January 13, 2019 7 min read
Anyone who has ever finished a good yoga practice knows, intuitively, that it’s good for your spine. It’s certainly hard to beat the feeling you get by the time you’re in shavasana. And no, it’s not just about lying flat on the ground. It’s a different kind of relaxation that comes only at the end of sixty (or ninety) minutes of a very deliberate sequence of postures.
That feeling is why we were particularly compelled by the perspective of neurosurgeon Sheri Dewan, who sees a lot of spines at her Chicago practice, both in her office and on her surgical table. Of course, Dr. Dewan would prefer not to need to see your spine in the latter context, if she can avoid it. And she believes yoga—Kundalini-style yoga, specifically—can be one of the more effective prophylactic tools for strengthening the spine and keeping back and neck pain at bay.
A Q&A with Sheri Dewan, MD
Q: When it comes to treating the spine, what’s in your tool kit outside of spinal surgery?
A: Over the last six years, I’ve seen an increase in patients wanting more-conservative treatments for the spine. I have a lot of young women who come to see me who are very physically active and aren’t interested in aggressive spinal surgery. Instead of simply recommending an operative procedure, we go through a conservative approach.
I typically start with a referral to a licensed physical therapist, depending on the patient’s spinal pathology. Treatment might take the form of light traction, which is kind of a stretching of the spine, or electrical stimulation called TENS (transcutaneous electrical nerve stimulation). Sometimes they will use a procedure called dry needling, which is essentially placing small acupuncture-style needles into the joints of the spine—the facet joints—to break up any layers of scar tissue that may form.
If I have patients who are interested in practicing yoga, I refer them to places in the community I know do a good job, safely.
Q: What is Kundalini yoga, and why do you recommend it?
A: Kundalini yoga, or spinal yoga, has been around for thousands of years. The yogi Harbhajan Singh Khalsa learned it in India and brought it to California in the late 1960s. “Kundalini” is the Sanskrit word for “coiled”: The practice is very focused on body mechanics, flexibility, core muscle strength, muscle tension, and loosening and adjusting the spine. It’s typically sixty to ninety minutes in total, with a five- to ten-minute warm-up and thirty to forty-five minutes of exercise followed by a relaxation period.
The key final point is the meditation aspect of it. When patients are dealing with chronic pain, whether it is neck pain, thoracic pain, or low-back pain, so much of it is psychological as well as physical. What I like about Kundalini-style yoga is that it not only focuses on your spine joints, your tendons, and your muscles to help relax and strengthen the whole body but then, in the end, you focus on your mind, which is also a huge component of the psychological pain that manifests as physical pain.
Some people are very inflexible to begin with, and some of my patients are in their seventies or eighties, so we need to proceed carefully. I typically recommend patients start out at a yoga center that they are comfortable with and then slowly work up to places that do more-advanced spinal yoga. But once patients have exhibited that they have the flexibility to do spinal yoga, they can even do it at home. I recommend doing it in the morning when they first wake up or even in the evening before they go to bed—once a day or twice a day, depending on their activity level and time.
Q: Physiologically, how does Kundalini-style yoga affect the spine?
A: Kundalini yoga focuses on opening up all your vertebral bodies. We have seven vertebral bodies in the cervical spine, then twelve in the thoracic spine, and five in the lumbar spine, and five make up the sacral spine. In a typical Kundalini practice, you are starting at the very base of the spine at the sacrum and working on stretching every level as you work up to the neck, or the cervical spine. A large component of it is rotating the joints. I tell patients that joints in the spine are just like joints in your elbows, your shoulders, your knees: You can have inflammation of the spinal joints, and they can get arthritic. People don’t conceptually think about the spine in that way, so it’s important to emphasize the inflammatory component.
We have two sets of spine joints running vertically. The whole idea of this yoga practice is to start at the base, work your way up, and slowly ease and open up the joint spaces through a process of rotation, loosening and stretching. That works to open up not only the tendons but also your muscles as you work your way up. The latter portion of Kundalini exercises strengthens the core. The abdominal core muscles tend to get very lax, and when that occurs, the lower spine doesn’t get strengthened, which can lead to chronic lower back pain.
Q: Whom do you recommend Kundalini yoga to?
A: I recommend it to almost anyone as a prophylactic measure for spinal health. I also recommend it for postpartum women. A lot of times, those abdominal muscles become very weak after pregnancy. I have a lot of patients who come to my office while they’re pregnant and eventually end up with low-back issues and sciatic issues. I usually recommend doing pregnancy yoga during the pregnancy itself, because it’s more gentle. Kundalini yoga can be a bit harsher in its physicality.
Q: What about people who come to your practice already experiencing pain?
A: I see many patients living in chronic pain. If the back pain is excruciating or severe, we do have to rely on medication management and sometimes even steroid injections for the spine. Once the patient is out of acute pain, they are able to participate, it’s good to get into a physical therapy or a yoga program moving forward. Then there’s the other category of patients, for whom we ultimately need to perform surgery.
Q How often would you need to do Kundalini yoga to reap the benefits?
A: Daily. I tell patients to do it when they’re home. First thing in the morning is key: Get up and stretch the entire spine out. Start from the base of the spine and work all the way up. There have been so many studies that show that if you relax the musculature in the upper and lower back, it can really help with the psychological component of chronic pain.
When you are starting out, I recommend finding a good guided class at a Kundalini center. It’s typically a sequence of moves—I’ve been to several different centers that all practice small variations, but typically it’s a set of twenty-six to thirty poses every time that start from the base of the spine and work up sequentially.
Once you’re familiar, you pretty much just need a yoga mat, and from home you can start out with some kind of moist heat to loosen the muscles up and then, after the yoga practice, lie flat and take some time to relax. Toward the end of your practice, if it feels good, you can try icing.
Q: Do you see a lot of people who have spinal pain or injuries from just sitting too much?
A: I see a lot of patients who have pain who do a lot of office work, so they’re basically at their desks for a good eight hours a day. They’ll get up maybe for a lunch break and then sit back down. For those patients who have a lot of low-back pain, I’ll recommend taking frequent breaks throughout the day—making sure they’re getting up, walking around the office or outside for forty-five-minute increments.
A lot of times we have the tendency to slouch, and our lower spine takes the brunt of it. The other thing I see a lot is neck pain, especially with computer work. I recommend ergonomic desks and chairs for my patients, so frequently I’ll write prescriptions for ergonomic desks and chairs to try to help them with the day-to-day.
Q: Are there yoga-like moves you can practice at your desk that can help?
A: For the neck, the series of exercises I recommend is very simple. Rotate the head from side to side five or ten times, coming back to the center position each time, or flex and extend the neck back and forth. Then take your trapezius muscles—the ones you use to shrug your shoulders and move your neck—and flex. Just abduct and adduct your trapezius muscles. Even that just small set of moves, doing it a couple of times a day when you’re at your desk, can help to loosen the upper neck.
For the lower spine, I recommend an exercise in which you suck your stomach in toward the lower lumbar region a few times a day. Think about pulling your stomach muscles in toward the spine, and that helps strengthen the lower abdominal muscles. They’re very simple exercises, but they really do make a difference. Of course posture is huge, as well as how you’re holding your neck more neutrally in position.
Q: What does good posture look like, and how do you get into it or maintain it?
A: It happens through time and practice. Everyone’s spinal anatomy is different. Everyone has a perfect position where their neck should be, and it is all dependent on the biomechanics of your own spine and your own flexibility.
But keeping your eyes at a more neutral level, instead of tipping the head forward or flexing, is important. The head should be more neutral and usually the shoulders back and the abdominal muscles tight. Essentially: If you tried sucking in towar
d the spine, that’s probably the best posture for your back.
I prescribe ergonomic chairs and desks, no particular brand—whatever the patient’s insurance company will approve. But typically even the desks that have keyboards that you can adjust to bring up higher can help a lot with your posture.
Dr. Sheri Dewan is a full-time board-certified neurosurgeon practicing in the Metro Chicago area, affiliated with Northwestern Medicine. She is one of roughly 200 female neurosurgeons in the United States. She completed her residency at Brown University and is a proud board member of Women in Neurosurgery (WINS), the Congress of Neurological Surgeons, and the American Association of Neurological Surgeons. Dr. Dewan donates her time performing charity surgery in southern India through the AIMS hospital group and also sits on the board of Allendale Foundation, a charitable organization for foster children.
This article is for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of goop.
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