front knee is flexed in this position.

Wheel

Jennie in Full Wheel (Urdhva Dhanurasana) showing hip extension.

 

The hamstrings are used a lot in sports such as running, hurdling, football and weightlifting and are prone to injury when the muscles are suddenly lengthened without being sufficiently warm prior to movement. When the hamstrings are tight (shortened), this can result in lower back pain, knee pain and discrepancies in leg length.

 

The inability to reach the fingertips to the floor in a standing forward fold (Utttanasana) is due to hamstring tightness. Tight hamstrings can lead to lower back pain because this causes a constant pull on the sit bones from which the hamstrings originate. This pulling force causes the pelvis to tip posteriorly and flattens the normal curve of the lumbar spine which in turn places the discs and lower back muscles under significant strain. The combination of a posterior tilted pelvis, a flattened lower spine (taking out the normal lumbar curve) and tight hamstrings places a person at risk and more prone to a back injury when attempting forwarding folding movements.

 

 

How Tight are your Hamstrings?

 

 

  1. Lie on your back with both legs straight out in front of you

  2. Inhale and raise your right knee into your chest.

  3. As you exhale begin to straighten the knee and straighten out the leg, so that it is in a straight line at a 90 degree angle to the floor

  4. Keep the left leg straightened out and down on the floor with the back of the left knee as close as possible to the floor

  5. Look in a mirror or ask someone to tell you if you can get the raised leg fully straight and perpendicular to the floor

  6. Repeat on the left side

 

The inability to straighten out the leg to a 90 degree angle is a reflection of hamstring tightness and will result in a posterior tilt of the pelvis in forward folding postures. This places the back under significant stress and if you attempted to reach for your toes during a seated forward fold then you are at risk of disc injury or back strain.

 

Those who cannot get the leg fully straight in the test above should avoid seated forward fold postures. Instead, the hamstrings can be lengthened and stretched via postures which will not cause a posterior tilt of the pelvis.

 

Yoga Poses for Tight Hamstrings (without the posterior tilt of the pelvis)

 

These postures should be performed once or twice a day over two to three months in order to see a difference in hamstring flexibility. The stretches are best performed at the end of the day when your hamstrings are still sufficiently warm from movement. Doing them first thing in the morning, without prior activity, is not recommended as no muscle should be suddenly lengthened without being sufficiently warm prior to movement.

 

 

The hamstrings have a lot of fascial tissue and so, to really work on improving the flexibility of tight hamstrings, stretches should be held for a lot longer than the 5-10 breaths which are common in most yoga classes. Instead, the stretch should be held for 1-3 minutes to really open up the hamstring muscle.

 

 

Modified Reclining Hand to Foot Pose I (Supta Padangusthasana I)

 

 

Jo in Modified Reclining Hand to Foot Pose I (Supta Padangusthasana I)

  1. This posture can be done against a wall or with the lowered leg through a doorway

  2. Bring the buttocks up close to the wall and position yourself so that the raised leg is straight and fully supported against the wall and the lowered leg is also straight.

  3. Keep the back of the knee of the lowered leg as close to the floor as possible

  4. Keep both feet flexed throughout the duration of the stretch (pulling the toes upwards towards the head)

  5. Keep your breath calm and relax the hands out to the sides.

  6. Hold this posture on each side for three minutes, increasing to five as your hamstrings become more flexible.

 

Modified Reclining Hand to Foot Pose II (Supta Padangusthasana II)

 

 

Paula in Modified Reclining Hand to Foot Pose II (Supta Padangusthasana II)

 

  1. Lie on your left side with a nice straight line between the feet and the head

  2. Prop yourself up onto the left elbow keeping the shoulder away from the ear

  3. Inhale and raise your right knee to your chest

  4. Try to take hold of your big toe with the index finger and thumb of the right hand and as you exhale begin to release the right leg away from the body, straightening out the leg as shown in the picture

  5. If it is difficult to take hold of the big toe then you can hold gently just above the ankle or hook a yoga strap or hand towel around the foot in order to hold the straightened leg in place

  6. Hold for one minute before changing sides

 Supta Baddha Konasana (Reclining Bound Angle Pose)

 

This posture stretches the inner thighs (the adductors) which are often tight when the hamstrings are tight.

 

Jo in Supta Baddha Konasana (Reclining Bound Angle Pose)

 

  1. Lie on your back, bend your knees and place your feet together flat on the ground.

  2. Bring the heels close to the groins (making sure that the position feels comfortable)

  3. Tilt the hips up towards your chest and then release and tilt them towards the feet. Find a position in between these two moves so that the lower back is not lifted away from the floor but it is also not pressing too hard into the floor.

  4. The arms are relaxed at the side with the palms relaxed facing upwards or down

  5. Inhale slowly and as you exhale begin to lower the knees to the sides.

  6. If you feel uncomfortable in this posture you can try the supported version by adding pillows or blankets underneath the lower back and the knees.

  7. Try to hold the pose for two to three minutes.

 

The postures given above are designed to stretch and lengthen the hamstrings which can help to reduce back pain when performed regularly. Therefore, these postures should also be performed in conjunction with the postures demonstrated in our previous article, Yoga for Back Pain.

 

 

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Yoga for Back Pain

 

Back pain is a common feature of modern living which is estimated to cost the NHS many millions each year treating this condition. For some, the problem is short term and may be resolved without requiring any medical treatment. However, many others experience chronic back pain which causes them significant pain and discomfort in their day to day activities.

 

Back injuries can be caused by many things such as lifting something that is too heavy, an awkward posture, physical trauma or poor fitness/physical inactivity. However, the frequent repetition of certain movements that we do every day, often without thought, is a major factor underpinning back pain for many people. For example, forward-bending movements when picking up shopping bags, brushing your teeth, drying your hair and getting dressed all place the spine under significant pressure by intensifying the force on the intervertebral discs and straining the supporting ligaments.

 

Many years ago, people with back pain were advised to rest as part of their treatment. However, it is now known that keeping the spine mobile and active is a necessary component in the management of back pain. Indeed, many studies have examined the influence of exercise/inactivity in the treatment of back pain and the evidence suggests that being physically active is more effective than “GP care” in reducing pain and disability.

 

Can Yoga Help Back Pain?

 

Yes, yoga can help in the management of back pain by stretching and strengthening the spine. Indeed, maintaining a healthy spinal column is fundamental in yoga practice because the spinal column forms the main postural axis of the body’s skeleton – most yoga asanas require spinal involvement and mobilisation.

 

However, certain types of stretching can actually worsen some back problems. Accordingly, before heading to your nearest yoga class, become acquainted with some of the yoga postures which are good for your type of back pain and others that should be avoided.

 

The Spine

 

The spine (also known as the spinal or vertebral column) is made up of 33 vertebrae bones. The lower nine vertebrae are fused into two larger bones known as the sacrum and the coccyx.

 

Fig. 1 The Spine

 

vert

 

The 26 moveable components of the spine (shown in fig.1) are linked by a series of mobile joints. Between the bones of each joint is an intervertebral disc. These discs serve as shock absorbers to protect the brain when we do things like walking, running or jumping.  The intervertebral disc can be separated into two parts: the inner disc (the nucleus pulposus) and the annulus fibrosis, the rings of ligament that surround and support the centre.

 

Fig. 2 The Intervertebral Disc

Disc

 

Normally, when in a standing position, the spine has a mild curve forward and here the weight is evenly distributed throughout each disc (see fig. 3a). However, during movements such as forward folding (lowering down to touch your toes) the lower back flexes and loses the normal curve (fig.3b). Accordingly, more weight is put on the front of the intervertebral discs.

 

Fig.3 Spinal Position in an Erect (a) Versus Forward Bending Posture (b)

 

Curve

  

During this movement, the inner disc (the nucleus pulposus) gets pushed backwards into the now stretching support ligaments. If this movement is done a lot, or if great force is applied as in heavy lifting, the ligaments weaken and the inner disc may “bulge” out or, even worse, the ligaments may tear causing the inner disc to leak out which would result in a herniated disc.

 

If your back pain is caused by a bulging or a herniated disc then you should avoid holding forward folding positions as they could possibly exacerbate your back pain by placing too much force and pressure on an already injured area. Accordingly, avoid postures such as Paschimottanasana (seated forward fold). Even taking a bend in the knees when performing this posture is placing the spine under significant pressure and may not be tolerated by those who have a history of disc injury.

Jennie in Paschimottanasana (seated forward fold). Avoid this posture if you have a history of disc injury.

If you have the type of back pain that is associated with a disc injury then you should seek advice from your GP or physiotherapist before proceeding with a yoga routine.

 

Disc damage can also be caused by the day to day frequent repetition of certain movements. In particular, forward bending movements place the spine under significant pressure as when we bend down (for example, when we pick up a shopping bag), over half of our body weight (in addition to the weight of the object being lifted) exerts tremendous force on the intervertebral discs and supporting ligaments. Such repetitive movements tend to be the cause of back strain. Although not as serious as a bulging or herniated disc, back strain can still result in significant pain and discomfort.

 

Yoga Poses for Back Pain

 

You do not need to “warm up” in order to complete the following postures. Indeed, many of these movements can be used as part of a gentle warm up routine prior to beginning yoga practice. However, complete the poses in the order in which they appear. 

 

Cat  (Marjaryasana) Cow (Bitilasana) 

 

How to do this posture

 

Cow (Bitilasana) Pose

Ryan in Cow (Bitilasana) Pose

Cat  (Marjaryasana)

Ryan in Cat (Marjaryasana)

 

  1. Come into table top position by placing the hands underneath the shoulders and the knees underneath the hips.

  2. To perform Cow, inhale and begin to look up, raising the eye gaze, the chin and the chest whilst dropping the belly button and raising the tail bone. This movement will extend the spine causing the lower back to dip slightly.

  3. As you exhale, move into Cat pose by flexing the spine and rounding the back (like an angry cat) and keep the head between the arms. Look towards the navel to stretch out the back and spine as much as is comfortable.

  4. Repeat 10 times, flowing smoothly from Cat into Cow, and Cow back into Cat. 

Moving back and forth from Cat to Cow helps move your spine into a neutral position, relaxing the muscles and easing tension.

 

 

Reclining Spinal Twist (Supta Matsyendrasana)

 

Twist

Jennie in a Reclining Spinal Twist (Supta Matsyendrasana)

How to do this posture

 

  1. Lie on your back and place the hands out to the sides, palms facing up or down.

  2. Inhale and as you exhale lift up the feet and knees away from the floor so that the knees are now over the hips.

  3. Inhale again and, this time, as you exhale (keeping the shoulders on the floor) lower the knees to the right side (keeping them at hip level) whilst turning the head to the left.

  4. The knees may not touch the floor when you first try this posture so do not over stretch. Only lower as far as you can whilst keeping both shoulders pressed into the floor.

  5. Hold for 5 – 10  breaths before switching sides.

 

Cobra (Bhujangasana)

 

 

Cobra (Bhujangasana)

Ryan in Cobra (Bhujangasana)

How to do this posture

 

 

  1. Lie on your stomach with the legs together. Try to keep the feet touching at least at the level of the two big toes.

  2. Place the hands underneath the shoulders so that you can just see the fingertips.

  3. Keep the elbows against the body.

  4. Inhale and as you exhale begin to straighten the arms to lift the chest away from the floor.

  5. Do not come up too high. Cobra is a gentle backbend in which you should be able to remove your hands away from the floor so that your position does not alter.

  6. Firm the shoulder blades against the back and lift through the top of the sternum.

  7. Relax the shoulders away from the ears, elongating your neck and try to gaze in front of you. Hold the pose for 3 – 5 breaths before slowly lowering the chest back down to the floor.

Cobra pose is a backbending posture which will strengthen and improve the flexibility of the spine.

 

Downward Facing Dog (Adho Mukha Svanasana)

 

Adho Mukha Svanasana

Ryan in Downward Facing Dog (Adho Mukha Svanasana)

 

How to do this posture

 

 

  1. Come into table top position by placing the hands underneath the shoulders and the knees underneath the hips. Take the wrists slightly forward of the shoulders.

  2. Create space between all of the fingers with the middle finger facing forward and rotate the index finger slightly towards the thumb. Press all fingers into the mat but especially the index finger and thumb and the base of the little finger. Lift up from the wrist and do not let this area collapse down. 

  3. Tuck the toes under and inhale and, as you exhale, begin to lift the knees away from the mat. Keep your knees slightly bent and the heels away from the mat. Begin to raise the back of the pelvis upwards and backwards and raise the sit bones up towards the ceiling. 

  4. Starting at the ankles, begin to draw the inside of the legs up into the groin and try to turn the upper thighs inwards slightly.

  5. On the next exhalation, begin to straighten the knees (but do not lock them) and push the thighs back and start to lower the heels down towards the mat. Do not worry if the heels do not connect with the mat. Never overstretch in any yoga posture.

  6. Narrow the front of the pelvis by directing the belly button towards the top of the thighs. 

  7. Firm the shoulder blades against the back aiming to widen the blades whilst drawing them down towards the tailbone. The head should rest between the arms. Keep the shoulders away from the ears and take the gaze towards the navel.

  8. Hold for 1 – 5 breaths. Beginners should aim to hold for 1- 2 breaths only. If you have high blood pressure then you should not hold this posture for more than 1-2 breaths.

 

The goal of Downward Facing Dog is not to get the heels on the mat but to get the spine as long as possible, stretching from the neck all the way down to the tailbone. As a beginner, keep a bend in the knees and the heels away from the mat. 

 

Downward Facing Dog reverses the forces of gravity that normally act on the spine. Accordingly, this posture is good to do at the end of the day if you sit down a lot in your job. You can read more about Downward Facing Dog here.

 

Legs-up-the-Wall (Viparita Karani)

 

Reclined

Jennie in Viparita Karani

 

How to do this posture

 

  1. Position your buttocks all the way into a wall and lift your feet up the wall so that they are at a 90 degree angle to the floor.

  2. Extend the hands out to the sides with the palms facing up or down.

  3. The feet are in “Barbie” position so that they are neither pointed nor flexed, instead they are a position in between.

  4. You can add a folded blanket or towel to the lower back which may make the posture more comfortable if you suffer with intense lower back pain.

  5. Hold for 5-10 minutes and try to maintain an awareness of the way that you are breathing during this time, inhaling and exhaling slowly as you relax into the posture.

Viparita Karani is excellent for relaxing the muscles of the lower back whilst draining stagnant fluid from the feet and ankles.

 

These gentle poses will help you to stretch, strengthen and lengthen your spine and can help to alleviate pain when done regularly. You can gradually increase the intensity of the postures by holding them for longer amounts of time as your back becomes stronger.

 

Back pain can also be caused by tight hamstrings and hips. Yoga asanas which stretch and strengthen these two areas will be discussed in the next article in our series on yoga and back pain.

 

 

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