Yoga & Back Pain: Could Fear Sometimes be the Real Cause of Pain?

Fused spine, tight hips – is fear causing the held tension?

by Kara-Leah Grant

I’ve had plenty of opportunities in my life to study pain, often on a daily basis. And now, based on this study and my experiences, I’m wondering:

Can fear cause physical pain – like sciatic pain?

Here’s a rundown on why that might be:

In May of 1991, when I was fifteen years old, I started experiencing sciatic pain down my left leg. Of course, I didn’t know what it was, and put up with it for a few months.

I noticed it was difficult to sit for extended periods of time, or to bend forward and wedge myself into the back of a two-seater car. Finally, my mum took me to the doctor, who sent me for CT scans. Those scans showed the disc between L4 and L5 was disintegrating.

Despite there being no specific incident or injury that had led to an otherwise healthy and vibrant 15 year old girl rupturing a disc, I was immediately scheduled for a spinal fusion.

In January of 1992, a surgeon cut me open, sawed off some bone from my right hip and fused it into between L4 and L5.

Fast-forward to 1997. It’s my second year at University, and I’d transferred from my home town and home university, Otago, to Auckland University.

I was struggling emotionally and mentally- although I didn’t know it at the time. For the first time in my life, I was getting bad marks – Bs and Cs instead of my usual mostly As. I totally identified with being effortlessly smart and had no idea how to apply myself or turn around my university situation. In June of that year, I was jogging along Milford Beach and felt the same sciatic pain, this time down my right leg.

I was devastated.

Did this mean I’d need another operation? I made the rounds of the doctors, who didn’t appear to know much. I dropped out of university, ostensibly because I couldn’t sit to attend lectures, study or write essays, but really because I was doing badly and seriously questioning the content of what I was learning.

Instead, I waitressed, and applied to journalism school. 220 people applied for 20 places, and I was the second youngest accepted on the course, which started in January 1996.

Three weeks before starting, I still had serious sciatic pain and was freaking out about whether or not I’d be able to go to class.

I was back home for the holidays, and going to my old gym, Les Mills. Realising that movement seemed to help, I decided I was going to get on the Stairmaster – no sitting required – at every opportunity I could. Within a week or so, the pain that had dogged me for six months was gone.

Just over a year later, I was living in Chamonix, France with a new boyfriend and a bunch of our snowboarding-obsessed friends. There were nine of us squished into a three bedroom apartment in the tiny town of La Tour, right at the top of the valley. The local gym had been flooded last summer so was out of action. I didn’t snowboard – too dangerous for my back was the excuse. Plus, without a work visa or any French, the only work I could find was sporadic cleaning and nannying.

Again, I was struggling – I had no outlet, no interests, no life beyond my boyfriend, his friends and partying.

Even that was largely on hold due to our limited funds. And bingo, whaddya know, my sciatic pain shows up again. Huh… interesting.

I put it down to the lack of movement and knew I had to get back to a gym, but I also wondered if it had something to do with my psychological state of being.

Four months later, we were in Niagara Falls staying with my auntie, I was back at the gym, back waitressing and the pain went away – until we took a two month road trip around the States which involved lots of sitting.

In pain, out of pain, in pain, out of pain… this was my pattern for years, until I finally resolved once and for all that I was going to to get to the bottom of this pain, one way or another.

That was early 2000, and the beginning of my serious yoga, plus I began to examine of all the underlying mental and emotional causes of illness.

Since 2000, my sciatic has been rare. It didn’t even show up during pregnancy, when I suspected it might. The only times I can recall it happening in the last decade is when I left Wellington to go and make a life in Glenorchy (facing a deep fear along the way), and when I let go of Glenorchy and moved up to Napier.

Two transition times. Coincidence or not?

I don’t know.

The sciatic pain, which may or may not have been aggravated during an Ashtanga class in November, hasn’t been consistent either.

At the end of January, I drove four hours to Tauranga. Sitting was agony. Absolute agony, but I had no choice but to be in the pain as I drove, so I decided to meet the pain fully.

As I drove I breathed mindfully and allowed myself to soften around my right hip and thigh, allowing the pain to be there in its fullest intensity. I brought my awareness as deep into the area as I possibly could. And in doing this, I had a sudden insight.

It doesn’t matter if I have to have another operation. It doesn’t matter if I’m in pain. It doesn’t matter if this is my reality. It’s ok – it’s all ok.

Shortly after that, we stopped for an ice-cream in Rotorua. The second I stood up, the pain was gone, and we ate standing by the car, given my sciatic as much of a breather as possible.

I got back in the car, ready for the last hour or so of driving, expecting the pain to kick in after about twenty minutes. No pain. No pain the entire way. Huh.

I got to my brother’s farm (we call it a farm but it’s really only two acres) in time for dinner, and I expected the pain to kick in then. No pain. That evening, we sat on the couch all night chatting, late, until 11pm. No pain.

No pain at all.

It was the strangest thing – I’d been in niggling sensation and pain for a few months…. so to suddenly have this void was almost disconcerting.

The next day, I drove two hours to Taupo and spent the weekend doing intense yoga practice with Matthew Sweeney – including an entire morning on backbending. No pain.

Monday, back in Napier again… and the sciatic flares up again. No apparent reason. It’s just… back.

Three weeks later, I head to Wellington for the weekend and the same pattern repeats. Pain while driving initially, and then released after taking a break, and no subsequent pain for the entire weekend.

Add to this is the strange way my back responds when I do Bikram classes right now. I’m pain-free going into class. Totally pain-free after class and feeling amazing. And in pain during class – although the type of pain is difficult to describe – it’s more like a heaviness, or a deep contraction, or a holding.

I’ve stopped doing Bikram for awhile, instead sticking to Mysore-style Ashtanga three times a week, Vinyasa a couple times and some Yin.

Then I read a chapter on pain in Benjamin Lorr’s awesome book Hell-Bent – Obsession, Pain and the Search for Something like Transcendence in Bikram Yoga. 

He looks at the conflicting ideas of pain in the yoga world. For example,  Never go into pain, pain is your body’s signal to stop. That’s what I’ve always subscribed to in my yoga classes and teaching. But in the Bikram world though, pain is explored differently.

“Most pain is your mind labelling a sensation you’ve never had before. You need to relabel the agony of stretching into the luxury of releasing. Of course, you don’t go and hurt yourself. It’s the fundamental job of the yogi to learn how to distinguish between different types of pain. The bad ones, you must avoid.” Emmy, renowned Bikram Teacher

Yet, there are other Bikam teachers who calmly proclaim a posture “should hurt like hell”. Do they mean good pain? Or bad pain? And does average yoga student know enough to differentiate between the two?

I sat up and took notice was when Lorr summarises three pages on the history of pain down to a couple of sentences (bold emphasis mine):

Pain exists on a continuum. on one extreme, there are classic Cartian pains tied directly to an injury; on the other end there is the entirely psychogenic pain that lives in the brain, disconnected from any physical injury. And in the vast blurry middle where we spend most of our lives, we have pains mediated by factors in both directions: connected to the flesh by controlled by the brain.

A page or so later, Lorr made me jump out of my seat. He’s quoting Dr. Brian Nelson of the Physicians Neck and Back Clinic who did research on using back strengthening exercises to delay back surgery. 43 out of the 46 people didn’t need surgery after the ten week programme. 43!!!

We found that 85% of the time we couldn’t determine the exact cause of the pain. Yes a CT scan will show areas of abnormalities in patients. And lots of doctors will interpret those abnormalities as the cause of pain. But when you look at the CT scans of people without injury, people who have no back pain, they will often show identical types of abnormalities. Dr. Brian Nelson

Because the clinic couldn’t link the pain patients were exhibiting to a discrete injury – which is exactly what I had happen at 15 – they believed surgery should be a last resort rather than a default option.

It’s highly likely I did not need that spinal surgery at 15, and that if I’d started yoga at that time, or at the very least a back-strengthening programme, my sciatic pain would have gone. Just like it’s come and gone many times in my adult life.

The clinic’s programme meant that patients experienced pain and soreness as a result of the exercises that they were doing – but this was necessary. It was a healing pain. Yes, a healing pain.

Which brings us right back around to the idea that some pain in yoga is a good thing. That some pain is only in the brain. Some pain is healing pain and some pain is bad pain.

Dr. Nelson goes on to explain why backbends are so great for people with disc issues – because discs are living tissues but because they have almost no blood supply, anything that brings more blood flow into the vertebral body is good. Why? Because the extra nutrients then diffuse down into the discs. In fact, back bending and forward bending are two of the only things known to increase diffusion to the disc.

My back and the back pain I’ve experienced has defined my life.

Post-surgery and for ten years afterward, I babied my back. I was afraid of hurting it, and opted out of anything I thought might be dangerous. I didn’t snowboard or ski or water ski or run or anything… I used it as an excuse to opt out, shut down, turn away.

Yet my back also forced me to face into life and go deep inside, learning about myself and my body because I simply got sick of living with the pain.

Now, working with an actual yoga teacher for the first time in the 15 years since I got serious about yoga, I realise that much of my body tension comes from this urge to protect my weak back – to protect my vulnerability.

Up until I was 15, I thought I was invincible. The world was my oyster. Then wham, out of the blue, with no apparent cause, I was laid flat. No wonder I physically contracted around my spine to protect it.

Letting go is taking courage, and trust.

I have to let go of the idea that I’m injured, or broken, or that I need protecting, or that my back is tight and inflexible.

I have to open up to the idea that I can move with ease, that it’s safe to let go, that I don’t have to hold tight against the unknown terrors of life.

I’m not surprised now that my sciatic flared up when I left Wellington and when I planned to leave Glenorchy. Both times I was stepping into the unknown and following my dreams – first to write a book in the mountains, and now to study with a great yoga teacher.

It’s the reverse of the flare-ups I had in my twenties, which seemed to occur when I was suck in a place and needed to take control and move on. Now, it’s when I let go and step into uncertainity.

Or maybe I’m just creating story out of nothing. Trying to make it all mean something, trying to give some narrative to my pain so I can understand it and feel safe.

Regardless, I’m not afraid of the pain anymore. I’ve learned that it is just a sensation in the body, that it comes and goes, that shrinking from it makes it worse and meeting it full force seems to make it ok.

Is pain bad in yoga? Should we always avoid pain? Does it mean we’re doing the yoga wrong?

There are no definitive answers to this. It depends on the person, the body, the mind and the circumstances. There is no right and wrong, there is only ever increasing discernment required to meet the moment as it is – as we are.

It’s this increased level of discernment I need as I work with my yoga teacher deeper into Marichyasana D – the same pose that likely triggered this round of sciatic pain. That pain is 100% gone now. In it’s wake, as I work into the deep twist, I can sense deep fear in my spine. I have a strong urge to react, the run, to get out of that place anyway I can.

But I can’t – I’m being adjusted and held by my yoga teacher who’s encouraging me to just stay with it.

It’s terrifying – literally. I’m in deep fear, and all I’m doing is moving my body in a particular way on the yoga mat.

It’s a process of breaking down, and coming out of Marichyasana D, I move through Boat pose, backbending and into forward bend counterpose where I sob. Deep tears of…. what? Grief? Is this what I’m afraid of? These feelings?

I don’t know. It’s an on-going process of discernment and courage – constantly facing into and opening to whatever’s there.

Now though, I suspect that all the back pain I’ve ever experienced is likely 100% psychogenic. It has it’s origins in fear, which causes contraction, tension and holding.

My tweaked sciatica last November? Maybe it wasn’t the yoga posture or the adjustment. Maybe it was because I was afraid.

I’m not suggesting this is true for all or most people with back pain or sciatic pain.

I’m suggesting that we learn not to assume we know anything, that we learn not to make blanket assumptions, that we learn not to shut down around ideas… That instead we learn to open up and be curious about our experience, daring to move toward pain – to inspect it, accept it, be with it, and learn from it.

That’s what I’m suggesting.