Editor's note: The below are intended to be general recommendations for yoga practitioners and teachers. They are not a replacement for the personal advice of a health professional. Yoga teachers should remain within their scope of practice: This means not attempting to diagnose, treat, or offer medical advice to students.
Lumbar spinal stenosis (LSS), a narrowing of the lumbar spine that causes compression of the spinal cord and nerve roots, is increasingly common and will perhaps affect as many as 65 million seniors in the U.S. by 2025. While some people with the condition will experience no symptoms, symptoms can include pain in the buttocks and pins-and-needles sensations, cramping, or weakness in the legs. Back pain is the most common symptom: Those with stenosis are three times more likely to experience it than those without.
Because of yoga’s well-known ability to relieve lower back pain, some people with LSS may wonder if yoga is safe and beneficial for them.
According to physical therapist Bill Reif, author of the book The Back Pain Secret: The Real Cause of Women's Back Pain and How to Treat It, those with LSS who’ve received permission from their doctors to practice yoga may find it to be a boon.
Reif says, “Yoga, like physical therapy, could help build core strength and improve control of the spinal curvatures, minimizing the effects of compression.” But he offers this caveat: “Yoga may be appropriate for those with mild, intermittent, or occasional symptoms. Those with moderate to severe stenosis with frequent pain may not be able to tolerate most active forms of yoga, and should probably seek out a more restorative practice that uses props to help maintain neutral spinal curvature.”
A yoga practice may benefit many of those with LSS as long as teachers, and students, are familiar with how common movements and poses may interact with LSS: Some are likely to alleviate, while others may exacerbate symptoms.
The Do’s and Don’ts
The following do’s and don’ts may be relevant for many yoga students with LSS; they can be put into play in many types of group yoga classes as well as in home practices like this one.
However, LSS can have many causes. “Spinal stenosis can be caused by infection, tumors, thickening of ligaments and growth of bone spurs, or disc problems,” Reif says. According to the Arthritis Foundation, though LSS can occur in younger adults with scoliosis or a congenitally narrow spinal canal, it is most common in those over 50; osteoarthritis and rheumatoid arthritis are contributors, as are traumas like falls that injure the spine. LSS can also occur in different parts of the spine—the spaces between vertebrae, inside vertebrae, or through which the nerve roots emanate.
Because of the many possible sources of LSS and locations of compression, different students may need different approaches, and all students should consult with their doctors about which movements they should avoid, and which they should focus on.
The types of poses and movements that follow may be beneficial to many yoga practitioners with LSS. Naturally, if pain or numbness begins or increases in any of the poses suggested, take it off your list. Reif says, “A yoga pose is often a ‘do’ if it feels good.”
1. Do practice mild forward folds.
Perhaps surprisingly, spinal flexion—forward folding—often leads to temporary relief of stenosis symptoms. Those with stenosis “often feel relief by stooping forward while holding onto a shopping cart,” says Reif, adding that they may even adopt a habitual forward-leaning posture. This is because flexion “increases the dimensions of the spinal canal, decompressing nerves and discs.”
The recommendation that those with stenosis forward fold slightly “is the exact opposite recommendation those with other back pain diagnoses typically receive,” Reif notes. For those with osteoporosis and kyphosis, it is extension—backbending—that is often recommended, but for those with stenosis, extension may lead to further compression (discussed more in the don’ts, below).
Reif adds that forward folds should be entered into gradually to protect vulnerable areas of the spine. “In order to find the ideal amount of forward fold, it helps to move slowly and use props to control the descent,” he says. For instance, when forward folding into half forward fold (ardha uttanasana) to forward fold (uttanasana), those with stenosis may want to first bring their hands to their thighs, then to their shins or blocks if a lower fold feels appropriate.
How far someone with stenosis should forward fold varies from person to person. One must go by whether the symptoms increase or decrease,” Reif says. Deep forward folds like paschimottanasana (seated forward bend) and uttanasana may yield relief for some; others may be happiest in half forward fold and staff pose, or drawing one knee or both knees in toward their chest while lying on their back.
2. Do focus on (roughly) neutral-spine poses.
If forward folding is the short-term solution to relieve LSS pain, cultivating a more neutral spine, in and out of yoga class, is a longer-term solution to avoid further compression.
“Neutral spine prevents further deterioration of facets, discs, and vertebral bodies, something all yogis need,” Reif says.
A neutral spine, according to Reif, “means holding the natural curves in the spine and working to lengthen it.”
Using a wall may help students experience what neutral is. In addition to providing some support, “a wall gives proprioceptive feedback,” says Reif.
When leaning against a wall, it may be easier for those with—and without—LSS to stack ears over shoulders and shoulders over hips. With their feet a couple of inches in front of the wall, they can work to bring their pelvis, mid and upper back, shoulder blades, and the back of their head against the wall, while allowing their necks and lower back to curve slightly away from the wall. (And if some flexion is necessary for comfort, they can practice a version of chair pose at the wall: walking their feet a couple of feet away from the wall, and bending their knees enough that their lower back flattens against the wall.)
The neutral alignment fostered by a wall can then be applied to seated poses, as well as poses like tabletop and plank.
Those with stenosis who have adopted a habitually flexed posture will benefit from making a return to neutral…gradually. “It might be necessary for someone with stenosis to forward fold to a slight degree in order to make some poses comfortable and attainable,” Reif says. This is okay: Insisting on an entirely neutral spine too soon might lead to pain. “Find the alignment that alleviates symptoms instead of being overly focused on the traditional form of the pose,” he advises. In other words, leaning forward in a lunge or in warrior I and rounding the lower back might be just what a yogi with stenosis needs to do until they can be fully upright without pain.
3. Do go slowly enough to encourage a mind-body connection.
“Being in the moment is especially important for those doing yoga with stenosis,” Reif says. A practice should be slow enough that students with LSS notice the sensations that each pose brings so they can stop well short of any increase in pain. In addition, maintaining awareness of neutral spinal alignment may be easier if a practice is on the slow side.
However, going slowly doesn’t mean lengthy holds in poses that call for deviations from a neutral spine (even slight ones). “Don’t stay too long in a non-neutral pose: Come back to neutral after a few breaths,” Reif says. (Unless, of course, you know that for you, a long hold in a slight backbend, twist, or forward fold decreases symptoms.)
For those just starting to exercise, restorative, gentle, or yin yoga classes might be the best bets because their pacing may encourage mindfulness. However, longtime practitioners may be able to maintain self-awareness, and modify as needed, throughout more demanding styles of practice.
4. Do strengthen your core.
“Core strength is necessary to support and decompress the lumbar spine,” Reif says. Instead of doing movements like sit-ups, which round the back, those with LSS could focus on poses that strengthen the core with a neutral spine, like bird dog, plank pose, standing balance poses, and supine leg lifts.
Practicing mula bandha and uddiyana bandha while seated comfortably or in combination with other poses can also engender spinal support from within. One way to begin to approach these “locks” is to draw the pelvic floor up and the belly in on an exhale and release on an inhale.
5. Do stretch your psoas.
“Those with spinal stenosis who have increased lumbar lordosis—inward curvature of the lower back—because of a tight psoas may find that stretching the psoas helps the spine assume a more neutral shape,” according to Reif.
Many yoga poses stretch the psoas: upright lunges, pigeon pose with the chest well lifted, dancer pose, and warrior I, but Reif also favors this one: Lie down at the edge of a bed, draw both knees in, and then lengthen one leg out, allowing it to drop down toward the floor. “Keeping one knee in will help prevent the lower back from overarching,” Reifs says. However, for those whose psoas is on the tighter side, simply lying on the floor, hugging the knees in, then stretching one leg out and letting the thigh drop toward the floor may be a significant stretch.
The risk for those with stenosis is that when trying to stretch the psoas, they may inadvertently overarch their lower backs, exacerbating symptoms: Instead, keep awareness in the lower back, encouraging expansion there as you inhale, and move into the stretch slowly, so you have plenty of time to halt the stretch before your lumbar curve increases.
6. Do sit if you need to.
Standing aggravates symptoms for some people with LSS, while sitting alleviates them. If standing poses increase discomfort, feel free to take a break: Sit in a chair, or come to a comfortable seated position on the mat or on a bolster. Consider chair yoga, in which active poses are done from a seated position, or restorative yoga, which is done lying down with support from bolsters and blankets.
7. Do consider a side-lying savasana or elevate your legs.
Those with LSS symptoms often find lying on their side in a fetal position or bending their knees enough for the spine to flex to be more comfortable than lying flat on their backs. So try relaxing at the end of class in a fetal position, placing a bolster or blanket between your legs, or lie on your back with your shins elevated on a bolster or chair to allow your lower back to release.
The paramount advice for those with LSS is not to go into any pose so far, so fast that they don’t have time to notice any increase in symptoms.
As discussed above, spinal flexion may benefit many with LSS. Some lateral flexion, rotation, and even minor extension may be tolerable for those with very mild stenosis, according to Reif, “if these movements do not produce or exacerbate symptoms. But extreme deviations from neutral may compress the disc and cause further narrowing and encroachment on nerve fibers, and, for many students, these movements may cause pain.”
Reif advises that students with LSS immediately stop doing any pose that increases pain or numbness. “If a pose or movement is causing or worsening symptoms, it’s a ‘don’t,’” he says.
These “don’ts” aren’t etched in stone, though: “Over time, it may be possible to make gains in all of one’s functional abilities and move the spine in all directions without increasing symptoms,” Reif says.
1. Don’t practice full inversions.
“Any inversion compresses the lumbar spine because of the additional body weight from above, potentially further narrowing the space through which the nerves must pass freely,” Reif says. “Additionally, inversions may make it more difficult to maintain a neutral spine for some individuals.”
Headstand, shoulderstand, forearm balance, and handstand should all be avoided unless a student is a longtime practitioner who can maintain a neutral spine in these inversions and can maintain control as they come into and out of the pose. Try milder inversions like downward facing dog and legs up the wall instead.
2. Don’t extend the lumbar spine beyond its natural curvature if it leads to an increase in symptoms.
“I do not consider a normal lordosis [inward curve of the lower back] extension in this conversation,” Reif notes. The gentle inward curve of the lower back is an important component of a neutral spine. However, those with LSS may not want to increase the curvature in that part of the spine at all.
“Lumbar extension, which can close off the spinal canal, is unlikely to feel good to those with lumbar stenosis,” Reif says.
He recommends avoiding backbends like upward dog, wheel, locust, and camel. Milder backbends, like sphinx and bridge, in which the arms can be used to channel the backbend only into the mid and upper back, may be suitable for some with LSS as long as they don’t lead to any increase in symptoms.
3. Don’t twist to an extreme and/or with a rounded back if it doesn’t feel good.
“Twisting can often lead to or exacerbate symptoms,” Reif says. Twists like deep versions of janu sirsasana (head to knee pose), revolved chair pose, and others that involve a rounding of the lower back could place uncomfortable pressure on the lower back, and should be avoided if they make any symptoms worse.
Reif does acknowledge that some measure of twisting may be accessible for those with mild stenosis.
“I would encourage only the twists that allow a neutral lumbar spine,” Reif says. He recommends “thread the needle twist” (sometimes called parivrtta balasana, revolved child’s pose) from hands and knees, and windshield wipering the legs.” Warriors I and II also involve minor twists that may be tolerable for many of those with stenosis.
Those with more severe symptoms may be better off finding only the barest hint of a twist or may be able to twist only to one side: If the stenosis occurs along the right side of the spine, rotating to the left may decompress the compressed area, whereas twisting to the right, toward the compressed area, could increase symptoms. Skip twisting to one side if it causes pain.
4. Don’t do deep side bends if they worsen symptoms.
A modest amount of side bending can strengthen and even decompress the spine, but, “Again, an extreme of range will possibly exacerbate symptoms,” Reif says. As is the case with twisting, side bend only to the extent that feels good, and if side bending to one side feels compressive, skip it.
In poses like gate pose or a standing side bend, stay as high as you need to in order to be comfortable.
5. Don’t roll up to stand.
Though forward folding may lead to relief, Reif points out that there are different mechanics involved when rolling up to stand from a forward fold. This movement is typically best avoided by those with LSS and other spinal problems, whether or not it produces instant symptoms, because lifting half the body’s weight against gravity is a tall task for an already-vulnerable lower back.
“Relying on the back muscles without the help of the hip or abdominal muscles places stress on the lumbar muscles, multifidus, erector spinae, and the intervertebral discs,” explains Reif.
Instead, to come out of a standing forward fold, keep your knees bent, walk your hands up your thighs, and keep your spine long as you rise to standing.
In Daily Life
In addition to following the do’s and don’ts that make sense to you, as often as possible, return to the self-awareness you’ve cultivated through your mindful yoga practice: Notice how the activities of your daily life affect how you feel. Which activities seem helpful? Which less so?
If some activities aggravate your symptoms, could you change the way you do them, repositioning your body to take stress off your lower back, or taking breaks to sit down and lean forward, elbows on thighs? Or perhaps you could approach those movements with more breath, or less hurry?
You may find that devoting some attention to your spinal well-being throughout your day—and night—gradually becomes easier, as do your movements themselves.