Chronic Back Pain Got You Down? Try Yoga!Imagine lying on a soft mat completely relaxed and pain free. This is how most yoga classes end. Sometimes the class begins and ends this way. The pose is called Savasana or corpse pose. Chronic back pain sufferers often think, "Oh, yoga, I can't do that -- I have too much back pain. But in this study, back pain sufferers not only did yoga twice a week for 90 minutes over a period of six months, they also reported decreased pain intensity, improved function, and even relief from depression.
Surprised? More and more studies are taking a look at alternative ways to treat chronic pain. Yoga has taken a front and center place in the quest for a low cost, accessible treatment approach for many health problems. And since back pain is so common, finding ways to reduce pain and disability without drugs or surgery could save patients and the health care industry a lot of money.
Not all of yoga is a resting pose. And there are different styles of yoga (e.g., Iyengar, Hatha, Bikram) with varying levels of intensity. The Iyengar style is especially adaptable for people with health problems, including chronic low back pain. Participants in Iyengar style of yoga can use props such as bolsters, blankets, and supports to help them assume and maintain any pose that is too difficult to reach or hold without help. With careful movement and focused breathing, the postures can be achieved with practice.
The patients in this study who participated in the yoga therapy were between the ages of 23 and 66 and had low back pain lasting more than three months. They could get up and down off the floor and agreed to attend 40 to 48 yoga sessions over a period of 20 to 24 weeks. They also practiced yoga at home for 30 minutes on nonclass days. And they agreed not to attend other classes (e.g., other forms of yoga, Pilates) or receive other forms of alternative care (e.g., chiropractic, acupuncture, massage).
A fair number of restrictions were placed on who could participate in this study. Anyone with spinal stenosis, abdominal or spine tumors, spinal infection, osteoporosis with vertebral fractures, or scoliosis (curvature of the spine) were excluded (not allowed) from the study. Women who were pregnant, anyone who had major depression or substance abuse issues, and patients with neurologic disorders were also excluded. Of course, anyone who was unwilling to try yoga or those who had already been doing yoga on a regular basis weren't signed up either.
For those readers who enjoy yoga themselves, the authors provide a table listing all of the yoga postures used in this study. No photos or drawings were provided. The names of the poses might not mean much to anyone who is not familiar with Iyengar (or other forms of yoga). Patients in the yoga group weren't necessarily familiar with the terms or poses either. A certified Iyengar yoga instructor conducted the classes. Each participant received an instruction manual with photographs and instructions to follow in class and for use at home.
There was a second (control) group of patients with chronic low back pain who followed standard medical care without the addition of yoga. Results for both groups were measured in a variety of ways. First, each person completed a well-known survey assessing disability called the Oswestry Disability Index (ODI). They also filled out the Visual analog scale (VAS) used to measure pain intensity. Depression was measured by the Beck Depression Inventory (BDI). And finally, everyone recorded what and how much pain medication was used. All measures were taken before and after treatment.
A few people in the yoga group ended up dropping out for reasons unrelated to the yoga. For the most part, everyone stayed committed and attended classes as well as practiced yoga at home. Six months after the study, two-thirds of the patients in the yoga group were still doing yoga! Most of the benefit from yoga was seen in the first 24 weeks. Although there was some continued improvements between 24 and 48 weeks, the results were not considered statistically significant.
Some people might think they are too old or too stiff to do yoga. But the participants in this study found that neither factor kept them from improving just as much as younger, more flexible folks. The yoga group was also able to reduce the number and frequency of medications for their back pain -- significantly more than the patients in the control group.
The authors compared the results of the yoga group with other studies of yoga, Pilates, and lumbar stabilization exercises. They found that this yoga group achieved equal if not better results when compared with all other studies available. The authors conclude that Iyengar yoga is safe and effective when applied over time by patients with chronic low back pain. The benefits of this style of yoga (e.g., resting poses at beginning and end of class, use of props to support the body) contributed to reduction in pain, depression, medication use, and disability and improvement in function.
Kimberly Williams, PhD, et al. Evaluation of the Effectiveness and Efficacy of Iyengar Yoga Therapy on Chronic Low Back Pain. In Spine. September 1, 2009. Vol. 34. No. 19. Pp. 2066-2076.
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