asana based exercises low back pain

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1/14

@

The

Yoga ReviewVol. III, No.

1,

1983

Asana-based

Exercises

or

the

management of

Low

Back

Pain

T. V. ANANTHANARAYANAN

Krishnamacharya

Yoga

Mandiram,

Madras-600018

and

T. M. SRINIVASAN

Founder

Member

Biomedical Engineering

Division,

I.

I. T., Madras.600036.

Abstract-Low

Back Pain

is

an

endemic disorder afficting

a

large

percentage

of

peopte.

The

aeliological

factors are mostly

psychosomatic

along with

postural

defects,

occupational

predispositions

and

sendentary

life

styles. Though several

rehabilitative

techniques

re

prescribed,

no systematicanalysis

of

these

are

available.

The

present

study

evaluatesseveralsimple asanas n

the basis

of biomechanical

principles.

These

studies

also select a set of

asanas

which work on the

back with

increasing

intensity.

A series of

tests are evolved to assess

he

physiological

debility

of

a

patient.

These

test

results form the basis

of

selection of

asanas

to

be

prescribed

to

the

patient.

A

chart

is

finally

provided

to

enable

he

therapist

to

increase

tho

intensity of asanas

so that the

muscles of the low

back

can be

strengthened

ystematically

and

progressively.

The

results of

clinical

trials on 16

patients

using

this method of asanas

selection

and

rehabilitation

indicates the

usefulnes

of

this

method for

the man-

agement

of

low back

pain,

Only

regular

practitioners

of

these

exercises

mprove

while inditrerent or improper practice has no rehabilitative value.

45


2/14

46

T.

V.

Ananthanarayanan and

T,

Itt, S,inivasan

l. lntroduction

Next to the brain

itself,

the

spinal c,

rd i the most

important

structure

in

the human

body for maintenan(e

oi

postural

equil ibrium

and

for communication. The

spine consists of seven cervical,

twelve

thoracic,

five

lumbar, five

fused

sacral

and

three to

four

fused

coccygeal

vertebrae.

Viewed

in the frontal

plane

the

spine is straight and

symmetrical.

Looking

from

the side however,

there

are

three

curvatures,

an

S

curve

with an

additional

C fused

at

the

bottom

of

S.

These

curves

give

the spine

increased

flexibility

and

better

shock absorbing

capacity

while

retaining appropriate

stiffness. The

intravertebral disc is a

mult i funct ional

element subjected to many types of

loads.

Activ i t ies

such

as

umping

increase the

load

on

the

discs.

Short

durat ion loads

(such

as

during weight

l i f t ing)

can

cause

irreparable

damage to

the

discs. The intravertebral discsconsti tute approximately one th i rd of

the

overal l

length of the lumbar spine,

whi le

n

the

rest

of the

vertebral

column,

the

rat io

is

down to

one

fi f th

only

(Finneson,

1980).

' this

increased

soft

t issue-to-hard

issue

atio as wel l as the

fact

that lumbar

spine

is

a

primary

weight

bearing

structure

accounts

for

LPB

ll .ow

Back

Pain) which is

so

widely

experienced.

In this

paper, spinepain

refers

o those

pain

not

related

to

nor

contr ibuted

by

infect ion, tumor,

disease,

fracture

or

by fracture

dis-

location.

Spine

pain

is

reported

most

frequently

in

the

lumbar

region

fol lowed

by cervical and

thoracic regions, in

that order.

There

are

a

large number of pain sensit ive structures in the spine. The annular

f ibres,

ongitudinal igaments, apsular

structures,osseous

tructures

etc

,

in

the

spinal

iystem

have

various

nerves

innervating

them.

Spine

pain

can

come

rom

physical,

chemicalor inf lammatory

problems

associates

with these nerves. There is also referred

pain

whose

origin

is

not

understood,

We sholl

deal

only with LBP

which has

none

of

the

above

pathology associated

with

it.

The

important

nonorganic

caused of

LBP

are

as follows:

il

Biomechanical

abuse

of

the

body:

Intense

and

sudden exher-

t ions, postural abnormal i t ies and occupational predisposit ions al l in

this

category.

Examples nclude

weight

i f ters,

long

distanceprofessional

drivers and secondarvscol iosis.


3/14

Exercises

or

Low

Back

Pain

ii) Obesity,

pregnancy and

postnatal

recovery: In all

these

cases,

the mechanism

of

pain generation

is

similar

to

those

in

the category

of

weight-lifters. The excess

weight

pushes

the centre of

gravity

farther

away

from

the spine

with the increased ever

arm

putting

excess

pressure

on

the lumbar system.

ii i) Sedentary

ife styles: It has

been suggested Krauss,

1965) hat

LBP

can

be

called

a

'hypokinetic

disease',

implying underutilization

of

the spinal and associated muscles.

Several muscles of

the

back

and

abdomen

are

involved in distributing

and supporting the

load on

the

lumbar vertebra if

a

person

stands

or

lifts extra

weights. This

is a very common causeof LBP with age

related degeneration

setting

in

due to

lack of exercise.

iv) Stress: A strong correlation between psychological tension

and LBP is

impl icated in

some

studies

(Sarno,

1978)

wherein the term

tension

myocytis

is suggested. The

term tension refers

to

psychic

camponent

which

is

the

precipi tat ive

cause

of

LBP. Tbe

muscle

pathology

may

have secondary

nflammatory changes.

I t

may be

a local

disorder of c ontract i le

state of

a

muscle

eading o

muscle

spasm

(Sarno,

1978).

Often,

the

abovo

factors are in

col lusion

to

produce

LBP.

The

hypokinetic

act iv i ty makes

the muscles

wcak

and unable to

support

normal structural

weight

whi le the

stress

produces

tense and

short-

ened muscles with restr icted

movements.

Doran and Newal l

(1975)

report that

f rom

a

sample of

262

patients

treated

in

dif ferent ways

(spinal

manipulat ions,

physiotherapy, corsets,

analgesics

and combi-

nation

of

these),

56

per

cent st i l l

had

back

ache

at

the

end

of

one

year.

However,

other studies

(e.

9.

Lindstrom

and Zachrisson,

1970)

indicate

that

physical

therapy

has an

important role

in

the

manage-

ment

of LBP an d sciat ica. The emerging

consensusof

opinion

of

many studies

(Nachemson,

1969)

is

that

exercise s very important

component

which should

be

performed

isometrical ly especial ly

or

abdominal

and

quadriceps

muscles.

The

back

muscles

may be

exercised

isornetr ical ly

r isotonical ly.

Further,

the

prograrn should

consist

of

relaxation

and

Iimbering

exercises

long

with

those hat

promote

elast i -

ci ty. The latter is necessary ince reduced elast ic i t l ' Ieads to lumbar

f lexion

or torsion

movement

which may further stretch

a muscle

or

tendon,

precipi tat ing

he cycle of

low

back

pain.

These two

cordinal

47


4/14

48 T

l'.

Ananthansrayanan

and T. M.

Srinivasan

aspects namely, relaxation

and

improved

elasticity

-

can be effectively

met

through

asana

and

pranayama

pract ice.

Further,

isometrics can

also be incorporated or abdominal strengthening. However, the treat-

ment of

LBP

in India

is

l imited mostly

to

tract ion

and

diathermy.

Very

l i t t le act ive

part ic ipat ion

is

el ic i ted from the

patient

during

physiotherapy.

The

physiotherapy

pract iced

here

s fair ly

outdated and

no

novel

procedures

uch

as

proprioceptive

aci l i tat ion

is

incorporated.

Though

yoga

asanas

are

attempted

in

isolated inst i tut ions

methods

to rat ional ize

ts appl icat ion

o

LBP have not been worked

out.

Even

in wel l

-

establ ishedhospitals,

the

causative

factors,

the

individual

differences,

progression

of

exercises, est

methods for suitabil i ty

and

stagesof exercise

egimen

etc

have

not

been

worked

out.

The

present

study hopes

o f i l l

this

much

required

cl inical

understanding

of

the

role

of

asanas

nd

pranayamas n

the

management

f low

back

pain

through

the

appl icat ion

of simplebiomechanicalprinciples.

2.

Biomechanics

of Asanas

Asanas

involve slow and steady movements

and

muscles

stretch

during maintenance

f

a

posture.

The asana exercises hus

fal l in

the

category

of

isometrics

and muscle

relaxation

achieved

due

to

stretch.

In

the

use

of asanas as a

therapeutic tool , s low

stretch

is

a

very

important method

for

achieving

muscle

elaxation

and

improved

motor

funct ion.

This

is

simi lar to r ehabi l i tat ion

echniques that

are

currently

known

as Proprioceptive

Neuromusclar

Faci l i tat ion.

Relar,at ion

of a

muscle

indicated

by

lowered

discharges rom

the

muscle

ibres)

s

obtain-

ed by stretching the muscle very slowly and maintaining the stretch

over

prolonged

periods

of

t ime

(Srinivasan,

98l).

Thus,

asanas

and

counterposes

work on

the muscles

through isometrics

and further

muscles

relax

through intense stretch. The feedback

mechanisms

n-

volved

also change

with

improved muscle

control

due

to

stretch

carried

out

by the

patient

himself

whi le

this

element s

absent i f

the

stretch s

through externa l means

i. e.,

through

electr ical

st imulat ion

or through

manipulat ion

by

the

therapist

(Vinod

Kumar, 1982).

A range of

postures

can

be selected

rom

the avai lable

i terature

on asanas

(Smith,

1980).

These sele:t ions

are made

on

the

basis

of

the work

brought on the low back by these asanas.

The asanas

are

l isted

n Table

I, along

with the major

muscles

hat

are

activated

during

the

exerc ises.

Since these

asanas work

on

low

back muscles,

heseare

selectcd

or

the therapeutic

egimen. Each asanas s

also

graded

on

the


5/14

Exercises

for

Low

Back

Pain

basis

of

force

which

it

exerts

on tho

joint

during

each

type of

movement. This

is also indicated

in

Table

L

The

biomechanical

calculat ion

proceeds

as

fol lows

(Ananthanarayanan,

1983).

Consider a

hypothetica l case of a

person

of l '76 cm height and 60 kg

weight.

The

lengths of different

parts

of the body

(such

as head

and

torso, upper

armn

hand,

high, leg

aud

foot)

are

assumed

for

this

person

and the

portion

of

body

weight

along with the centre of gravity

is

assigned

on

the basis

of

avai lable

studies. From

this,

the

moment of

force of each

body segment

about the

point

of atta chment s computed.

These

are

then added up depending

on the number

of

segments

hat

are moved while an

asana is

performed.

For

example,

n

Uttandsan(r,

the

tors:, upper

arm,

lower

arm and

the

band

are

moved

about

the

hip

joint;

the total monrents of t trese parts amourrt to l57i kg cm.

Simi lar ly ,

each asana

is

c lass ihed n

the

basis

of the

body

parts

moved

and

hence

the moment of force

generated

about the

hip

joint

The

act ' ra l values

computed

are

shown in

Table

I"

[ t is

ev ident that

ihe

higher

he moment,

he

greater

s

the force

recrui ted

n

the t ack

muscles.

To mai i t ta in the

asana

posi t ions,

thus

greater

work

is

put

on these

rnuscles. ln i t i i r t ly ,

depending on

t- ie

intcnsi ty of LBP, asanas

having

ryp

ot

movement

m

u 5c te|5

invol

va o

osono

mcmcnt ot thc

joint

'ficcdcd

lo

movc

body

port

ogornst

grovi ty)

llaD

srtcrlslon

grluteus

moxtmrJs

r?ctur

tmoris

(gemi

i.adirFf(,s

Seni mcribrengsui)

"91

wipodopcotom

\----a

shqlobhcsqno

870

kg

cms

kg

cn6

zJ

I

Hip

f lcrron

padls

moJor

r l [ ioc

us

(

pe

ctrmus

go

or

ru s

tensor fosc,oe totoc)

o.E

qponosono

ey\

supinc

beflt

leg flcxrorr

s

voJrosono

N

to

ut

onosono

4)

ooschi

motonosono

370

00

kg cms

185,

00

kg

cm s

1

264.

80

kg

cm s

1571

53

lgcms

1

571. 53

ko

cu,"

Table

I.

Major

muscles nvolved and

forces

at

the bip during cli f t 'erent sanas

contd.)

49


6/14

50

T,

V. Ananthanarayanan

nd

T.

M. Srlnivasan

Iypa

ot

rf iovamGnt

murglcs invol

rd

otqnq

nentdttldt

sre

lotnt

neEc'3d o

fiic{3 body

port ogslnst gmvitY)

I r 'Jnl i art tn;10n

tqcro rP|mut

(semr

iptndlr t

mul

i l lou

J*1"

chgkrsYehqrsng

**g

bhu

6ngqsort

/s

.---.9

rholsbhqrenc

ni ltgib{;

1126,

i lB

smt

ZZtl.66

r9nit6

Trunh

ltcr ion

raElur

obdorninua

arlcrnql

ono

Internsl

ob{iqu.B

"dt

rytrr beni

l.g

ttsrlofi

s"*'t

tupine

irur*

tlairirl

*/

porchl'lutcnd|onq

r t r ,09

Hg

6rn

l?63,6t kS

cme

157]. t3

Fgrf l i

Tablo I"

Major

musclesnvolved

and

forccs

at the hip

during differentasanas

smaller

momont

and hence

esserwork

on

low

baek rnuscles hould

be

recommended.Howdlver,n

l i terature, ead

and torso i ft

( lying

down)

is

prescribed

arly n

rehabil i tation

hich

wil l

put enorme,us

train

oR

back

muscle

and

is thus

eontraindicated

n

the

present

study.

The

present iomechanicalri teria hus enablea gradedselectionf asanas

so

that he

ow baekmuslces re

slowlyand

progressively

trengthened

by

proscribing

ncroasinglyif l icultasatts

br

practice.

3.

Test and Trcatment$chedules

The above

sumrnarized

methodof

grading

asanas

s

the

basis

for

rehabil i tation

f

tBP. However,

efore

proceeding

ith rehabil i tatior:,

i t

is necessaryo

assess

he

abil i tyof

the

patient

o

cnrry out

the

basic

movements

F'or this,

a seriesof seven

ests are

introduced

on

the

basisof

muscle

est ing

devisedby Krauss

(1965).

Charts

I

to

7

summarize

he ests

o

be

conducted,

he contraindicated

satlasn each

group. The patient s instructedo carry out the exercises nd his

inabi l i ty r

pain

duringa

movemeRt

i l l determine he

evel

at

which

these

excrcises

hould be started. The

general

ules o bc

fol lowed

(and

ecornmended

y

several orkers;

re


7/14

Exercises

or

60cro

sprnotr

.scmi

spinolrs

mul

tr t

du s

quodrctq

lumbo?urn

Low Back

Pain

CHART

I

CHART 2

5t

lESl

t: -

lor up 'pcr

bock

, j ;

="F"

+rl

LJL

I

ri I

Lr I

o9l

potrert

to

o?cD

bocl

|-4

^J L

dJ

rt

towcr

bock

ond

lcgs

ore

gt i l i

D

A-

,^

/L-

IESI ?: .

tor

Quodrotus tu iborum

pu $

I

a--/\-

slor br@lhino

il

o.A-

r

z

p

it

euooiotus

tunborvm r3

tttlt

+:.


8/14

52

rES"

3

?or

o

9oo9 l tLtocus

to t

stiftncss

I

aN ,

D

l

)

ll

e::1

IV

AVO|D:-

-'l

^

tor

wcok

psoos

r t t rocus

*l V

tor

gt i l l

Psoos

it taocus

;|

Nt {

VT

a'G,.-

psoos

moror

i l laocus

gl,utcus

mo

tmus

7cctus lemorrs

scmi tcndrnosus

SCmi

membronosus

CHART 3

CHART

4

IEST

4: .

loi

towcr bocl gtutcus ond

hohgtE

)

st 'cngth

o=-

-

--J

"E1

l

AVOID

At

s londinq

posturcs

'nr t rot ry

-

unt r l the

musc(ca

qofn

s t re^9th


9/14

Exercises

or

Low

Back Pain

53

TLS?

5

,

fet

hom; t r ing

strl lnc

ts

e_

J-

E-ff

:i_

_:-

)

a_-_tt

(

onr lpr rsror ,

l l

a

i


10/14

54 T,

V.

Ananthanarayanan

nd

T. M.

Srinivasan

mov4

qams

ond

hqdd

i :

;1::1.'J

*'

sro'd'u

Samt

glnOl lS

cOpt l l s

sPtcnrg5

9qP113

;plcnrus

ag.vlcts

CHART

7

l.

Sit-upsare

contraindicated

n pat ients with

acute

and subacute

lumbar pain and

definitely

ot

advisable

or

older

patients'

2.

Isometric abodminal

exercises

are

preferable being

milder) o

back extension xercises.

3.

Deepknee

bending

laces

nordinate

stress n

the

knee.

4. Toe.touching

and sti ff leg

raisedo

not

relax

the

back but can

put

great

strain on back

muscles.

Once the

ist

of

asanas

are determined

rom

the

set, the actual

sequence

s worked

out on the

principle

of

alternate

pose

and counter-

pose.

Let

us consider

specific ase

of

test result

conducted

on a male

patient,37

years

old,

176

cm height,60

kg weight,

a

professional

execu-

tive.

The

test

results

rom the

Charts

I

to 7

is as follows :

-o-Jr

- ) ,

I

-ln

UL

t

I

-


11/14

Exereises

or

Law Back

Poin

Since

no

asana

in

this sequence

s

contraindicated,

he entire

sequenee

s retained.

Rest

may

be

incorporated between3

and 4

and after the completionof the asanas. Simple breathing schedules

are

carried out

with

the patient seated n

a

chair.

The

practice

of

prescribinggentle

exercises

oordinated with

easy

breathing

or

LBP

patients

whose

muscles

are in spasm inds support

n White and Punjabi

(1978)

also. Variations n

breathing

attern

include

ong exhalation

and holdingbreathafter exhalation,

he

latter

beingparticularly seful

as

an

abdominal

exercise.

This

then

is

the

criteria

or

selection

f an

exercise

chedule

nd a sequenceuildup o be

prescribed

o

a

patient.

4.

Results

nd Discugsion.

A

total

of

16

persons

etween

ges

2

and

60

were taken

for testing

and for therapeutic schedule. All patients bad LBP without any

pathology testi f iod

by medical

personall ,

with

5

out

of 16

having

LBP

for

more

than

5

years.

The

sample

consisted

f

8

females

3

post-

natal,

I

retroverted uterus, 2 age-related

egeneration,

tension

myocytis

and

I due to

exertion)

and

8

males

4

tension

myoeytis,

due

to intense xertion,

gait

related BPi.

The

pationts

were interviewed

ndividually

during

which

he

details

of medical

istory,occupation,

onsion

rtate,

doctor's recommcndations

etc,

were

noted"

Each

patient

is

then

examined

on the

basis

of

Cbavts

tlrrough

and be

subjective

eports,

mobil i tyof

joints,loeation

and ntensityof

pain

tc arenotod. The seguences built up on tbebasis

of these

ests

asdiscussedarl ier The course f therapywas

usually

to

6 individual

nneetings

nce

a week

asting

about

an

hour. Duringeach

subsoqunt

isit,

he

improvoments

re

noted

and

the exercise chedule

is

made

progressively

ore dsmandingso that the muscle

strength

can

be

buil t up,

thus incorporating

preventive

aspect

also in thsse

sched

les.

After a six month

practice

of asanas,

questionnaire

as

cir-

culated o each

patient

to

assess

he

changes rought about by

the

treatment,

Of thc 6 people reated,l reported signi f icantesseningf LBP

and

the

remaining

reportedsl ight improvement

i th pract ice

but

recurrence f

pain

i i

pract ice

s discontinued.

Hence, egular i ty

of

pract ice

s

essentia lor

the

nrDrovementn

the

condi t ion,

55


12/14

56

T. V. Anarxthanaravanan

nd

T. M.

Srinivasan

The

main

points

to conclude

rom the

patient

response

after

a six

month

followup is as follows

:

l .

Overwhelming

majori ty

( l l

out

of

16,

nearly

70

percent)

reported

signif icant improvement

n

their condit ions

with

near

normal

mobi l i ty

and

absence f

pain.

2. Those

who

reported recurrence of back

pain

also reported

irregulari ty

of

pract ice.

3

The

assigned

xercises

n the

basisof

biomechnical

omputat ion

is a safe

rnethod

with

easy

ntroductory

postures

fol lowed

by

those

which

worked with

greater

intensity on

the

back.

Severalsimple exercises erived from asanas have been analyzed

in

this

study

through

principles

of

biomechanics

so

that an

objective

basis s

provided fot

assessing

he

activity of low

back muscles during

these

postures.

A

series

of

test

protocol

has been

worked

out for

testing

the flexibility

and strength

of

low

back muscles.

The

patients

can be tested

with

this

protocol

and the test results indicate

the

level

at

which

this

asanas

may

be

prescribed,

o

that

the

back

is

not over-

strained

ini t ial ly.

Extension

of

these

calculat ions

to avai lable

reha-

bi l i tat ive echniques

ract iced

elsewhereshows

clearly

the

unsuitabi l i ty

of

those which

can be vry

severe

on

an

already

weak oack.

A cl inical

study

on l6

patients

hrough

the

present

method

of asana

select ion

nd

progressive ui ldup

has

clearly

shown that

an overwhelming

majori ty

(about 70

percent)has a

good

recovery ro m low back pain.

Asana

pract ices are characterized

by

slow

movements, isometric

muscle

contract ion

an,Jstretch

of antagonist muscles

The

slorv

move-

ments

provide a low energ y

cost and

hence at igrc is avoided.

Isometrics

are

those

n which

the muscle

s contracted

under

constar)t

ength;

here s

no

movementof

the

oint,

however

since

he

musclecarries

weight,work

is

done by

i t In cases

f

joint

Cisart iculat ion

t is

st i l l

poss ib le

to keep

the

muscleact ive

through

the

pract ice

of

isometrics.

The musclestretch

has

ery important

impl icat ions

n ntusc le

ynarnics. Herein the muscle

is both

relaxed

reduced

activ i iyt

and

the feedback rom

the

muscle s

altered so that muscle ccntrol can be readjusted. For example, in

cases

f ;

say,

spast ic i ty ,

a

readjustment

of

a lpha

motoneuron discharge

is

possib le hrough

changes

n

ref lex response

n

a muscle

dur ing

stretch.

This modulat ion

of

motoneuron

activ i ty is

not

possible

i f the l imb

is


13/14

Exercises

or

Low Back

Pain

moved

passively

by the therapist.

Further, the

work

done

by

the

muscles

can

be

increased hrough the

introduction

of

breathing

during

asaRas.

The

asanasaught hereare

dynamic and

with

counterposos.

Slow

repetitive

ostures

help o

activate

both

the

agonistand the antagonist

during

movemnt.

Thus, sudden isor,netriowo,rk s not

assigned

o

the

muscle

especially

boso

which

are

weak

due o

disuse. Further, during

slow

movements

he

joints

and the

connectivs

issues aro

stretched

gradually

without extreme lexion

and

associated angerof

damage,

Movement

also

irnplies ncreased

ci'reul,a.tion

nd' warrning

up

of

the

muscles.

Breathing

n

syncronism

with

movements

for

example, low

exhalation

during

forward

bending)

add to tbe

depth oF

rnovements.

Breathingalso ndicates o the practitioner whether the ptrysicrrl imits

of exercises

being

reached

whon

breathing beoomes ifficult

or

comes

in

spurts. It

alsoputs

more

work on the muscle o that muscle

one

improves.

Low

BackPain

LBP)

s a

wide spreadmalady

affi icting

more

than

50

per

centof

the

population

at

any

one

time,

in any country.

The

exercises uggested

ereare hopefullyan

improvement

over the

previous

ones.

However, ntense

nvestigation

and

long

followup

are

required

before

prescribing

ny

set of

exercises

ased

on

asanas

as

final thera-

peutic egimen or

low

back

pain.

Acknowlsdgment

The

authors

wish

to

place

on

record

the

advise

and

constant

vigilance

f

Sri Desikachar during

the

course

of

developmentof these

procedures.

References

l.

Ananthanarayanan

T,

v.

(1983)

'Management

of

Low

Back

pain;

Biomechaniccl

analysis

of asanas

nd

pranayama'

MS

thesis,

Bionredical

Engg.

IIT Madras,

India.

2. Daniels

L. and Worthingham

C.

(1980)

,Muscle

Testing,

W.

B.

Saunders

Co.,

pa .

pp

t6.74.

3. Doran.

ML

and

Newall, DJ

(1975).

'Manipulation

in

treatment

of

low

track

pain..

A mult icentre

tudy'

BMJ.

Vol

2,

pp

l; l -164.

4. Finneson,

B.

E.

(1980)

Low

Back Pain'

J. B.

Lipprncott

Co.,

Pa.

ppZ2O-241

57


14/14

58

T.

V. Ananthanarayanan

nd

T. M.

Srinivasan

5.

Krauss,

(1965).

'

Back Acke

.

stess

and

tension,,

George

Allen and Unwin,

pp9-4,77-110.

Lindstrom,

A and

Zachrisson,

M.

(1970)

physical

therapy

on

low

back

pain

and

Sciatica'

Scand

Jr Rehal

Med,

Yol

2,

pp

37.42.

Nachemson,

A

(1959)

Physiotherapy

for low

back

pain

patients,

ScandJr of

Rehab

Med.

Vol I,

pp

85-90.

Sarno,

J. E.

(1978)'Therapeutic

exercise

for

back

pain'

in Theropautic

Excrcises

(ed)

J.

V. Basmajian,

Williams

& Wilkins

Co.,

Baltimore,pp40g-429.

smith'

M. J'

N.

(1980)

'An

lllustrated guide

to

Asanas

and

pranayama',

Krishnamacharya

Yoga

Mandiram,

Madras.

srinivasan,

T. M.

(1981)

'Electrophysiological

correlates

during

yogic

practices,,

The

Yoga Review,

Vol

I No. 4

pp

165-173.

vinod Kurnar,

K.

(1982),

'Micro'processor

based

neurological (n

Reflex)

monitor-

ing'. MS Thesis, BiomedicalEngineeringDivision, IIT, Madras, pp 51.

while'

A.

A. and Punjabi,

M.M. (1978)

'clinical

Biomechanict

f the

spine, J.

B.

Lippincott

Co.,

Pa,

pp

277-344.

,

o

D

6.

7,,

8.

9.

10.

l l .

12.

asana based exercises low back pain

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