Physiotherapy Rehabilitation

Therapeutic Yoga and the Spine: A complex of Body, Nerve system and Mind

What is Therapeutic Yoga?

Therapeutic yoga refers to the use of yoga for medical, psychological, and emotional therapeutic purposes to improve bodily imbalances and promote health of the body and mind. It may include various body manipulations, breathing techniques, meditation, and psychological elements. Therapeutic yoga can be used to treat various conditions such as disabilities, physical injuries, chronic pain, stress, and mental health issues. Also It teaches us is the realization that everything essential for our health and happiness already exists within our bodies. For all living beings to thrive, there must be a balance between permeability, rigidity, and flexibility, persistence and adaptability, as well as space and boundaries.

Yoga and Spine

The spine constantly expends a significant amount of energy fueling the unconscious muscle actions to counteract gravity. Yoga helps identify and activate inhibited or less efficient muscle actions that may interfere with the expression of deep strength, allowing for the release of energy resources.

Considerations for spinal exercises in Yoga

The Cat-Cow exercise reduces stress on the lumbar intervertebral discs due to viscosity. However, for individuals with sensitive lower backs, it can serve as an exercise to evaluate the directionality of pain in cases of lower back pain. Flexion-intolerant patients typically experience pain in flexion, while extension-intolerant patients experience pain in extension. Such movements can be applied as one of the various methods to identify individual neutral spine positions.

Therapeutic Yoga and Spine

Transitioning from a seated posture to a forward bending position. Transitioning from Chair Pose (Utkatasana) to Forward Bend (Uttanasana) can easily limit initial lumbar spine movement and facilitate involvement of hip flexion movement. This can be utilized as movement re-education for individuals experiencing pain in the lumbar spine direction of flexion.

Complex spinal movement: flexion + rotation: It can be observed that there is a greater range of motion when rotating the spine in a flexed position without weight-bearing compared to rotating the spine while standing upright. According to the study during spinal flexion, rotation increases by approximately 16 degrees, while during spinal extension, rotation increases by approximately 13 degrees.

The variations of the Downward Dog pose in yoga enhance thoracic spine mobility. These variations can be integrated into mobility exercises when connected with plank or push-up movements.

Shirley Sahrmann, PT“When functional impairment of the spine is detected, our goal is to identify misalignments and directional movements that manifest the patient’s symptoms (pain).”

Representative muscle imbalance patterns – Janda’s Crossed Syndromes

Crossed syndrome refers to a pattern of muscle imbalance and postural dysfunction that typically involves opposing muscle groups in the body. The term was coined by Czech neurologist Vladimir Janda to describe these common patterns of muscular imbalance that contribute to faulty posture and movement mechanics.

Two main types of crossed syndromes:

  • Upper Crossed Syndrome (UCS): In UCS, there is tightness and overactivity in the muscles of the upper back, neck, and chest (such as the upper trapezius, levator scapulae, and pectoralis muscles), combined with weakness and underactivity in the muscles of the lower neck, mid-back, and shoulder blades (such as the deep neck flexors, lower trapezius, and serratus anterior muscles). This imbalance can lead to rounded shoulders, forward head posture, and an increased curve in the thoracic spine.
  • Lower Crossed Syndrome (LCS): In LCS, there is tightness and overactivity in the muscles of the lower back and hips (such as the erector spinae, iliopsoas, and rectus femoris muscles), combined with weakness and underactivity in the muscles of the abdomen and buttocks (such as the deep abdominals and gluteus maximus muscles). This imbalance can lead to an anterior pelvic tilt, increased lumbar lordosis, and hip dysfunction.

The importance of sitting with proper posture.

Proper posture while sitting helps maintain the natural curves of the spine, including the cervical (neck), thoracic (upper back), and lumbar (lower back) regions. This reduces the strain on the spine and prevents the development of conditions such as kyphosis, lordosis, and scoliosis. Good posture supports the muscles surrounding the spine, including the back, abdomen, and pelvic floor muscles. This helps prevent muscle fatigue, strain, and overuse injuries. Maintaining proper posture while sitting can help prevent and alleviate various types of musculoskeletal pain, including neck pain, back pain, and shoulder pain. Poor posture can lead to muscle imbalances and tension, which may contribute to chronic pain over time. Sitting with proper posture allows the lungs to fully expand, facilitating better breathing and oxygenation of the body. It also promotes healthy circulation, reducing the risk of blood clots and swelling in the legs. Slouched posture lengthens the spine, increasing pressure on the vertebrae. Conversely, upright posture relatively reduces spinal compression load.

The association between yoga and the nervous system

In many instances, muscle flexibility is not determined by the actual physical length of the muscle or muscle fibers. The resting length of a muscle, its level of tension, and the extent to which it can be stretched are all set by proprioceptive nerve endings within the muscle. What is considered appropriate, safe, and functional in the nervous system is established through previous bodily experiences related to what the nervous system perceives as appropriate and safe. Additionally, strength is also a product of how the nervous system recruits and organizes muscle fibers within surrounding muscles and movement chains. If the nervous system recruits and organizes muscle fibers inefficiently, muscles may have to work harder to overcome resistance from other muscles in the body, leading to decreased strength. Increasing muscle flexibility and strength is also a process of re-educating the nervous system through repetitive stretching and conscious practice. We come to realize that there are remarkably diverse ways to perform even the simplest movements.

The correlation between chronic pain and emotional state through yoga

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According to the paper, among 42 subjects, 20 underwent a 16-week yoga program, comparing yoga therapy with conventional therapy, where 77% of the therapeutic yoga group showed functional improvement and 64% experienced pain reduction. The yoga group exhibited superior functional improvement, pain reduction, and reported lower levels of depression. Additionally, in a follow-up assessment six months after treatment, the yoga group was found to maintain its effects, indicating its value as a form of self-care. Furthermore, the characteristics of chronic back pain (CBP) involve neural circuits operating in the emotional regions of the brain, with individuals transitioning from acute to chronic pain showing decreased activity in pain regions and increased activity in emotional regions.


Therapeutic yoga postures are not exercises intended solely to strengthen or stretch specific muscles or muscle groups. While such effects may be anticipated, the human body is unique, with varied responses to gravity, pathways for muscle recruitment, and levels of tension in joint capsules and ligaments. The way we move is influenced greatly by the quality of movement from bones and muscles, as well as by factors such as the endocrine system or blood.

Sihyun Kim - Physiotherapist at Korehab Clinic


Yoga Instructor
Myofascial Release Therapy
Lymph Manual Therapy
Movement Corrective Specialist
Orthopedic Manual Physical Therapy
Proprioceptive Neuromuscular Facilitation Therapy
Neuromuscular Development Therapy


  1. Kinematic Analysis of Lumbar and Hip Motion While Rising From a Forward Flexed Position in Patients With and Without a History of Low Back Pain Marcia A Esola MS, PT. Philip W McClure MS, PT
  2. Pearcy, Mark, I. A. N. Portek, and Janis Shepherd. “Three-dimensional x-ray analysis of normal movement in the lumbar spine.” | Spine 9.3 (1984): 294-297.
  3. CIRCADIAN VARIATION IN HUMAN STATURE. Thomas Reilly, Adrian Tyrrell and J.D.G. Troup* | Department of Sport and Recreation Studies, Liverpool Polytechnic, Byrom Street, Liverpool, L3 3AF, U.K | Department of Orthopedic and Accident Surgery, Royal Liverpool Hospital, Liverpool, L7 8XP, U.k.
  4. Therapeutic Application of lyengar Yoga for Healing Chronic Low Back pain Kimberly Williams, Ph D., Lois Seinberg Ph D., and John Petronis, M.S.
  5. SPINE Volume 34, Number 19, pp 2066-2076 ©2009, Lippincott Williams & Wilkins
  6. Evaluation of the Effectiveness and Efficacy of Iyengar Yoga Therapy on Chronic Low Back Pain Kimberly Williams, PhD,* Christian Abildso, PhD, MPH, Lois Steinberg, PhD,+ Edward Doyle, MD, MS,* Beverly Epstein, MD, PT,# David Smith, PhD,S Gerry Hobbs, PhD,* Richard Gross, PhD,1 George Kelley, PhD,* and Linda Cooper, MSW, MBA*
  7. Two Isometric Yoga Poses Reduce the Curves in Degenerative and Adolescent Idiopathic Scoliosis Loren M. Fishman, MD, BPhil (Oxon); Erik J. Groessl, PhD; Paul Bernstein, OMS || 2017
  8. Hashmi, Javeria A., et al. “Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits.” Brain 136.9 (2013): 2751-2768.