Individuals who suffer from chronic back pain will do just about anything to find a treatment for their condition that actually works. From topical ointments and over-the-counter pain relievers to more stronger therapies and medications, such as epidural steroid injections, narcotics, or even antidepressants, those with back pain have many options for treatments but few that work well long-term. Research conducted over the last 10 years paints a positive picture about the future of alternative, integrative therapies in treating back pain, especially in the lower back (lumbar region). Yoga is one of these therapies and is proven to be effective in relieving tense muscles, strengthening the core, and improving the quality of life for the millions of people who manage this all-consuming, debilitating type of pain each and every day.
Why Treating Low Back Pain Is Important
In addition to being painful and uncomfortable for the patient, low back pain is the most expensive work-related disability in the United States. This chronic condition is linked to missed work days, mental health problems, including depression and insomnia, and even financial issues related to medical expenses. As you can see, treating low back pain is not only important for a patient’s well-being and quality of life, it is also important for society as a whole. After all, citizens need to be happy and pain-free to be the best they can be in the workplace, at home, and in every other facet of their lives.
How Yoga Can Help Ease Low Back Pain
Our current culture seems to promote leaning forward to view our electronic devices more clearly. Whether it be a laptop, a smart phone, or a fitness tracker, it seems as if everyone you see is either leaning in, looking down, or arching their neck to get a closer look at their latest gadget. It might not seem like these small, repetitious glances add up to much, but they are the arch enemy of those often-neglected back muscles. Sedentary lifestyles, which are becoming more and more common in the era of office work, are also a main culprit of low back pain. The sitting position causes you to round forward, putting strain on your back muscles, which leads to chronic pain over time.
The good news is that regular practice of yoga can help restore the natural lumbar curve. This curve is often jeopardized with normal activities that make up daily living, such as sitting for long periods of time, sleeping in an uncomfortable position, or working on a computer. In practicing yoga, you bring balance and harmony to both sides of your body and help to restore the natural alignment of your spine and midline.
For a typical back pain patient, one side of the back is affected more strongly than the other, leading to plenty of imbalances and posture issues. By focusing on strengthening and lengthening various muscles groups on both sides of your body through yoga, you can help to relieve your tense muscles (a huge catalyst for pain symptoms). In addition to the physical benefit, the breathing aspect of yoga has proven to be effective in reducing stress and anxiety and heightening the relaxation response, which may minimize pain intensity by changing the way pain is processed in your brain.
So, what yoga classes are suitable for people with low back pain? The answer is not surprising. Seek out classes with words like “restorative,” “gentle,” “relaxation,” and “beginning,” in their titles—these classes emphasize posture and pain relief over flow. In addition, these classes tend to be more accepting of individuals modifying postures to their comfort and skill level. Another bonus is that the instructor may be able to give you more attention in this type of environment where long holds of specific postures are more common. If you haven’t been to a yoga class like this before, you can look forward to the instructor coming over to adjust you during one of these long holds, allowing you to really melt into a posture and feel its restorative effects. Steer clear of classes that incorporate the words “power,” “Ashtanga,” or “flow” in their titles as these ones tend to be more vigorous and are often targeted toward intermediate and advanced students with a high level of mobility and flexibility.
Why the Core Is Key to Back Health
Time after time, the back pays the price for weak, undeveloped core muscles. Many people have a bad habit of not using their own abdominal muscles to support themselves and maintain good posture. When this habit goes on for an extended period of time, you end up supporting yourself with all the wrong muscles groups, namely in the lower (lumbar) region of your back. This, in turn, can lead to strain, stiffness, muscle weakness, tightness, and pain that can radiate all the way to your neck or the backs of your thighs (sciatica).
Your core muscles must be strong and stable to support your body and lead a healthy, active lifestyle. Bad backs caused by weak core muscles keep people from enjoying the activities they love the most. Whether it be knee boarding, snowshoeing, hiking the Pacific Northwest trails, or snorkeling along the coasts of the Hawaiian islands, there are countless activities that that enable people to get active, get outside, and live their best life possible. When back pain hits, it’s all too common for people to miss out on these types of activities, opting to stay home until the pain subsides. Although this may be the best course of action for acute back pain, research strongly suggests that mild to moderate exercise, including yoga and tai chi, are effective alternative therapies for the treatment of low back pain.
Yoga classes that use slow, subtle postures that focus on core strength seem to be the most helpful in maintaining proper posture, restoring spinal alignment, and reducing the symptoms of back pain. At the forefront of this new yoga movement is Iris Mickey, a certified yoga practitioner and Yoga for Back Care instructor at the University of Wisconsin Health. The type of yoga Iris teaches is entirely different than many modern power and Vinyasa yoga classes. In her discipline, poses are typically performed in a seated or static position and the movements (most of which work the core) are gentle, slight, and barely noticeable from a short distance. These simple movements activate those muscles that many Americans commonly neglect, bringing strength and healing to the whole body.
Through her classes, Iris has found that “The body wants to heal itself but sometimes it needs help. When back pain arises, it is often a signal to stop or that you need a different alignment or engage your core more. If we can learn to tune into what is good movement and what isn’t, it’s self-empowering.” As more research is done on the connection between yoga and low back pain, there is hope that more instructors will integrate postures and holds that develop core strength and emphasize low back health.
A Closer Look at the Research: Impact of Yoga on Low Back Pain
In a systematic review of 14 trials, the Annals of Internal Medicine determined that yoga is an effective nonpharmacologic treatment option in the management of low back pain. Regular practice of yoga is linked to lower self-reported pain scores than regular care alone. Additionally, this review found that participants in yoga control groups have better function and lower pain intensity compared to those placed in standard exercise control groups. Incredibly, the benefits don’t end there. This review also provides concrete evidence that yoga surpasses physical therapies, such as ultrasound, electrical muscle stimulation, and ultrasound, in terms of effectiveness. It’s important for physical therapists, pain specialists, chiropractors, and primary care doctors alike to take these new findings to heart. After all, rehabilitation programs that incorporate an integrative, multi-disciplinary approach in the form of yoga classes or similar interventions increase the likelihood that those on disability for a back-related condition will return to work.
Need more convincing that yoga is a go-to option for strengthening and soothing a sore back? Look no further than the 2017 “Yoga, Physical Therapy, or Education for Chronic Low Back Pain” study published in the Annals of Internal Medicine. In this study, 320 people between the ages of 18 and 64 with moderate-to-chronic low back pain were followed for one year. Initially, study participants were assigned to one of three groups—12 weekly yoga classes, 15 physical therapy sessions over 12 weeks, or educational therapy, which included a book and periodic newsletters on managing back pain. Following the initial intervention, participants engaged in the same types of therapies but did them from home or attended sessions on a less frequent basis.
During the study, researchers measured pain intensity and level of disability by administering well-validated questionnaires to the participants. Results confirmed that yoga is just as effective as physical therapy in reducing the symptoms of low back pain. Fifty percent of participants in the yoga and physical therapy groups reported improvements in pain and disability compared to only 14 percent of those in the education group. Although yoga may be just as effective as physical therapy in minimizing pain symptoms, yoga may be more tolerable and well-liked by a majority of people—fewer folks dropped out of the yoga group than the physical therapy group over the course of this study.
Additionally, researchers found that about half of participants in the yoga and physical therapy groups were able to reduce their use of pain medications after three months. This incredible finding has the potential to change standard care guidelines for the treatment of low back pain—both nationally and worldwide. As the opioid epidemic continues to grow, affecting countless individuals’ health, productivity, and quality of life, alternative, holistic therapies are becoming more and more sought after. And now science has a simple, effective, noninvasive, and most importantly, nonpharmacologic answer for all those suffering from intrusive back pain: yoga. In the words of the senior author of this study, Janice Weinberg, a biostatistics professor at the Boson University School of Public Health, “I’d tell my friends to use yoga for back pain. It is cost effective, it can be done at home or in group settings where there is social support, and it is also thought to have mental health benefits.”
Back to Basics: Some Final Words About Yoga and Back Pain
In this article, you’ve learned why treating low back pain is important, the best yoga classes to attend to ease your pain symptoms, the role of the core in maintaining back health, and the effectiveness of yoga interventions compared to more traditional therapies. Although all this knowledge is exciting, keep in mind that yoga is not a cure-all for back pain. Some people will need other types of care, such as chiropractic and acupuncture, to keep their symptoms at bay. And others’ pain may be so excruciating that prescription medication—or even surgery—is the first line of treatment recommended by their doctors.
Another thing to consider is that yoga is a great alternative therapy for those who are unable to take certain medications or receive more invasive therapies, such as trigger point injections, due to a preexisting condition. Pregnant women, for example, may benefit from a holistic approach like yoga during bouts of low back and pelvic pain during their pregnancies. Yoga interventions in this particular population have not only been shown to provide pain relief, these interventions may also ease the symptoms of stress and depression, which can positively impact expectant mothers as well as their growing babies.
If you’re battling a bad back, think about incorporating yoga into your pain management regimen. Regular practice can have a positive impact on your level of activity, quality of life, and overall health. And it may even help reduce your use of over-the-counter or prescription pain pills.
As a final word of caution, do not to try a new exercise routine of any kind when you are experiencing severe, acute back pain that keeps you from participating in your normal activities. Wait until you reach the subacute stage (pain lasting 12 weeks or more) before you try your hand at the relaxing, gentle stretches and postures that make up the ancient, healing practice of yoga.
References
1. Mayo Clinic. Back pain. https://www.mayoclinic.org/diseases-conditions/back-pain/diagnosis-treatment/drc-20369911. Updated March 2017. Accessed January 2, 2018.
2. Spine Health Institute at Florida Hospital Medical Group. Yoga and low back pain: Dr. Patel examines the research. http://www.thespinehealthinstitute.com/news-room/health-blog-news/yoga-and-low-back-pain-dr-patel-examines-the-research. Updated July 2017. Accessed January 2, 2018.
3. Consumer Reports. Try yoga for back pain. https://www.consumerreports.org/back-pain/try-yoga-for-back-pain/. Updated February 2017. Accessed January 2, 2018.
4. University of Wisconsin Health. Yoga for back pain. https://www.uwhealth.org/health-wellness/yoga-for-back-pain/50154. Updated February 2017. Accessed January 2, 2018.
5. Bakalar N. Back pain? Try yoga. The New York Times. June 27, 2017:D4
6. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J, Grusing S, Brodt ED. Nonpharmacologic therapies for low back pain: A systematic review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017;166(4):493-505. doi:10.7326/M16-2459.
7. Saper RB, Lemaster C, Delitto A, Sherman KJ, Herman PM, Sadikova E, Stevans J, Keosaian JE, Cerrada CJ, Femia AL, Roseen EJ, Gardiner P, Gergen Barnett K, Faulkner C, Weinberg J. Yoga, physical therapy, or education for chronic low back pain: A randomized noninferiority trial. Ann Intern Med. 2017;167(2). doi:10.7326/P17-9039.
8. Kinser PA, Paul J, Jallo N, Shall M, Karst K, Hoekstra M, Starkweather A. Physical activity and yoga-based approaches for pregnancy-related low back and pelvic pain. J Obstet Gynecol Neonatal Nurs. 2017;46(3):334-346. doi:10.1016/j.jogn.2016.
