Yoga and Back Pain

Yoga and Back Pain

Introduction

            Unfortunately, “more than three-quarters of the world’s population experience back pain at some time in their lives” (Attanayake, et al. 2010).  Chronic back pain is back pain that exists within the patient for more than three months (Archer, 2008).  Thanks to chronic back pain, “Americans spend billions of dollars every year on medications, therapy, and other treatments” (Smith, 2012).  Chronic back pain is the most frequent injury that nurses sustain, and it is one of the most common causes of job-related disabilities (Smith, 2012).  Twenty-Seven percent of adults in the United States “report experiencing low back pain, and back pain is the leading cause of disability among adults age 45 and under” (Kelly, 2009, p.103).  One percent of Americans is “chronically disabled due to” chronic lower back pain (Chametcha, et al., 2010, p.10). Three out of four adults in the United States use some form of alternative therapy, including yoga (Attanayake, et al., 2010).

            Finding alternative ways of easing chronic back pain is personally important to me.  I come from a family where back pain is common.  My maternal grandmother has severe osteoporosis and lives with chronic pain.  She has always had bad posture and did not do much exercise when she was young.  Her back pain was caused by degeneration of her spine, leading to spontaneous compression fractures (Natural Standard, 2012).  She has had several surgeries and has taken osteoporosis medications, including injecting herself daily with Forteo, a medication used to build new bone, for two years.  It has been difficult to watch my grandmother struggle with back pain and I want to avoid long-term back problems by staying strong and flexible.

This past summer my mother had to have surgery on a herniated disc that was causing intolerable pain.  Herniated discs are a result of part of the disc pressing on a nerve (Natural Standard, 2012).   She has had back pain her entire life, off and on.  She does not do yoga, although she eats a healthy diet and exercises regularly.  If my mother had not been a surgical candidate for her herniated disc she would have been looking for ways to live with the chronic pain she had and yoga would have been one of the options that she considered.  It would be easy to modify yoga positions to adapt to the specific pain someone has; for example my mother was advised not to twist if she did yoga.  It is possible to change the yoga routine as needed for the individual.

As a senior in high school I began having excruciating back pain after wrenching my ribs while tumbling in gymnastics, and I was in constant pain for about a month.  I hope that was not a glimpse of what is to come in my future, as some of the causes of back pain can be hereditary, but if it was, I want to know about any alternative forms of treatment that are available, specifically yoga (Natural Standard, 2012).

Causes of back pain

            Many different things cause lower back pain.  In her article Is Yoga an Effective Treatment for Low Back Pain: A Research Review, Zena Kelly states that “recent literature suggests that low back pain may be caused by a combination of physical factors…as well as psychosocial and behavioral factors” (Kelly, 2009, p. 104).  Kelly is critical of conventional medical care, because it does not seem to help or approach care in a holistic manner.

            Most people first experience lower back pain between the ages of 30 and 40 years (Natural Standard, 2012).  As we age, back pain is more likely because aging wears down our spines as, “spinal disks become flatter and less flexible” (Mayo Clinic, 2012).  Conditions such as arthritis and herniated discs can cause back pain and injuries can also result in pain (Natural Standard, 2012).

Although most causes of back pain are physical, emotional stress can cause back muscles to tense and lead to pain.  In a stress-related back pain diagnosis, “psychological factors either initiated or are maintaining the back pain, or both” (Deardorff, 2012, p.1).  When we are emotionally stressed, our blood vessels become constricted and the reduced blood flow to soft tissues, specifically muscles, leads to less oxygen in the soft tissues.  Muscle tension, spasm, and pain result from this lack of oxygen in the soft tissues (Deardorff, 2012, p. 2).

Using yoga to treat back pain

            More people with back pain today are looking for other ways of treating their pain (Kelly, 2009).  Yoga “is an ideal intervention for low back pain” because of its holistic approach (Kelly, 2009, p. 104).  In the seven studies that Kelly contrasts in her article, five different styles of yoga were used; Viniyoga, Iyengar, Anusara, Hatha, and a combination of an unspecified style of yoga and Pilates (2009, p. 106).  The style of yoga used did not seem to matter since “all of the studies showed positive results regardless of differences in type of low back pain, duration and frequency of intervention, type of yoga used, and the poses and practices used” (Kelly, 2009, p. 108).  Positive results included significant reduction in disability compared to the control group, near normal mobility and an absence of pain, and reduction in pain medication usage, time off work, and symptom recurrence (Kelly, 2009).

                        In a study published in the Annals of Internal Medicine Vol. 155 (9), the effectiveness of yoga and standard forms of care for chronic back pain were contrasted (Tilbrook, et al., 2011).  As a result of the study, it was found that “offering a 12-week yoga program to adults with chronic or recurrent low back pain led to greater improvements in back function than did usual care” (Tilbrook, et al., 2011, p. 570).  Although exercise treatment is popular, it was found to not have as large of an impact on back pain as yoga does.  Along with being a form of physical exercise, yoga provides mental focus, and “patients are taught good posture, self-awareness, and self-care along with relaxation” making it more beneficial (Tilbrook, et al., p. 570).  Only eight of the 313 participants in the study had negative effects that could have been attributed to the yoga (Tilbrook, et al., 2011, p. 570).

            Using yoga to cope with chronic back pain helps for several reasons.  Yoga “loosens muscles that have been tightened by inactivity, stress, and tension” and leads to improved posture and increased range of motion and flexibility (Kelly, A.L., 2003, p.104).  Once muscles have become less tense and the body is able to move more easily, the pain lessens (Kelly, A.L., 2003).

            In an article discussing the evidence surrounding the idea that yoga may help back pain, it was stated that “patients who practice Hatha yoga say it is valuable for preventing and managing stress-related chronic health problems, including low back pain” (Graves, et al., 2004).  Ninety-eight percent of 3,000 people practicing yoga as a form of treatment surveyed said that it was helping them (Graves, et al., 2004).  In one study that the authors investigated, the people who reported that they were having pain again after practicing yoga also admitted that they were not practicing it regularly (Graves, et al., 2004).  Although the authors admitted that more studies need to be completed in order to more accurately assess the actual benefits of yoga on chronic pain, their findings were mostly positive (Graves, et al., 2004).

What to target

When considering back pain, it is important to think about the strength of the individual’s core muscles (Smith, 2012).  The core “is the region from the ribs down to the hips, front, back, and sides,” and the abdominal muscles actually wrap around the back (Smith 2012, p.8).  The weaker the core, the less support your core can give to the spine, and the more likely it is that the spine will no longer be properly aligned (Smith, 2012).

            An article in Yoga Journal, written by Timothy McCall, M.D., disagrees with the previous viewpoint on strengthening the core as a way to prevent and treat back pain (2012).  McCall believes that the often-recommended stomach crunches as a prescription for avoiding further pain actually “increase tightness in the hip flexors, like the psoas, potentially exacerbating back problems” (2012).  Instead, McCall feels that the best approach is to figure out which muscles need to be strengthened and stretched and create a yoga program to do just that (2012).

            It seems as if both articles have merit.  The fact that stronger core muscles lead to a more stabilized spine that is less likely to move out of alignment makes sense.  McCall’s argument that targeting the core can actually aggravate also has value (2012).  I like McCall’s concept of creating an individualized yoga program to target the needs of each person since the cause of back pain is different for every person.  More research needs to be done on what the yoga poses are that will most benefit individuals who suffer from chronic back pain.

Yoga and quality of life

            Chronic back pain often leads to a decrease in quality of life for patients (Chametcha, et al., 2010).  Meditation is “considered to be a part of yoga [and] is a valuable tool to calm down uncontrollable surge of negative emotions,” something that chronic back pain often produces (Chametcha, et al., 2010, p.10).  Using yoga as a way to relieve the psychological stress that often results from chronic back pain is a holistic approach rather than using medications.  Although the study by Chametcha, Hongasandra, Raghura, and Tekur, discussed in the International Journal of Yoga has limitations, in that it took place during a week-long residential intensive yoga program, yoga “increased the [quality of life] and spinal flexibility better than physical therapy exercises for [chronic lower back pain]” (Chametcha, et al., 2010, p.7).

            Chronic pain sufferers find it difficult to be comfortable.  People enduring chronic pain are “not comfortable while awake, and usually [don’t] sleep well at night” (Kelly, A.L., 2003 p. 100).  It leads to weight gain, sexual difficulties, anger, depression, and low self-esteem (Kelly, A.L., 2003).  The connection between physical and emotional pain becomes especially evident when investigating the effects chronic pain has on an individual’s life.  The emotional issues that arise will be discussed later.

Emotional benefits

            When they are in constant pain, many people end up completely shutting down in order to manage.  Since chronic pain can lead to depression, they become “uncomfortable with their own thoughts” (Kelly, A.L., p. 104).  Yoga is a way for individuals to move toward reflection on their lives in a positive way.  Because every patient has a different level of pain with unique causes, “it’s a personal, private journey, and they can take it as slowly as they want” (Kelly, A.L., 2003, p.104).

Along with reflecting on their lives, yoga helps patients to feel empowered.  Individuals are able to “feel less like a victim, because they’re taking control” (Kelly, A.L., 2003, p. 104).  They are able to do a physical activity that may lead them toward feeling healthier, and they do not have to simply rely on medications to relieve their pain.  Surgery and medication are done to the individual while yoga is something you do.  It is a form being actively involved in positive treatment of the pain the individual is experiencing.

Yoga and the medical world

            Recently yoga has been becoming more respected and used in the medical world.  Although much of the time patients bring up the idea of alternative therapy with their doctors, in some cases, physicians will suggest yoga as therapy for their patients (Attanayake, et al., 2010).  The American College of Physicians and the American Pain Society recommended yoga, as well as several other therapies, for people suffering from chronic back pain in clinical practice guidelines issued in 2008 (Archer, 2008).

            An article called Team up to fight pain, in Yoga Journal, discusses teams of specialists working together to come up with new plans for treating patients who have chronic pain (Kelly, A.L., 2003).  These “pain teams” combine conventional-care providers, such as physicians, physical therapists, and psychologists, with complementary-care providers, such as acupuncturists, massage therapists, and those who are educated in yoga.  The different practitioners work together to come up with the best possible care plan for individual patients (Kelly, A.L., 2003).

            As James N. Dillard, assistant clinical professor of rehabilitation medicine at the Columbia University College of Physicians and Surgeons explains, “treatment of pain by one therapy or a single approach is just not appropriate” (Kelly, A.L., 2003, p. 103).  Using several different approaches to treat pain is believed by the “pain teams” to be the most effective way of helping their patients and they get better results from combining the approaches.  Dillard also comments on the rising interest in this type of care because patients are tired of just taking lots of medications to try to handle their chronic pain (Kelly, A.L., 2003).

            Although the “pain teams” program includes various types of complementary-care, yoga is key to the success of the up and coming practice (Kelly, A.L., 2003).  Many of the patients involved in the program “have been completely sedentary for years…they’re petrified to move” (Kelly, A.L., 2003, p. 103).  Using yoga, these individuals are able to gradually increase their movements and eventually become more physically active.  Often, as they are able to move around more, “they begin to break the cycle of pain…[and] they require less medication” (Kelly, A.L., 2003, p. 103). Although their pain does not go away completely, they are able to more easily manage it and become active members of society again.

Yoga compared to pain medication

            When it came to helping back pain, yoga, deep tissue massage, and Pilates rated the same as pain medications in survey results published in Consumer Reports in 2010 (Attanayake, et al., 2010).  Prescription pain medications are often used in the treatment of back pain in order for the individual to make it through a normal day and in order to sleep (Natural Standard, 2012).  These include anti-inflammatories and narcotic pain relievers.  Use of narcotic pain relievers can lead to addiction for some people and it is necessary to be careful while taking them (Natural Standard, 2012).  These medications have many unpleasant side effects, including dizziness, nausea, and drowsiness (Kelly, A.L., 2003).

            Steroids are also used in the relief of back pain.  If steroids are used for an extended period of time they can cause the immune system to weaken and increase the likelihood of infection (Natural Standard, 2012).  If the individual ha been taking Corticosteroid steroids for more than two weeks they may suffer from withdrawal symptoms and steroids can increase the risk of developing ulcers or gastrointestinal bleeding (Fields, 2002).  Steroids can also cause Osteoporosis, which in my grandmother’s case was the main cause of the spontaneous compression fractures that caused her back pain in the first place (Fields, 2002).

            While pain medications may cover up chronic pain and provide temporary relief, they do not, with the exception of anti inflammatories, treat the source.  Anti inflammatories reduce inflammation but do not strengthen or build muscle or increase flexibility.  In the long-term using anti inflammatories can lead to negative effects such as kidney bleeding (Mayo Clinic, 2012).

Iyengar Yoga to Treat Back Pain

            Hatha yoga is differentiated from other types of yoga because it “is based on the knowledge, development, and balance of psychophysical energies” (Graves, et al., 2004).  Lonnie Zeltzer, M.D. a professor at UCLA School of Medicine, feels that Iyengar yoga, a type of Hatha yoga, is the best option for easing back pain (Kelly, A.L., 2003).  Iyengar yoga uses “bolsters, blocks, straps, blankets, and other supportive props” that make it easy to modify individual poses (Kelly, A.L., p. 104).  The use of props lets patients manipulate poses in ways that will target their individual pain and its source (Kelly, A.L., 2003).

Conclusion

            Although much research still needs to be done to prove this as a fact, yoga seems to be a feasible resource for people suffering from chronic back pain.  Since yoga is very versatile with many different poses, it is easy to create a program to fit the individual that will not exacerbate their already unbearable pain.  There needs to be more in depth examinations, not only of yoga as a tool for people dealing with back pain, but the types of programs these people should follow.  Although there is some information it is conflicting and difficult to dissect exactly what each program is targeting.  Yoga holds many benefits for people looking for a way to manage their pain.  Instead of simply helping to relieve pain, yoga also targets the area of pain and helps the victim to begin the process of healing the area by strengthening muscle and increasing flexibility. 

As someone who is likely to face increased amounts of back pain in their future if I do not start actively working to prevent it, yoga is an interesting option.  Using less conventional methods for preventing and treating back pain could mean moving away from treatments that are detrimental to my health.  These treatments include the use of pain medications and steroids, which I discussed previously.

References

Archer, S. (2008) New guidelines for back pain include yoga. IDEA Fitness Journal 5 (1), 89.

Attanayake, A. P., Dash, S. Somarathna, K.I.W.K. & Vyas, G. (2010) Clinical evaluation of selected Yogic procedures in individuals with low back pain. AYU 31 (2), 245.

Chametcha, S., Hongasandra, R., Raghuram, N., Tekur, P. (2010) Effect of yoga on quality of life of CLBP patients: A randomized control study. International Journal of Yoga 3 (1), 10.

Deardorff, W. (2012) Stress-related back pain. Retrieved from http://www.spine-health.com/conditions/depression/stress-related-back-pain.

Fields, T. (2002) Steroid side effects: How to reduce Corticosteroid side effects. Retrieved from http://www.hss.edu/conditions_steroid-side-effects-how-to-reduce-corticosteroid-side-effects.asp

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

Kelly, A. L. (2003) Team up to fight pain. Yoga Journal, 38-46.

Kelly, Z. (2009) Is Yoga an effective treatment for low back pain: A Research review. International Journal of Yoga Therapy 19, 103-112.

Mayo Clinic (2012) Causes of back pain. Retrieved from http://www.mayoclinic.com/health/back-pain/DS00536&slide=3

McCall, T. (2012) A Yogic approach to back pain. Retrieved from http://www.yogajournal.com/health/1465.

Natural Standard (2012) Back Pain. Retrieved from http://www.naturalstandard.com/databases/sports/all/condition-backpain.asp?

Smith, Kathy. (2012) The Wonders of Yoga: More than just meditation, this ancient exercise provides an all-around workout. Healthcare Traveler 19 (11), 8.

Tilbrook, H.E., Cox, H., Hewitt, C.E., Kang’ome, A.R., Chuange, L.H., Jayakody, S. Aplin, J.D., Semlyen, A., Watt, I., Torgerson, D.J. (2011) Yoga for chronic low back pain. Annals of Internal Medicine 155 (9), 569-78.