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Yoga for low back pain

Heaps of people come to yoga classes because they have low back pain and someone, often their GP, has told them it might help. It seems to be taken as fact that yoga must be good for backs and especially those in pain but this is based on a lot of assumptions such as stretching must be good for back pain or even that yoga itself is inherently therapeutic for bodies (there's a whole can of worms!). As part of my physiotherapy degree course I undertook a self-directed project to investigate the evidence for the use of yoga as a treatment for low back pain.

Approximately one in seven of us experience back pain every year and around half of these cases report it limiting their physical activities one way or another. Whilst acute incidents may be triggered by strain on structures eg a muscle strain when you lift something too heavy for you or a large disc protrusion, most long-term back pain is likely to be affected by more than just the tissues within the back.

Body chemistry can amplify pain signals and perpetuate them, so for example stress or lack of sleep can increase the body's production of stress-hormones and make pain-producing nerve pathways more sensitive. Systemic illness can increase sensitivity or decrease the body's speed of recovery. As always our body's ecosystem is complex and nothing happens in a vacuum. What we are starting to see now in the scientific research is a realisation that structural changes such as ones people see on their MRI are common in all of us, just as common in those without back pain as those with it.

Just for the record, this DOES NOT mean it is all in your head! It means that pain is more complex then simple tissue injury at the site. It means that stress, being unwell or being overworked can affect your pain sensitivity. Makes sense right? certainly we accept this in other biological insults such as the common cold- how many times have you heard someone say they can't shift their cold as they are rundown or stressed? In a lot of ways pain is no different.

Is this why yoga can be effective? After all, we know it acts on more than our body right? There is a growing movement at the moment in physiotherapy to adopt the 'biopsychosocial' approach to injury management:

Biological factors eg structural tissue changes or injury

Psychological factors this could be stress affecting body chemistry or healing or could be behaviours such as over/underexercising

Social factors such as needing to care for family members or the physical/psychological affects of our work

Interestingly adults with back pain report psychological distress 2.6 times more often than adults without. Recent studies combining cognitive behaviour therapy with meditation and gradual movement programs was shown to improve pain intensity and increase functional capacity. Sound like a practice we know???

A study on yoga practitioners in Australia found 20% of students named health/medical as their reasons for starting yoga and a huge 58% cited 'to reduce stress and anxiety'. Wait a minute! Now we know yoga is the bomb for reducing stress and anxiety!!! And many classes work on gentle movements, body awareness, relaxation and meditation or mindfulness. Perhaps it's this amazing combination of elements that people seem to find so helpful when they are managing ongoing pain. Certainly several studies have implemented yoga programs for people with long-term back pain and found improvements in pain and disability scores. And lets not forget the amazing camaraderie and community that often comes along with yoga classes- this social support network is also likely to have an affect on our body's biopsychosocial ecosystem.

It's this holistic approach to health that initially attracted me to yoga and then to physiotherapy. Now I offer specific appointments that combine the two as well as normal physiotherapy and strength training. If you are struggling with long or short term back pain and would like to investigate the possibility of using yoga or any other activity to tackle it please get in touch and let us help you get back on track.

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1.! Australian Institute of Health and Welfare. Back pain and problems. Canberra: AIHW; 2014 [Available from:! 2.! Freeman MD, Woodham MA, Woodham AW. The Role of the Lumbar Multifidus in Chronic Low Back Pain: A Review. PM&R. 2010; 2(2):142-146. DOI:10.1016/j.pmrj. 2009.11.006.! 3.! Storm PB, Chou D, Tamargo RJ. Lumbar spinal stenosis, cauda equina syndrome, and multiple lumbosacral radiculopathies, 2002! 4.! Bogduk N. Clinical anatomy of the lumbar spine and sacrum. 3rd ed.. ed. New York: New York : Churchill Livingstone; 1997.! 5.! Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain, 2009! 6.! O'Sullivan P. It's time for change with the management of non-specific chronic low back pain. 2013; 7.! Chou R. Diagnosis and treatment of low back pain : a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine. 2007; 147(7):478-491. 8.! Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Annals of internal medicine. 2007; 147(7): 492-504.9.! Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2005; 143(12):849-56. 10.! Posadzki P, Ernst E. Yoga for low back pain: A systematic review of randomized clinical trials. Clinical Rheumatology [Review]. 2011; 30(9):1257-1262. DOI: 10.1007/s10067-011-1764-8.! 11.! Cramer H, Lauche R, Haller H, Dobos G. A systematic review and meta-analysis of yoga for low back pain. Clin J Pain. 2013; 29(5):450-60. DOI:10.1097/AJP. 0b013e31825e1492.! 12.! Diaz AM, Kolber MJ, Patel CK, Pabian PS, Rothschild CE, Hanney WJ. The Efficacy of Yoga as an Intervention for Chronic Low Back Pain: A Systematic Review of Randomized Controlled Trials. American Journal of Lifestyle Medicine. 2013; 7(6): 418-430. DOI:! 13.! Hill C. Is yoga an effective treatment in the management of patients with chronic low back pain compared with other care modalities - A systematic review. Journal of Complementary and Integrative Medicine [Review]. 2013; 10(1) DOI: 10.1515/jcim-2012-0007.! 14.! Holtzman S, Beggs RT. Yoga for chronic low back pain: a meta-analysis of randomized controlled trials. Pain Research and Management. 2013; 18(5):267-72.

#physiology #physiotherapy #injury #painmanagement #yoga #psychology

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