Sunday, December 12, 2010

Final Paper: Back Pain and Yoga


There have been a few studies done in regards to yoga and if it actually helps back pain. “About 1% of the U.S. population (both men and women) is chronically disabled as a result of low-back pain” (Tekur, 2008, p. 637). I can relate to their pain because I had stress fractures in my spine when I was 14. I got my stress fractures from playing soccer. Since then I have had random back pains when I do certain things, such as sit down for a long period of time. In the research done it shows that yoga does help lower back pain. Perhaps that is why “an estimated 14.9 million Americans practice yoga, 21% of which use it for treating neck and back pain” (Williams, 2005, p. 107). This statistic helps support that yoga must have a positive impact on back pain. Otherwise the percentage of people who take yoga to help their neck and back pain would not be such a high percentage of the people who practice yoga. Much of the research supports that back pain is in fact reduced and helped through the practice of yoga. In a study done on chronic pain they found that “low back pain was the condition most commonly treated with YTQ (yoga, tai chi and qigong), with 34 % of YTQ users reporting YTQ for this purpose” (Bertisch, 2009, p. 5). This study helps support that a good percentage of people who practice yoga do it in order to help reduce their back pain.

Causes for Back Pain:

There has been much research done on causes for back pain. Much of the research shows that people get lower back pain due to their jobs. For example there have been studies done showing that “there is strong evidence for manual materials handling as a risk factor for back pain” (Hoogendoorn, 1999, p. 390). People who do heavy manual lifting are more likely to get back pain. Usually when people get back pain from their work they continue to work through it in order to make ends meet financially. This can cause even more back pain. Whether they continue to work or stop they usually do no other physical activity because of their pain. However, it is said “that activity is more effective than bed rest for acute low back pain” (The Journal of Family Practice, 2004, p. 662). Many people do not realize that bed rest can actually cause more back pain. It is said that about “70-85% of the population has had at least one episode of back pain sometime in their life” (Williams, 2005, p. 107). Many people who do manual labor jobs fall into this high percentage of people who have experienced back pain in their lives. There are many other causes of back pain such as stress fractures in the spine, scoliosis, and bad posture.

Physical Aspects of Yoga and Back Pain:

“Yoga, through static physical postures (or asanas), uses stretching to improve muscular strength and flexibility, which could be beneficial for low- back-related pain management” (Journal of Family Practice, 2004, p. 661). One aspect of yoga is just the static stretches. The studies have shown that this can help reduce back pain, especially low back pain. One research study done compared yoga, exercise and a self-care book for chronic low back pain to see which had the greatest impact. The findings from that study “suggest that yoga is an effective treatment” (Sherman, 2005, p. 855). The author says that the result of doing yoga lasted for multiple weeks and did not appear to be from medications taken by the participants (Sherman, 2005, p. 855). This study helps support the theory that yoga may help reduce back pain. Another article states that this “randomized control study on Viniyoga, back related functions and symptom reductions were superior in the yoga group compared to the self-care book and exercise groups after 12 and 26 weeks of intervention” (Tekur, 2008, p. 641). Since the study was so long and did multiple check-ins with participants it raises the experiment’s reliability. Actually doing the physical movements of yoga helps relieve the pain in the lower back when done correctly according to this study.

Mental Aspects of Yoga and Back Pain:

“Yoga may be beneficial for back pain because it involves physical movement, but it may also exert benefits through its effects on mental focus” (Sherman, 2005, p. 855). When it comes to yoga it is not only about the physical movements and positions, but the mental focus that goes along with the poses. The mental focus “help[s] people to increase their awareness of how they had been moving and positioning their body” (Sherman, 2005, p. 855). This is an important factor when it comes to back pain. If someone is always sitting in positions or lying in positions that hurt their back but do not realize it, then in the long run it hurts the back more. It is important to be aware of how you are moving, positioning and what you are doing when it comes to preventing and helping lower back pain. Another part of mental awareness from yoga is during the actual practice. It is important to make adjustments if a movement is hurting, or straining a muscle. It is also important to have mental awareness of what each part of your body is doing, each limb, each muscle and your breathing. When you focus on each aspect of your body and its positioning it can help relieve tension if you reposition the body. Your mind has to work with your body in order to know when a position needs to be altered or it can cause more pain. It is important to focus on what you are doing at all times during the practice of yoga in order to make the correct adjustments. Krishnamurti (1999) says “the human mind is in disorder” (26). While focusing on all aspects of the body and mind during yoga the mind is wondering from one thing to another, causing the mind to be in chaos while focusing on multiple things at once.

Breathing Aspects of Yoga and Back Pain:

Learning new breathing techniques during yoga can help reduce lower back pain. Breathing techniques can help people become more aware of their breathing rhythm, helping them relax during the positions. When breathing during yoga “the lungs should expand fully and the stomach should extend outwards” (Muktibodhananda, 1998, p. 167). This allows each individual to get as much as possible from the position. Good pranayama can only be accomplished while using the mind. Breathing and mind are greatly connected. In one study “yogic breathing practices were included…to reduce the breath rate… which is an effective way to achieve mastery over the mind” (Tekur, 2008, p. 640). When you control your breath it can help relieve tension within the body, especially the lower back. When people do stretches and the body is lifted off the kidneys and lungs it relieves pain in the lower back. Deep, slow breathe helps your body relax. A lot of pain is caused from people being too high-strung and not relaxing their muscles enough by breathing at a slow, regulated pace.

Types of Yoga Beneficial to Reducing Back Pain:

Different types of yoga are not as beneficial (if at all) for helping reduce back pain. Some types of yoga are too difficult for people to do if they have back pain. “Bikram and vinyasa, may be to vigorous for patients with back pain who are unfamiliar with yoga whereas other styles (for example, Iyengar) may need modifications from normal practice to be appropriate for patients with back pain” (Sherman, 2005, p. 856). These are a few examples of yoga practices that may be too difficult for people who suffer from back pain. Ivengar is good for people with lower back pain because many of the classes offered have all the modifications needed in order to not cause more pain and may even reduce pain. With these modifications and this style of yoga it is not stressful for the back or spine. “The postural tenor that defines Iyengar yoga in form and practice” (Singleton, 2010, p. 19) does not cause more pain to the lower back when the adjustments are made during the practice.

Another important thing to remember is that yoga is about comfort. If a position is uncomfortable adjustments need to be made so it is comfortable and easy to do. It is important to not strain yourself and cause more back pain while trying to do movements and positions. In fact yoga should not cause any pain or strain to any part of the body. Before starting any type of yoga you should do back ground research making sure the style of yoga chosen will not have a negative impact on the back pain that is already there.

One thing about yoga in society is how it is quite expensive. In order to use yoga as a treatment for back pain one must have the money to pay for the classes. An important factor to consider is that “chronic pain may be most pronounced among socioeconomically disadvantaged ethnic and racial minority populations. “ (Reid, 2008, p. 2). The fact that many people who are not economically stable have a higher chance of having lower back pain, it makes it much harder to use yoga as a treatment. Many people who may be socioeconomically disadvantaged do manual labor jobs with lots of heavy lifting, which is one of the main causes for lower back pain. Their economic status makes it hard for them to use yoga as a treatment.

Drug Use and Back Pain:

Many Americans who suffer from back pain take medication/ painkillers on a regular basis. Many have not been able to find alternative solutions in the past. Recently people have been trying to use yoga as an alternative solution to taking painkillers for their back pain. In a study done it found that drug usage reported immediately following completion of the study treatments decreased significantly in the yoga group” (Williams, 2005, p. 114). This finding from the study supports that yoga has such a beneficial impact on lower back pain that they were able to reduce or stop taking medicine. This does not mean that yoga will work for everyone’s back pain. In this particular study it showed that as a group it decreased, that does not mean that for each individual it was decreased.

Flexibility, Strength and Back Pain:

In a few studies it was shown that being more flexible and strong in the back and abs region may help reduce back pain. “It stands to reason that activities such as hatha yoga that improve muscular strength, flexibility and balance would similarly improve function and decrease low back pain” (The Journal of Family Practice, 2004, p. 662). The stronger your core is the less pressure you have on your lower back. With my personal experience of having stress fractures I get more and less pain depending on how much I am working out my abs and back to make them stronger. When I work them out often and harder my back pain lessens; but when I do not workout often trying to strengthen my abs and back I have more pain in my lower back. In a study the researchers found that “spinal flexion, extension, right lateral flexion, and left lateral flexion increased in both groups with significant difference between groups and higher effect sizes in the yoga group” (Tekur, 2008, p. 641). The more your upper and middle back are flexible and strong, the less work your lower back has to do. Strengthening and stretching can help relieve tension in the lower back. When your back is tight, it is uncomfortable and can cause pain; when loose and flexible it relieves the stress and pain in the lower and rest of the back.

Personal Experiences With Yoga and Back Pain:

In many of the articles it stated “no reports of harm from yoga in low back pain therapy” (The Journal of Family Practice, 2004, p. 661). I strongly disagree with this statement based on my own personal experiences. As stated before I had stress fractures in my spine and to this day I get lower back pains from it. When practicing yoga if I hold a pose for a certain amount of breathes when I release it I will have shooting pains in my back. Also if I am bent over towards my toes (whether it be from a sitting down or standing position) and then straighten my back out, I get tremendous pain. Another instance when I will have pain is the following day. Depending on the stretches done and the duration of the stretches the next day my back will be very sore and achy. This can cause it to be uncomfortable to sit down, lie down, or stand up for a long time (after about 35 minutes I will get pain). I find it hard to believe that none of these studies had no one experience the pain that I experience. Perhaps this is because the research groups were so small they did not get anyone with the same experience that I have gone through. The only thing I can think of is the adjustments made during the actual practice of yoga. Perhaps I should not be doing many of the positions I do because of my back pain. The only other reason I can think that no one in the study resulted with more back pain is that they do a different type of yoga than what I usually practice.

Works Cited

Bertisch, S., Wee, C., Phillips, R., and McCarthy, E. (2009). Alternative Mind-Body Therapies Used by Adults with Medical Conditions. National Institues of Health, 66 (6), 511-519. doi: 10.1016/j.jpsychores.2008.12.003

Does yoga speed healing for patients with low back pain?.(2004). The Journal of Family Practice. 53 (8), 661-662.

Hoogendoorn, W., Poppel, M., Bongers, P., Koes, B. and Bouter, L. (1999). Physical load during work and leisure time as risk factors for back pain. Scand J Work Environ Health, 25 (5), 387-399.

Krishnamurti, J. (1999). This Light in Oneself True Meditation. Massachusetts, Krishnamurti Foundation Trust.

Muktibodhananda, S. (1998). Hatha Yoga Pradipika. India, Yoga Publications Trust.

Reid, C. (2008). Self-Management Strategies to Reduce Pain and Improve Function among Older Adults in Community Settings: A Review of the Evidence. American Academy of Pain Medicine, 1-16. doi: 10.1111/j.1526-4637.2008.00428

Sherman, K., Cherkin, D., Erro, J., Miglioretti, D. and Deyo, R. (2005). Comparing Yoga, Exercise, and a Self-Care Book for Chronic Low Back Pain. Annals of Internal Medicine. 143 (12), 849-856.

Singleton, M. (2010). Yoga Body The Origins of Modern Posture Practice. New York, Oxford University Press, Inc.

Tekur, P., Singphow, C., Nagendra, H., and Raghuram, N. (2008). Effect of Short-Term Intensive Yoga Program on Pain, Functional Disability, and Spinal Flexibility in Chronic Low Back Pain: A Randomized Control Study. The Journal of Alternative and Complementary Medicine, 14 (6) 637-644. doi: 10.1089/acm.2007.0815

Williams, K., Petronis, J., Smith, D., Goodrich, D., and Wu, J. (2005). Effect of Iyengar yoga therapy for chronic low back pain. International Association for the Study of Pain. 107-117. doi: 10.1016/j.pain.2005.02.016

1 comment:

  1. I can relate to this topic because I am also and athlete who has had multiple injuries to my body and became very tired of taking pain killer after pain killer just to cover up the pain. I feel that yoga is a very good substitute for medicine and can be seen as a new break throw in physical therapy.