Restorative yoga is a practice that is majorly under-appreciated and under-utilized in the prevention and treatment of back and neck pain. Santosha.com describes restorative yoga as “a gentle, therapeutic style of Yoga that uses props to support the body to deepen the benefits of the poses. It is a soothing and nurturing practice that promotes the effects of conscious relaxation.”

Restorative yoga can be done at any time and should be done regularly by everyone. It is a very useful practice to perform if one is feeling run down, after a high-intensity workout or competition, during a woman’s menstrual period or during periods of high stress from work or school.

The benefits of such conscious relaxation include decreased markers of stress such as lowered heart rate and blood pressure, better digestion, and improved sleep. Restorative yoga is helpful for everyone but may be especially useful for those with chronic back pain. It can be practiced even during episodes of significant pain and spasm but the client will likely require assistance with setting up the props.

There are several possible explanations for why restorative yoga is particularly therapeutic for those with back pain:

1. It increases parasympathetic tone. The parasympathetic nervous system (PNS) enhances muscle relaxation and may decrease hypertonicity or sustained, unnecessary tension. Such hypertonicity is often observed in the erector spinae muscles, the upper trapezius, the gluteals, the pelvic floor or the muscles of the jaw which can cause or contribute to neck and back pain. When these muscles are able to relax it results in less compression in the joints. It also improves blood flow which can reduce pain by allowing for more efficient dispersal of the waste products of the muscle cells (e.g. lactic acid).
    
2. Improved function of the PNS may also play a role in normalizing the perception of pain. A person with chronic pain may be hypersensitive to any input of sensation so that a benign amount pressure or stretch may cause them to feel real pain. Additionally, the brain plays a role in dampening the perception of sensation but this dampening mechanism often malfunctions in those with chronic pain. It is possible that the PNS sends a neuro-chemical signal that helps to restore the normal function of the nervous system at the peripheral receptors, in the brain or both.
    
3. Restorative yoga results in improved quality of sleep. If a person has back or neck pain that is the result of an injury to muscle or ligaments, from whiplash for example, certain hormones are essential for tissue repair. One of those hormones is human growth hormone which is secreted in greater doses during deep sleep. Adequate sleep may also result in less irritability or sensitivity to emotional overwhelm, which in turn may contribute to less muscular tension.
    
4. Restorative yoga could be used as a form of positional release. A technique in which a muscle is passively shortened to allow decreased hypertonicity. It could also be used to provide facilitation of improved breathing patterns. For example, you could place props under the thoracic spine to lift and open the upper chest, thereby increasing inspiratory volume or you could place a prop on the belly to provide more tactile feedback for diaphragmatic breathing.
    
5. Another potential reason for the efficacy of restorative yoga for back pain is that it is a deeply introspective and meditative experience. It provides an opportunity to quiet the mind and to allow discovery of emotional, intellectual or spiritual insights. Often this insight will guide the patient to what really lies at the root of their pain. Perhaps it’s stress that comes from repressed feelings about a person or situation in their life. If excess weight is a factor, perhaps they will discover the source of their overeating. Their pain may be related to a compulsive addiction to exercise or a lack of motivation to do any physical activity. Restorative yoga may provide the opportunity to discover the key to the desires and repulsions that drive self-destructive behavior. Or perhaps it will simply allow one to feel less victimized by their pain and to enjoy a period of relative ease.

A couple examples of restorative postures for back pain that I have already blogged about are:

Legs up Wall/Viparita Karani - This is a great yoga pose for reducing swelling and fatigue in the legs. It can be adapted to support a neutral spine position or increased or decreased lordosis. The variation pictured below supports a more lordotic version of the pose. Lie on the floor without a bolster (perhaps on a folded blanket) for a more neutral version. If you prefer less lordosis, you can try lying with your sacrum on a rolled up sticky mat or lying with the knees bent and the soles of the feet flat on the wall. Women who are more than three months pregnant should not do this pose. Patients with a positive strait leg sign (for HNP) should also avoid this pose.

Reclined Hero/Supta Virasana - This pose opens up the throat and upper lungs and can ease feelings of stress and anxiety. Reclining Hero is a deep backbend for the lumbar spine. It is not recommended for those with stenosis or spondylolisthesis but may be beneficial for those with HNP, osteoporosis or back and neck pain caused by postural dysfunction. This pose should be avoided by those with recent knee injuries. Women who are more than three months pregnant need to use enough props to support the torso at an angle of at least 45 degrees from horizontal.

About the Author: Lisa B. Minn is a licensed physical therapist and yoga enthusiast. She has been incorporating aspects of Yoga her physical therapy practice since 2001 and became a certified yoga instructor in 2004. You can read more about the therapeutic applications of yoga on her blog, ThePragmaticYogi.com.

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