You are Not a Car 🚗
By Kristine Kaoverii Weber | March 17, 2023
Once a woman I’ll call Betty came to my yoga class. I walked into the room and saw someone new sitting in a very deep forward bend, upaviṣṭakoṇāsana – legs apart, forehead on the floor. I went over to introduce myself.
Betty told me that she had back pain. Someone had told her my class might help. Then I asked her if the posture she was doing gave her any relief. “Not really,” she replied. “But I do a lot of yoga.” Since we had time, I asked her to tell me more. She explained that she did sun salutations every morning, that she took vinyasa classes 3-4 times a week, and that her back pain was getting worse.
I asked her if she thought that her yoga practice might be hurting her back and she quickly responded, “Of course not! Yoga is good for you!”
I agreed with her and explained that not all asanas are good for everyone all the time. Most people need different things from yoga at different times in their lives, particularly when they are in pain.
Back pain is a common and elusive challenge. It will effect 8 out of 10 people in their lifetimes. 73 million people are in pain right now – and it’s not easy to treat.
This is largely because the western medical world is still digging itself out of its biomedical model hole. The biomedical model dominated the 19th and 20th centuries. It’s a way of looking at human beings as if they are basically… cars. You got a part that’s defective? You replace it. Your fluid is low? Put some more in. Battery dead? Jump start it.
The biomedical model spawned the invasive, expensive, and often unnecessary (not to mention ineffectual) treatments that have dominated low back treatment for decades.
Whatever you think causes a problem will determine how you try to fix it.
Western medicine concluded that back pain was some structure outta whack in your back (that’s the technical terminology 😁).
But for most people, that’s not accurate.
Most back pain is now called “Non-specific Back Pain.”
That’s because western medicine now understands that most back pain does not show up in x-rays or MRIs. It’s just there, and it can’t be explained structurally.
It’s like that story about the guy who lost his car keys in the dark so he goes over to a street light to try to find them. And someone says “what are you looking for?” and he said, “My car keys” and they say, “did you drop them here,” and he says, “No I dropped them in the bushes but there’s no light over there.”
We are looking in the wrong place for solutions.
Research has shown consistently that there’s almost no correlation between back pain and the condition of the structures in your low back. There are people walking around with backs that look like train wrecks in their MRI but they are not in pain. There are others who have perfectly gorgeous lumbar spines and nerves and are in excruciating pain.
Some studies have correlated low back pain to lower educational levels.
Many studies suggest that exercise improves back pain.
If you want to get to the root of backpain, you have to look beyond the streetlight – structural explanations don’t come close to offering solid answers.
This dysfunctional thinking is not exclusive to medical professionals BTW – it’s pervasive in our culture. Which is why people keep turning to pharmaceuticals and surgeries for help – we have all been programmed to think that our bodies are cars – it’s a cultural phenomenon.
So, what really causes back pain?
Loneliness, depression, inflammation, nervous system dysregulation, lack of social support, poverty, lack of education, lack of meaning and purpose, sitting too much, spiritual disenfranchisement, existential angst, limited access to health care, working too much, bad relationships, limited access to green spaces, shame, old physical injuries, old emotional injuries, and a lot more.
Chronic pain is a biopsychospiritual challenge that deserves a broad perspective and approach which will never be found exclusively in a pill.
Yoga is not the answer, especially not random fitness yoga classes. But some approaches to yoga may help – even the western medical world realizes its potential which is why it’s been included in AMA guidelines for treating chronic back pain.
Betty is doing better. She changed her whole perspective about yoga – away from thinking that she needed to do hard classes towards discovering what pose variations served her. Then…she worked it.
She studied the practices and studied herself. She embraced the deeper teachings. Her attitude shifted. It was extraordinary to witness what happens when someone stops thinking about themselves like a car that someone else must fix and starts to develop agency, hope, and possibility.
Please Join me live April 22, May 6, and May 20 for The Neuroscience of Yoga for Low Back and Hip Health where will be exploring the physiology as well as psychosocial spiritual factors and learning specific yoga practices.
- Sääksjärvi, S., Kerttula, L., Luoma, K., Paajanen, H., & Waris, E. (2020). Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study. Spine, 45(19), 1341–1347. https://doi.org/10.1097/BRS.0000000000003548
- Babińska, A., Wawrzynek, W., Czech, E., Skupiński, J., Szczygieł, J., & Łabuz-Roszak, B. (2019). No association between MRI changes in the lumbar spine and intensity of pain, quality of life, depressive and anxiety symptoms in patients with low back pain. Neurologia i neurochirurgia polska, 53(1), 74–82. https://doi.org/10.5603/PJNNS.a2018.0006
- Boden SD, et al The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects : a seven-year follow-up study. J Bone Joint Surg Am. 2001;83-A(9):1306-1311.
- Kalichman L, Kim DH, Li L, et al Computed tomography-evaluated features of spinal degeneration: prevalence, intercorrelation, and association with self-reported low back pain. Spine J. 2010;10(3):200-208.
- Kwon, M. A., Shim, W. S., Kim, M. H., Gwak, M. S., Hahm, T. S., Kim, G. S., Kim, C. S., Choi, Y. H., Park, J. H., Cho, H. S., & Kim, T. H. (2006). A correlation between low back pain and associated factors: a study involving 772 patients who had undergone general physical examination. Journal of Korean medical science, 21(6), 1086–1091. https://doi.org/10.3346/jkms.2006.21.6.1086
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A thoughtful and helpful stance. I only wish you had mentioned the issues of posture, strength of spinal support muscles, and compression as additional causes of back pain.
yes of course. But the whole point of the blog is that mechanics are not the only answer to the problem.
Looking forward to your insightful education, with your skillful navigation through the english language so its easy to comprehend and take-in as a part of my practice.
thanks Joe! xo
This is a BRILLIANT blog. So wonderful to see a yoga teacher who is so up on modern pain neuroscience.
What terrific article. Thank you so much. Now, if I could just stop feeling so overwhelmed with how much I have to learn to improve my classes to benefit my students and myself!
We teach from what we know. There’s always more to learn. When you approach with kindness and ahimsa, you are doing the right thing.
Hi. Good blog. Important for people to know that yoga is only as good as their internal awareness and ability (hopefully increasing) to listen to their own body — interception . We definitely are not cars!
My question is this however. I was distracted by your use of the term biomedical. Medicine based on biology is fine. Did you mean biomechanical? Treating the body as if it were a machine is a holdover from the industrial age.
Thanks for your thoughts. If you did mean biomedical, could you explain why?
Thanks Joyce! The model is called the “Biomedical model” and yes, it is a holdover for sure! here are links if you want to go down that rabbit hole. https://www.ncbi.nlm.nih.gov/books/NBK230283/ https://en.wikipedia.org/wiki/Biomedical_model
Thanks. I did go down the rabbit hole and I understand why you called it that now.
Nurses often tell the human perspective better than md’s, in my experience.
Integrative and functional medicine are better context for a healthy practice.
Thanks for this Kristine. I’ve had chronic low back pain for years & thought Yoga helped me. But now you have me thinking it may be contributing. Once I’ve stretched it out, it feels better, however the next morning I usually wake up in pain again. Some forward bends do hurt when I come out…so I have to do so slowly. Should I stop the forward bends?
Thanks for our help,
It’s hard to know what is causing your back pain without an assessment. I think it’s really important to talk to a PT or a well trained Yoga Therapist
I practiced vinyasa yoga quite faithfully 4-5 years ago and taught vinyasa, 6-7 classes a week. Then I found Subtle yoga. So grateful to have found you Kristine and this amazing community. You share the gifts of enhanced self-study, self-awareness, and intention setting that offers connections and Union with the universe. Gratitude 🙏☮️
I practiced Yoga for many years and had problems with painful lower back pain. I made an appointment with a Chiropractor, who arranged for an x-ray which showed that I had a deformity of the lower spine. It was the forward stretches that had triggered the pain.