Mary Schatz, M.D.

Being A Woman Can Be A Real Pain-In-The-Back!

Being A Woman Can Be A Real Pain in the Back

PMS and Endometriosis: Three Stretches That Will Give You Relief.

•  Do you have back pain that seems to be related to your monthly cycles?

•  Have you noticed that back pain begins when you ovulate and ends when your period begins?

•  Have you been diagnosed with Endometriosis?

If you answered “yes” to any of the questions above, your back pain may be associated with your menstrual cycle.

Not sure? Try keeping a Back Pain/Monthly Cycle Log for a few months to see if there’s a relationship between your back pain and your monthly cycle.

The following excerpt from Dr. Schatz’s classic yoga book Back Care Basics can show you how to cope with monthly back pain and get RELIEF! Not only will it give you insight into why your back may hurt, it provides three easy and relaxing yoga poses that will rapidly help relieve your symptoms.

PMS, Endometriosis, and Back Pain

Premenstrual syndrome (PMS) and endometriosis (displaced fragments of uterine lining) are both well-known female health challenges. The symptoms of PMS (in­cluding depression, mood swings, emotional fragility, fluid retention, food cravings, pelvic pain) and the pain and infertility caused by endometriosis are widely recognized. What is less well known, however, is that both of these conditions can be associated with back pain.

In two clinical studies of women with premenstrual syndrome, one-fourth to three-fourths of the women with PMS reported back pain that began with ovulation and

ended with the onset of menstruation. The exact cause of back pain in PMS is not well understood, but it may be related to the release of hormones called prostaglandins shortly after ovulation. (These hormones are also responsible for the uterine muscle contractions that women experience as cramps.)

Pelvic congestion can also be a cause of back pain in the premenstrual part of the cycle. The blood vessels in the pelvis become swollen and engorged with blood as a result of the hormonal effects of ovulation. The associated swelling in the soft tissues of the pelvis causes back pain in many women.

Endometriosis is a condition in which small pieces of uterine lining tissue (endo­metrium) become attached to the outer surfaces of the uterus, ovaries, fallopian tubes, blad­der, and intestines. They are subject to the same hormonal influences as normally located endometrium. As the monthly cycle progresses, the areas of endometriosis gradually increase in thickness, just as the uterine lining does. When it comes time for menstruation, they begin to break apart and bleed. Unlike the uterine lining, however, this tissue has no way to move out of the body. Over time, this recurrent hemorrhage causes the pelvic organs to become stuck together with adhesions and scar tissue.

Endometriotic implants on the network of nerves at the back of the pelvis can cause back pain. They have even been shown to cause classic symptoms previously thought to result only from a herniated intervertebral disc.

Although yoga exercises for PMS and endometriosis cannot cure either condi­tion, they can relieve some of the muscle spasm that occurs due to pelvic nerve irritation, and some of the discomfort of pelvic congestion. Perhaps just as important, exercises and relax­ation impart a sense of control and help reduce feelings of stress, anxiety, and depression.

The poses B.K.S. Iyengar recommends for discomfort related to the menstrual cycle demonstrate his three cardinal principles of therapeutic yoga: spreading (creating space for fresh blood to enter the organ), soaking (providing time and space for fresh blood to bathe and nourish the organ), and squeezing (removing used blood and fluid by pressure). This approach helps alleviate pain related to pelvic congestion.

Guidelines for Yoga Practice During Menstruation

Yoga teaches balance: balance of the body in relation to gravity; balance of the mind between action and observation; and balance of the neuroendocrine system between activity and relaxation.

Through a regular yoga practice, you learn which poses are effective in reestab­lishing balance in various aspects of your existence. Certain poses in this ancient discipline are particularly useful to establish inner balance during menstruation. These poses ease menstrual cramps, heavy bleeding, pelvic discomfort, and the lower back pain sometimes associated with menses. They are also effective at smoothing out the emotional rough edges some women encounter at this time of their cycle.

Just as some poses are helpful at period time, other poses should be avoided.

These guidelines are based on sound physiological knowledge and time-tested applications of yogic principles to women's special needs. Women are cyclic beings. For a woman to deny this fact interrupts the self-understanding she seeks through yoga.

The time of menstruation can be welcomed as a time for going within and allowing yourself to have low energy. Use this time to experience different aspects of your nature. High-energy exercise and vigorous yoga needs to be balanced by the quiet and peace gentle yoga can offer. The time of menstruation is a perfect time to vary your exercise routine by turning inward.

In general, poses requiring exertion and great energy are not recommended during the first few days of menstruation. Physical strength may be somewhat diminished at this time, causing you to be shaky or off balance. Attempting a strenuous practice when your energy is low can lead to injury or further depletion of energy supplies. This is a time to allow yourself to rest by practicing the restorative yoga poses that follow.

Yoga Poses for Back Pain with PMS, Menstruation, and Endometriosis

 Reclining Cobbler's Pose with Chest Support

Props needed: folded blankets, head pad, neck support roll, wall.

Position and Adjustment. Fold a firm blanket like a paper fan, so that it is approximately four to six inches wide, four to eight inches thick, and as long as the length of your body from just below your waist to the top of your head. Facing a wall, sit on the floor with the blanket behind you and pull it toward you so it touches your buttocks. Fold your legs in toward your body so the sales of your feet are touching each other and your toes are pressing against the wall. Using your arms for support, let your spine down onto the blanket. Use your neck support roll and head pad to support your head comfortably. Place your arms out to either side, with your palms facing up (Figure 11.4). If your inner thighs feel overstretched, either move your buttocks farther away from the wall, so there is more distance between your heels and your buttocks, or support each knee with folded blankets.

Breathing and Imagery. Rest in this position, using the Relaxation Breath, for thirty seconds to several minutes. Visualize softening the muscles around your hip joints and in your pelvis to release any tension brought on by back discomfort. This is an open, recep­tive pose. Sense the receptiveness of the whole body as your lungs receive each inhalation.

Rationale. This soaking pose allows cleansing, nourishing blood into your pelvis while stretching the inner thigh muscles.

 Reclining Kneeling Pose

Props needed: wooden block (or several books), blankets, head pad, neck roll.
(As needed: rolled towel, folded towels, belt, socks.)

Position and Adjustment. This pose requires sufficient propping to support your trunk comfortably, while keeping your knees in contact with the floor and your thighs parallel. Even flexible students who could practice this pose without props should take advantage of the deep relaxation the props allow.

Kneel on a blanket with a ten- to fourteen-inch stack of fan-folded blankets behind you. (Yoga bolsters can also be used. See Resources.) Have your knees close together and your thighs parallel. Your head pad and neck support roll should be in place on the end of the blankets. Separate your feet and place a four-to six-inch wooden block (or a stack of looks) between them to sit on (Figure 11.5). Using the strength of your hands pressing into he floor beside your buttocks, gently lower your trunk onto the blankets behind you.

Proper support for your head and neck is crucial for relaxation. (To refresh our memory about proper head and neck padding, refer to the detailed description in chapter 5, "Relaxation Techniques," and see Figures 5.3-5.5.) You may need thicker padding than you do for lying flat (Figure 11.6). Adjust your padding so that your throat does not feel either stretched or compressed (Figure 11.7, Incorrect).

Reclining Kneeling Pose is best performed on a firm, noncompressible mat, such as a nonskid mat. You should not feel pain where your knees and tops of your feet come into contact with the floor. If you do, kneel on thicker padding. If the inside of the knee joint hurts, come out of the pose and insert a twisted sock into the crease of the knee before sitting on the block. If the ankles and tops of the feet hurt, place a rolled towel one to three inches thick under each ankle.

Do not allow your knees to separate widely. If they do, place a belt or strap in he bend of the knees before you sit down.

Knee joint or lower back pain calls for an increase in the height of the trunk or buttock supports. If your elbows do not reach the floor, put folded towels under your forearms for support.

To come out of the pose, move your trunk into an upright position by pushing 'our hands into the floor near your waist (Figure 11.8). Then, still kneeling, separate your knees and stretch your trunk forward. Rest your forehead on the floor or a folded blanket Figure 11.9). Lengthen, relax, and release your back.

Breathing and Imagery. Stay in the pose thirty seconds at first, gradually building up to five minutes. Use the Relaxation Breath. See your body as a graceful arch extending from your knees to your shoulders. Visualize widening and lengthening from the )ubic area to the navel.

Rationale. This squeezing and spreading pose reduces congestion in the pelvis and pacifies the nerves and muscles of the back and abdomen by increasing the space available for the pelvic and abdominal organs. Its chest-opening action also helps correct rounded upper back and shoulders.

Other Useful Poses

Practicing the standing poses described in Chapter 7 (using a table for sup­port) can ease back pain during menstruation. Pelvic pain and congestion may cause the muscles in the pelvis to become tense, which may lead to back pain. Standing poses gently stretch and release these muscles. The Relaxation poses described in Chapter 5 are also useful, especially those that squeeze the abdomen, such as Child’s Pose (Figure 5.11) and Supine Child’s Pose (Figure 5.10).  Also especially beneficial is Forward Bend with Torso Support (Figures 10.6 and 10.7).  Visualize the squeezing action of these poses, seeing swelling leave the pelvis with every exhalation.


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