Bikram Yoga and Back Pain

This testimonial is the story of my personal recovery from debilitating pain from herniated discs through the practice of Bikram Yoga.  This yoga gave me back my life. In the depths of my pain, I remember sitting in the car with my husband outside one of our favorite restaurants crying. I couldn’t even imagine enduring the suffering of a nice, romantic dinner. The thought of sitting for 45 minutes was pure torture.

The following is my story and experience. I have included a posture-by-posture list of my personal approach to the practice for back pain-sufferers. I offer the information to help you on your way. People write me daily asking if Bikram Yoga will work for them. I am not a doctor. It worked for me. It has worked for hundreds of my students. The principles work. Please read the entire article, including frequently asked questions before writing.

My story

I injured my back in the fall of 2001, shortly after starting yoga. I had spent my youth playing sports: rugby, field hockey, snowboarding, running and weight-lifting. A lifetime of aggressive contact sports culminated in two herniated discs in my low back at S1/L5 and L5/L4. They caused acute low back and sciatic pain radiating down to my left knee.

I was in pain constantly, even in my sleep. I couldn’t roll over in bed. The pain was so acute some days that my husband had to put my shoes on my feet. I was unable to carry a bag of groceries. It was excruciating to go to work, to rest, to sleep, to walk, to drive.

I dreaded the shaking pain from brushing my teeth.

My doctor offered three options: drugs, discectomy or cortisone shots for life.  At this point, I had begun to practice at a wonderful yoga studio. I decided see if yoga could help first.

It was no miracle cure from the start. Classes were hard and uncomfortable  I was new to yoga, so I had limited body awareness. I had set backs regularly. At the time, my job only allowed me to attend 3 to 4 times a week  Some days I didn’t think I could handle the pain and challenge of a class, but I always felt better after attending. I had increased range of motion, better sleep, less pain and an ability to participate in more. I always felt worse when I skipped class.

Somedays, I would turn my head to the side after Cobra and pour tears from the pain.

Over eighteen months, I saw slow progress.The miracle happened when I started practicing two times a day. It took me 10 days of doubles to be pain-free. PAIN. FREE. As in, no pain. I could sit without a back support. I could roll over at night. I could put my pants on standing up.

I kept it up for two months, resting on Sundays. I had a few set backs in the first couple of years. Under extreme stress or after moving or shoveling snow for hours in the Vermont winter, I have had times where I get sore again. I have found that the quicker I get back to yoga and the more frequently I practice, the faster I recover. 

Now, eleven years out from the initial bad spell, I live a free, active life. I hike, snowboard, shovel, stand on my head. I competed last year in the Tough Mudder. There are no yoga poses that I skip or avoid. I haven’t thrown out my back since 2004.

I have had two babies and never experienced back pain. 

I continue to practice 4-7 times a week, every week. I practiced regularly throughout both pregnancies. In fact, I took the nooner and had my son that night.

I recognize that double classes are not possible for all of us. With less frequent practice, the healing will simply take more time. Be patient with yourself and your students. Be strong and work hard. All you need is your body and this yoga to heal yourself.

Anatomy of Back Pain

Once a herniation, always a herniation. Intervertebral discs function to cushion the spine and absorb shock.  A herniated disc is essentially a disc with a hole in it. In a herniation, the annulus fibrosis (the tough outer membrane of the disc) is breached, and the softer, inner membrane (nucleus pulposis) extrudes. In general, pain occurs when the extrusion comes into contact with a nerve.

A traumatic accident or years of accumulated abuse and degeneration of the tough outer walls most commonly cause herniated discs. Studies report that by the age of 20, 80% of Americans have experienced back pain. A vast majority of the population shows herniated discs on an MRI, but not all people experience pain. Most people with painful, herniated discs have either tight hamstrings (creating downward pressure on the pelvis) and/or weak abdominal muscles. Both cause a state of nearly constant forward bending in the low spine and unsupported movement of the lower back.

The spinal nerves are located on the back side of the spine. When a person bends forward, the front of the vertebrae move closer together. This forces the disc toward the back of the spine and the spinal nerves. Persistent, unsupported forward bending will cause or aggravate back pain from herniated discs. It is essential, especially in the beginning of healing for the student to be very cautious with forward bending. Remember that bad posture, driving, working on the computer, slumping on the couch, gardening and sitting are all forward bends.

In a culture where we spend most of the day seated, it is no wonder back pain is endemic.

For most people, when their low back hurts, they lean forward and touch their toes. This will exacerbate the back pain. You just spent all day forward-bending. More of the same will get you more of the same.

It will sound counter-intuitive to most people to backward bend when they are sore, but it is essential to make that philosophy shift. Instead of leaning forward, a back pain-sufferer should try a supported standing back bend throughout the day as needed. It will be hard and sometimes painful in the beginning because of the trauma-like protective tension in the muscles and inflammation. You cannot approach your healing from a place of fear.

That has been the hardest point for me to get my students to understand. I have watched students yank on their toes in the final stretching, skip camel, drop into child’s pose between postures and do the whole class with their gut hanging out. After years, they cannot understand why they are not healing. When they finally understand and embrace the anatomy of their back pain and try the postures the right way, they begin to live without pain.

Back bending heals the spine.

Back pain sufferers need backward bending to strengthen and relieve pain.  In a back bend, the backside of the vertebrae come together, moving the discs and their extruded nuclei away from the spinal nerves, thus relieving pain. Pain relief may not be instantaneous because there is often a good deal of swelling in the area and tension in the muscles from experiencing pain. Time will help.

Step one in back bending is traction. Imagine lifting your vertebra off the offended disc. Create length in the spine first so you can flex and extend without pain. You don’t need a $5,000 anti-gravity table for that. Simple yoga poses like Half Moon Pose or Pranayama Breathing are simple and safe ways to relieve pressure and tension in the spine. These exercises also serve to make your back muscles stronger to support the compromised joints in your spine.

Second, it is important for those with herniated discs to begin strengthening their abdominal and back muscles. One can never heal or repair a herniated disc. The hole will always be there. The student must develop enough muscle strength to support the back and prevent aggravation. That means: SUCK YOUR GUT IN. Throughout the class, draw the abdominal muscles in during all postures, even backward bending. When you are walking, lifting, bending, pay attention to your abdominal muscles and engage them.

Third, spine twists are a healing movement for herniated inter-vertebral discs. The rotation of the vertebrae serves to draw the extruded material back into the disc. Any time the low back has been compacted or strained, a spinal twist (like the reclined abdominal twist) will help undo the damage. Initially, the degree of rotation will be limited because of the compression and pain. This is why your physical therapist says it is contraindicated. They are primarily interested in helping you with pain management. Over time, as the pain decreases and your alignment and strength increase, your range of motion will follow.

What to do in class: There are four main concepts to work on during class.

  • Easy does it in forward bending
  • Traction first
  • Back bend like crazy
  • Activate your abdominals

The following is a list of modifications that may need to be made in the beginning of a student’s healing process while there is a lot of inflammation in the lumbar spine and trauma in the muscles.

Expect your limitations to change.

These modifications are temporary changes to help you get through the tough times. As you are able, you will move back to the regular execution of all postures. Really. You.

Pranayama: Take this opportunity to engage your abdominal muscles as much as possible.  Remember that a strong belly means a strong back.

Half Moon: The side-bending is helpful in relieving the tension in the muscles around the lumbar spine.  Use it to help you feel less uncomfortable. Remember, traction first. Draw the belly muscles in and lift up out of the waist as you bend to the side.

Backward bend, backward bend, backward bend. Traction first: stretch UP before a back bend. Remember to keep your arms straight and reach back so you don’t sink into your lower back. Concentrate on lifting your chest as you arch back. Feel the back bend begin in your neck, travel down the rib cage through your thoracic spine and down into your lower back one vertebra at a time. Use 100% of your back strength.

Hands to Feet: Take it very easy. Walk your hands down your thighs instead of keeping your arms with your ears. Try to touch the floor. If putting your hands on the floor is too much, bring your hands to your thighs, chin up, suck in your stomach and flatten your back. No rounding when the pain is acute. You should look like an upside-down letter L from the side.

Awkward: Work the backbend in part one like it is your job. Oh wait, it is. Work your abdominals throughout.

Eagle: No problems. Remember this pose is a back bend. Work it. Again, stomach in.

Standing Head to Knee: This one is a major challenge in the beginning. If you can reach your foot, try standing up a little higher with it and sucking your abdominals in when you feel sore. If you cannot reach your foot due to pain, stand up straight and lift your thigh as high as it will go. DO NOT GRAB YOUR KNEE OR YOUR THIGH. This will put more pressure on your low back. As you are ready, contract the abdominals and begin to round forward vertebra by vertebra and reach toward your foot until you can grab it. This pose will be a long time coming for most people in acute pain. Take your time and have patience. Pushing beyond what you are capable of today will not speed your healing process. 

Standing Bow: Work it as strongly as you can; it’s good for you! This is a unique opportunity to stretch your tight hamstrings while in a backward bend.

Balancing Stick: You may not be able to come down to parallel because your arms and torso drag on your lower back fairly intensely. If not, set it up. Step forward and stand rock solid like a statue and stretch your body apart from your toes to your fingertips. Belly in, of course. Over time, start to take it down inch by inch. Patience, grasshopper. 

Standing Separate Leg Stretching: This posture may strain the low back in the beginning, but it is important to get a stretch to those tight hamstrings. The goal is to find a happy medium. Try hands to the thighs or hands to the floor in between your feet, depending on your flexibility, with a flat back, stomach in just like suggested in Hands to Feet. No rounding of the spine. Go down only as far as you can from hip flexion, not spinal flexion.

Triangle: Another good one to open your hips and reduce back pain. This pose is also a great spine strengthener and gentle twist. Do your best without fear.

Standing Separate Leg Head to Knee: Similar to balancing stick, you may only be able to set it up. Step out, arms strong, belly in and turn to the side. Build the strength in your abdominal muscles, create traction in your spine and in time you will be rounding down with the best of them. As you begin to round down, move with your spine as far as it will go. When it stops, you stop. Don’t let yourself start creating compensation patterns because you really want to touch the floor or get your head to your knee. This is a process of healing, not “getting” postures.

Tree: Great hip opener. Work those abs.

Toe Stand: Test it out. Sometimes the bend forward hurts in the beginning. It is a great opportunity to loosen your hips and that can be a great relief to your back, so return to it as soon as bending forward no longer causes you pain.

Savasana: When the pain is acute, you may need to bend your knees up in Savasana. Straightening the legs is a mild psoas stretch and you may not be ready for it. As soon as you can, return to the regular execution of savasana as tight psoas are a major cause of back pain. It may help to dribble your knees up and down like they were basketballs when you stretch them out to shake out some of the tension out of your lower back muscles and relieve the cramping.

Wind-removing: The only reported problem is picking up the foot. Sometimes the pull on the front of the spine by the psoas muscles doesn’t feel good. Do what you need to do to get your leg up. Sometimes it helps to bend the opposite leg, sole of the foot on the floor, while you are lifting the target leg into position. Enjoy how the floor is supporting your whole spine.

Sit up: None in the beginning. Log roll over and push yourself up. Over time you will return to them. When you are healthy enough to try them again, remember they are a curl-up, not a heave-up. Concentrate on bending your spine consecutively from the neck to the pelvis. This takes a lot of strength.

Cobra: Work your hardest even though it may be sore in the beginning. It is good for you. Think of lengthening forward as you lift up and bending every vertebra in your spine from bottom to top. 

Locust: Just do your best. It will help to strengthen your back, but your legs may feel too heavy in the beginning. Lock your leg muscles tightly. Work them off the floor as you can.

Full Locust: Go for it! Length and strength. Remember, extension of the spine helps to move the bones back to their proper alignment. BEND your SPINE.

Bow: Another good one that may feel like cramping in your low back. Work through it while respecting your limitations and don’t baby yourself. Remember, you are bending your spine as much as possible.

Fixed Firm: Tight hip flexors can pull acutely on the low back in this one. That may be uncomfortable, but it is important to get them a good stretch. Do the best you can. Concentrate on lifting your chest once you can get to the floor. That should take some of the pressure and acute bend out of the lumbar spine. If your lower back is really crampy, try squeezing and then releasing your gluteus muscles.

Half-Tortoise: Walk your hands down your thighs to come to the floor, contracting the abdominal muscles. Take this opportunity to relax and gently stretch the over-tired muscles at are trying to protect you from pain all day long. In some acute cases, you may need to open your knees up to 24 inches and drape the belly down in between. In this way, you stretch the back muscles, but the lumbar spine is actually in a backward bend. Imagine your spine like a hammock, hanging between two trees.

Camel: Sore or not, camel is your friend. Don’t be scared. Camel is here to help. Traction first, then extension. Do your best. And remember, friends don’t let friends skip Camel.

Rabbit: Go easy or skip in the beginning. You can also modify like Half-Tortoise above. I mean EASY.

Head to Knee: Try it, but go easy. No strain, no pain. 

Final Stretching: Bend your knees if you need to, to get your feet.  Chest up, flat back, stomach in.  As you develop strength and flexibility, you will be able to bend forward with the rest of the class.  ALWAYS SUPPORT YOUR LOWER BACK WITH YOUR ABDOMINALS IN ALL FORWARD BENDS. If you are Type A and have a hard time not struggling to “achieve” a posture, bend your knees and glue your chest to your thighs so the forward bend is isolated to hip flexion. 

Half Spine Twist: So good for you over time. This rotation will actually help to draw the extruded disc material back inside. Your degree of rotation will and should be limited in the beginning. Pull in on your abdominals, lift up out of your waist and rotate.

Kapalbhati: This is a great opportunity for you to develop strength in your abdomen without doing sit-ups or Pilates classes. Work it.  

ImageSara Curry is a Certified Bikram Method instructor and owner of Bikram Yoga Portsmouth. She lives in Southern Maine with her husband and two children.

Sara receives lots of emails from around the globe.  Before you write, please consider these frequently asked questions:

Why Bikram Yoga? I recommend Bikram Yoga because it is a therapeutic series and it works. It was scientifically designed to work the entire body and you don’t have to worry if the flow your teacher designed today will be right for you. That’s why I recommend it to my students, my friends and my family.  It has an even balance of back bending and forward bending. Bikram Certified teachers are some of the most rigorously trained teachers in the World. All Certified Bikram teachers have attended a 500-hour, intensive training and completed a 6 month internship. Part of that training is in yoga therapy, yoga for the infirm and anatomy and physiology. All Bikram teachers are required to attend re-certification every three years.

I have herniated discs in my neck.  Will Bikram Yoga help me? The same principles apply to cervical and lumbar discs. Individuals with neck pain may need to keep the neck neutral for the first few months. That means you won’t be able to drop the head back in Pranayama or look up at the ceiling in Cobra. That’s okay. Go as far as you can with your neck today. Concentrate on bending the rest of your spine first, particularly the thoracic spine. Be patient. You can do this.

What about a spinal fusion? The important concept to remember with a fusion is that every vertebra in the spine is responsible for a small percentage of the range of motion in any direction for your spine. Each bone does a few degrees pf motion and that can add up to a total spinal movement of more than 90 degrees. Once two or more bones are fused together, that percentage of the motion is lost forever. Don’t try to make the joints above and below the fusion make up the slack. This will only result in injury to that cartilage.

I live too far to study with you.  Where else can I find Bikram Yoga? You can find certified teachers and Bikram Yoga studios all over the world by using the “Class Finder” here. You can also look for teachers of the Hot Yoga Method or Core 26 trained by Tony Sanchez.

My doctor told me not to backbend and not to twist.  Will Bikram Yoga hurt me? Remember that Sara is not a doctor and does not know you as a student. If you have questions about the series, bring the Bikram Yoga book to your physical therapist to ask about the individual postures. With that in mind, remember your doc and PT are in the business of responding to your symptoms. They want to get you pain free today. Rehabilitating from back pain is not a pain-free process. There are no solutions in the medical field other than drugs, steroids or surgery and none of them work to eliminate the problem.

Can you prescribe a series of postures for me? The 26-posture series above is a beginner-accessible series of therapeutic postures suitable for all ages and levels of abilities. It is the series of postures that I used and worked for me, so I’d recommend them. I am not a doctor. I know this is a scary time, but you are uniquely like everyone else. You CAN heal yourself.

There is no Bikram near me, but I want to practice under a teacher at least in the beginning.  What should I look for?  I highly recommend practicing under a trained instructor. You may be an expert electrician, but if you have less than 10,000 hours under your belt in yoga, this is not your field of expertise. Don’t try to go it alone with a DVD when you have a serious injury like this.

Look for a teacher with a minimum of 500 hours of training. Remember that Registered Yoga Teachers, RYT, need only 200 hours of training before they can buy that title. Find out about their training in yoga therapy or anatomy and physiology. Talk with your teachers about their experience in working with back injuries. If they send you into a series of forward bends, hit the road.

In the beginning of your healing process, be cautious of practices based on vinyasa or “flow” yoga, as they include a lot of forward bending. Upward and Downward Facing Dogs are not suitable for the beginning phases of rehabilitation. Examples are classes called Flow, Vinyasa, Jivamukti, Power, Ashtanga or any other discipline with a lot of sun salutations or “vinyasas.”.  These practices will be available to you later when you are through the acute stage of your pain. Yoga is great fun. Heal up so you can enjoy the all-you-can-eat buffet in your area!

For those of you suffering chronic pain, I also recommend reading Healing Back Pain: The Mind-Body Connection by John Sarno.

47 Replies to “Bikram Yoga and Back Pain”

  1. Do you have any experience dealing with neck injuries and fused vertebrae? I have Fusion and plating at C-5 C6, with some demyelination of the spinal cord which does not seem to be degenerative, and I am rated at a 15% permanent disability as a result of symptoms from the demyelination. I have done some bikram yoga, but I am terrified to lean my head back because of the fused vertebrae, And symptoms I have experienced when leaning my head back very much, or trying to lean back all the way. Other than working with physical therapists, doctors and teachers, do you have any specific advice or specific people to whom I may be able to speak to help me stay as healthy as possible as long as possible in my life? I am in the Washington DC metropolitan area, and work as a welder.

    1. Adam, the big concern with a fusion is that you will never be able to move the fused section and it is important that you don’t try to force the vertebrae above and below it to make up the slack.

      1. So try conservative neck backwards bends as part of the postures (the plate is in the front – but it’s a little plate with only 1 screw in each vertebrae) but just be careful and go slow? I do like the bikram studios I’ve been to, but every teacher I’ve met is very hands off when I explain my situation. I think a few classes- even 1 or 2 – with someone who can give me some feedback would help me a lot with understanding what I need.

      2. Yes. In a group session, the teacher won’t have time to give you 100% personal attention. It would be worth it for you to pay for a private class and get the help you want so you can bring that knowledge back to class with you.

      3. Will do! If you have any suggestions for fusion-experienced teachers around DC that would be great! Otherwise I’ll start calling…. A business contact for Rima in Reston maybe?

    2. I don’t know DC well, but my friend, Rima, owns the Reston studio and I have heard great things about several studios in the metro area. I would call them and ask them to help you. There is a lot you can do with out hurting yourself.

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  3. OMG this is so true, I had my first session of Bikram Yoga at Caloundra 2 weekends ago. I have been suffering back pain off and on with 20 years. For the past 3 months my back has been extremely sore and affects my life style to the point of tears some days. I am active and enjoy boxercise, bootcamps and running, but for the past 3 months I can only walk as the pain intensifies when I do any sports.
    After attending my first Bikram Yoga class I could feel the relief straight away. I was away on a girls fitness weekend which started with Bikram Yoga on The Friday night followed by Paddle Boarding the next morning, then a 1 1/2 Hour bootcamp, and nice stroll to the pub for lunch, then an 1hour boxercise session that afternoon. Not to mention the 2000 skip ropes I had to do for our cabin group session. The next day we finished with a bootcamp session in the morning.
    I was so excited that I could participate in all these activites, as I thought that I would be watching the other workout after just doing some skipping. I couldn’t believe how much relief I have received from one session of Yoga.
    I am planning on going back today and becoming a Hot Yoga Junkie as once again my back is sore and I am struggling just to put my knickers on in the morning. It is a good day if I don’t have to hold the wall or sit down to put my pants on, how sad is that!
    I’m so glad that I got to read this article as I was just getting sick of listening to myself wine about how hard it is to get out of bed or pick my grandson up because I know that the pain will return and I will not be able to do anything without thinking about how it will hurt my back.
    I cant wait to get back to running, so looking forward to life again!!!!

  4. Hi, my wife has back / sciatica (likely) disc issues. She started getting into Bikram and loved it all around – agree with all your points, from my perspective. However, we have read that increasing core temp is a big time NO NO during pregnancy, especially the first trimester. What did you do, what are thoughts? There seems to be a LOT of evidence that supports core temperature elevation is bad for a fetus, but you had two healthy babies and never stopped….

    1. Absolutely. The good news is that in a Bikram Yoga class, your core temperature increases less than when jogging. The human body’s thermo regulation system is amazing.

    1. If she or her Dr is worried about it, just have her bring a thermometer in to class to check. On average your internal temperature increases about a half a degree in class. Just be sure she puts a wet paper towel or wet washcloth over the business end until it is used as you don’t want it measuring the air temperature.

  5. I haven’t tried Yoga, is it quiet the same with tai-chi’s meditation? I’m really interested on trying yoga for my never ending back pain. I hope it’ll work.

  6. A thousand thank yous for this exhaustive explanation. I needed this to understand the “whys” of backward bending and how to be more mindful in class of what my spine is doing in every pose.

  7. Yes, thank you Sara. I found your story and suggestions for the various postures so helpful for everything on the mat. Really increases awareness. With much appreciation…. Judy

  8. Thank you so much for all of the information on modifications for lower back issues. I did something to my back last week in class and continued my practice to help relive the pain bit then again this morning in Standing Head to Knee I re-pulled or injured my back again!! I finished class taking it easy in forward bends. I’m just so frustrated. I’ve never had back pain in life and want to continue my practice. I’m going to do the modifications and hope the pain goes away. Also, did you practice throughout your entire pregnancy? Do you think the heat will cause my core temp to rise to dangerous levels? Thank you!!

    1. I did and I have two, beautiful, smart, healthy kids. It is not like a sauna or a Jacuzzi. A Bikram class increases your internal temp about a half of a degree. That is less than running. If you are worried, bring a thermometer in with you and check. Just remember to cover the end with a wet paper towel or you will just be reading the ambient air temp.

  9. HI Sara! I am trying to figure out how to know how much and when to increase the forward bending poses. I’m sorry this is long, but it’s just a long story. I have done Bikram yoga on and off for many many years. Even before it was so popular, I had the Bikram book with detailed instructions, and an audio cassette of Bikram Choudbury himself directing the class. I did it in my steaming hot attic in Nashville, TN. Eventually there were studios in town where I practiced regularly, so I feel like I am perfectly qualified to do this practice alone at home, which is my only option. The closest studio is just too far away. I recently decided to pick my practice back up and decided that 75 – 80 degrees was warm enough (I practice in silky long johns, so I’m warm and slippery and that’s as hot as I can get it in the winter) I’m visiting Portland late summer and am going to try to fit in a class with you!

    I have had a minor issue with my very low back off and on my whole life, but it only manifests in the first moment or two when I get up in the morning. It doesn’t hurt to lie down, it just hurts when I get up. I’ve seen a chiropractor off and on; the latest one says my coccyx is cocked and it can’t be fixed, just kept from getting worse. I don’t believe this. Everything can be fixed. So one day a few weeks ago, after doing yoga, I was struck with debilitating pain, practically immobilized for about 18 hours. (I assumed I did something wrong, too much, too casually in yoga, but in hindsight, it may have resulted from something earlier in the day, I can’t remember what I did that day) It was all I could do to feed my dogs, and their bowls did NOT get picked up afterward. I live alone in a very remote location and I was snowed in at the time. Even if there were someone to call, no one could get to me, so I had no access to help of any kind. After 18 hours or so, it was gone, like nothing ever happened. This panicked me terribly and I knew that I can NOT be a person with a bad back, so I went in search of information and that’s when I found you and this site. My heart hurts for anyone who has to have pain like that day in and day out. I’m glad you no longer do. 🙂

    It took me a couple of weeks to get over my fear and resume my practice. In the meantime I had another terrible episode like the first one. But this time I attributed it to playing with my 2 yr old niece. LOTS of muscle action while bending forward. Again, all better in less than a day. As soon as I returned home, I came back to this site and studied it very carefully and resumed my practice using all of your suggestions. I even started trying to do doubles, but the first day I did, I spent several hours working in the garden in between my morning and evening session and next day, bam! Back in bed for most of the day. Again from strenuous forward bending activity. So now I know, for the time being, I need to limit the amount of work or play I do with forward bends.

    Now, to the actual question. I have been almost eliminating any of the forward bending postures. I keep my head up and back straight in the forward bend portion of Half Moon, either skip Standing Head to Knee, or only do one set with my back as straight as I can get it. Same with Separate Leg Stretching and all of the forward bending postures. I half do Half Tortoise, skip Rabbit and Sit ups, and give my all in the back bending postures, (especially Camel) deliberately, abs engaged, hips solid; I’m enjoying it very much.

    Now for the actual question. I can’t figure out when and how quickly to put back in the forward bends. The problem is, these don’t actually hurt while I’m doing them, I’m just cautious about having pain afterward. In fact the only poses that hurt my back in the way that it hurts during these “episodes” are the Savasanas, both front and back, so I modify those as well. I’m snowed in again, alone with 2 dogs and 4 cats, so I can’t afford to lose a whole day because I can’t stand up. Oh and my favorite pose is Head to Knee. It’s a little painful getting into it, but then it feels just wonderful and my back says “thank you”! 🙂

    Thank you so much for this site and for your insights. I look forward to hearing your advice on this.! Have a wonderful day. Namaste’

    1. First, everyone’s rehab is differently and the path to increasing forward bending depends primarily on your connection to body. It is a process of testing and feeling and connecting with how the poses make you feel before, during and after.

      You say head to knee is painful getting in. This is a very deep and intense forward bend. Perhaps you’re going too far too fast? Or to hard in it?

      There are a tremendous amount of life-factors that contribute to and exacerbate back pain. Without having you as student, I really can’t give you much advice on your practice as I don’t know your body and can’t see your alignment. I don’t know if you have tight hamstrings that need to be stretched in a safe way or if you’re using your abdominal strength effectively, etc.

      It is wonderful that you have a long history of experience with the yoga. The issue with practicing with an injury is two-fold. 1. You don’t have training in assisting someone with an injury, and 2. It is difficult to correct yourself because you are looking out from the inside. I strongly recommend that you find a way to get to a class with an experienced teacher, even if it is once a month so you can get some guidance in your practice. If there is no experienced Bikram teacher, try the local Iyengar studio. Their focus on slowing down and correcting alignment will help you in your BY practice.

      Best of luck.


  10. Thanks very much for your response. Important point that I should have mentioned is that I modify the separate leg stretching so it is mostly a side bend instead of a deep forward bend. And my back is tense and alert from the spine strengthening series, (no rabbit or tortoise to release that tension), so it takes just a second to relax into it. I do have tight hamstrings (and hips), so I do all of the poses that stretch them, just with a straight back. I have excellent body awareness and am confident I can figure this out on my own, in fact this very day I’m going to start easing the forward bending back in. I will think about your suggestion, however, maybe do a private session for some very specific evaluation. Thanks again for your response and have a wonderful rest of the day! 🙂

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  12. Hi Sara! I have practiced at your amazing studio in Portsmouth, NH and for many years at the Salisbury, MA studio and with Sam Goldman in Auburn, MA! I’m now in DC at the Ballston Studio with Zahara. My question about lower back pain- I have been practicing Bikram on and off for many years (~9) and I believe I have correlated my increased back pain to times when I have been doing less yoga and I truly believe it to be an amazing and healing practice. However, when I threw out my back last March (after a long stint of running a lot of miles, heavy weight lifting and not enough yoga) I went to both a physical therapist (who was pro yoga) and chiropractor (who was not at much). And both said my spine was TOO flexible and that I had to build more core strength to counteract this hyperextension (in my practice I have a great back bend and slow tight forward bend). You do emphasize core strength however, you also say to bend backwards uninhibited to heal back pain. I know you are not a doctor but I’m just trying to make sense of this conflicting advice – do I work on core strength and still back bend like crazy to heal the spine or stop back bending because my spine is too flexible??

    1. Try to look at it this way. When you backward bend, are you doing so with strength or are you flopping back as far as you can go? Yoga is about balance. If you are very flexible, you don’t just keep seeking more more more flexibility. In Bikram Yoga, we say “too good is no good.” If you are very flexible, you need to work to balance that with strength.

      Should you back bend for your spine health? Yes. For you, you probably need to hold yourself just above your depth so that you force yourself to develop strength to hold your body in position, rather than leaning on your joints and forcing your ligaments to do the job of your muscles. Does that make sense?

  13. Whenever you back bend, concentrate on STRETCHING UP first and staying lifted up as you go back. If it feels easy, you’re not doing it right for your body. It is very hard to teach flexible students to use their strength because it’s so easy to flop over on your joints and sit there.

    In addition to that, you wrote in your original comment about what got you to this current episode of back pain. Those activities will aggravate your spine health. You have to decide how important it is to you to continue them (is it your life’s work? does it bring you great joy? are you a professional body builder?). If it’s necessary, just be sure to get to yoga every day in addition to those activities. If they’re not that important, why are you hurting yourself?

  14. Hey Sara, What’s your take and suggestions on a 4-month long sciatica pain? I’ve worked through staying behind the “pain” and working the stretch. Forward bends can be a bitch, so I’ve learned to “listen to the body”. I noticed when I push a little more in backward bending, it flares up again. Any suggestions would be so helpful. I practice Bikram 4-6 times a week, and have been for 9 years. I’ve worked tremendously on breath and a deep meditative state during this process and feel that my practice is actually becoming more concise and solid even with the “injury”.
    Thank you –

    1. Chris,

      I love to hear that. Truly, that’s the best of the work we’re doing on the mat. Learning to tune into our bodies and what they need.

      Sciatica is a tricky condition. True, 85% of sciatic pain stems from bulging lumbar discs, but there could be other factors at play here.

      Do you have any other people on your healing team for this problem? It usually takes a team effort to get to the root of the problem. Examples would include an Osteopath, Massage Therapist, Chiropractor and if your chiro doesn’t give you strengthening exercises to do, a PT or OT .

      As much as you’re practicing and as accurately as you’re working, there has to be something you’re missing. Alignment, strength, range of motion.

      The fact that really cranking the back bends causes a flare up makes me wonder if you’re mostly bending just the lumbar spine. Try working harder to bend your upper back/thoracic spine (everything with a rib attached) and use your muscles to lift up out of the low back so you’re not compressing on the sciatic nerve. Let your teachers know you’re working hard on this and have them help catch you when you “hinge” at the low back.

      Let me know if that helps.

  15. Hi Sara

    I loved finding your article as it gave me such hope. Thank you for writing it and sharing your wonderful story!

    I was diagnosed with 2 slipped discs in 2013 whilst going through chemo (L3/4 L4/5) and used pilates to manage it from there on in. I occasionally moved back to yoga, which I prefer, (sun salutations etc) only for it to flare up again – not realising I was making it worse with the forward bending. Then I met a wonderful Bikram teacher in Thailand who taught me that Bikram can mend my back and another teacher at the same studio highlighted this link to me. He was right, I practiced at least once a day and had no problems whatsoever for 2 solid months.

    Sadly since returning to where I live – London – my back is flaring up again. I have been following a voice recording of the Thailand Bikram class every day and it had helped keep my back at bay. Unfortunately it has since flared up – I thought I was strong enough to try an Iyengar yoga where I must have pushed it too much. I tried a proper heated Bikram class in a studio, which I loved, but I have to be super careful as I have stage 3 adrenal fatigue after 3 years of intense treatment for breast cancer so have been advised not to exercise in such extreme heat. I have also just found out that chemo and drugs have left me with the beginning of osteoporosis so have been advised to start some strength training to build me up. I am of slight build and hyper-mobile.

    I am really interested to know your thoughts on any of the above as am feeling a little confused as to what to do thats bets for my entire body. The beginnings of sciatica and a very tight glute is beginning to scare me and I want to act before it gets much worse.

    Thank you


    1. Emma,

      That is certainly a serious concern. The heated room can put a lot of strain on the kidneys and adrenals. However, for some practitioners, it actually improves function of these organs. Tell me this, how did you feel after your first “proper” Bikram class? Were you depleted? Shaky? STARVING?

      While I think it is lovely that you had a recording from Thailand, remember that you have a serious injury and are not a trained teacher. At this phase of your recovery, I would STRONGLY recommend practicing with a teacher, not a self practice. There is so much to learn about your alignment that you can’t do on your own (or you wouldn’t be in this state today).

      If the heated classes are really destroying you, try talking to your studio owner. Maybe you could do a private class once a week with the heat off so it’s warm, but not killer. Is there a cooler part of the room? You can try practicing near a door or under a fan like we do with women in pregnancy.

      Whatever way to you get it, get that yoga, girl. It makes you feel better and you deserve to enjoy this life!



  16. Hi, I had a terrible back pain and found out I ve a herniated disc L5/S1 and a disc protrusion on L4/L5
    this 3 weeks ago. I use to practice bikram, twice a day when I can, since now 3 years. Daily yoga and daily Gym
    One day I did 3 bikram class, as I was getting ready for the bikram teacher training (which I wanted to do this fall) at the last class I felt pain on my lower back
    since then a nightmare.
    I use to perform all the asana without any problem and very deep, my backhanding was really deep, my camel as well
    now i cannot do camel i cannot do backhanding
    I cannot do yoga
    And i don’t have any pain to forward bending
    I m waiting for another Rmn
    I feel very depressed and I don’t know what to do. After I ve read your post today I tried to back band and camel (pose that i always love the most) and I cannot reach my heels on camel, because of the pain.
    What can I do? I don’t have pain on the leg, only my sacral area.
    Any suggestion will be really appreciated
    I want to be back to my practice, your story is encouraging
    Thank you

    1. Mitra,

      I am not your teacher and don’t know your practice, but from what you’re describing it sounds like your issue is one of over use and going to deep in the postures. My recommendation is that you find yourself a highly qualified, experienced teacher and let them help you. Deeper and longer is not always the path to healing.

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