Below is a guest blog and personal commentary on the Cochrane review of yoga treatment for chronic nonspecific low back pain from Beth Novian Hughes, MS Yoga Therapy, C-IAYT, who has back pain and is a long-time practitioner and teacher of yoga.
The results of the Cochrane review of yoga treatment for low back pain don’t surprise me at all. As a sufferer of low back pain, as well as a yoga teacher and therapist, I have seen how yoga can work to help treat low back pain.
My own experience with back pain began years ago with on and off again episodes of pain. After an injury 18 months ago, the pain was no longer on and off again but constant, although low level. My back problems were then exacerbated last year by my taking a very long hike without a break, and the chronic pain became excruciating. At this point I turned to yoga therapy. You may be wondering why I needed a special yoga practice for my back if I was already a yoga practitioner and teacher. Yes, I had a mild practice of yoga, focused on the whole body. But like so many in this field over time I started leading classes with my voice not my body (which is great for the clients), and my practice became busy and my self-care became secondary. I needed to move my own practice to the forefront and focus on helping my back if I was going to live a pain-free life.
So, what yoga did I choose to do? As a yoga therapist with a Master’s degree in the subject, I was familiar with many options. When my back pain became chronic I experimented with Pilates, chiropractic, inversion therapy, and acupuncture as well as yoga therapy, and I read books; I became my own guinea pig. Some elements of these therapies seemed to help, some didn’t. What I put together was a yoga therapy routine that included core strengthening, stability, balance, self-care and meditation. It took me until September to settle into a steady routine. Once I got used to this it took about 15 minutes to do the poses and 15 minutes to meditate, and I practiced every morning, every day. My self-care came first, before clients, before anything. I scheduled it on my Google calendar. And I improved, I got stronger, I could feel the pain was decreased. When I attended group yoga I could feel the difference in my body. I could walk further without breaks. I started to get my life back.
It took about three months for me to see a marked improvement in my chronic back pain. Over Labor Day weekend, when I was just beginning my yoga routine, I saw my daughter for a visit/vacation that included hiking. I couldn’t walk very far without needing to take a break because of pain; I needed to sit down. When I next saw her at Thanksgiving I was much improved and able to walk a lot further, something she commented on. The yoga practice I designed for my back was clearly working. Although the Cochrane review doesn’t have much information on whether improvements in pain and functioning are maintained beyond six months of yoga practice, I plan to continue this practice indefinitely.
You may wonder why I didn’t use more conventional back exercises such as physical therapy. The Cochrane review didn’t find many studies comparing yoga to other types of back exercises, but the studies they did find seemed to show no difference in back pain and functioning between the two types of exercise. The review suggested that choosing between yoga and other types of back exercise is up to the individual. However, yoga includes three major branches: poses (asana), breathwork (pranayama), and meditation. Other exercise forms do not include all three of these areas. For me, the meditation time is vital to the success of the practice. During meditation one can slow down, breathe, and turn on the relaxation response. All of this has important effects on the physiology that one may not get from other forms of exercise. I believe that the combination of poses, breathwork, and meditation may set yoga apart and help decrease depression, stress, and anxiety, and increase quality of life, even if these outcomes haven’t been measured in many clinical trials. It is also encouraging to see from the review that although yoga shows an increased risk of minor adverse events compared to doing no exercise, yoga is no riskier than other forms of back exercise. This seems predicable to me, flares happen and it is possible for exercise to aggravate a flare.
It goes without saying that one should consult an experienced yoga teacher when beginning a journey to a happy back using yoga. It is certainly possible to injure yourself if your alignment is off or if you are practicing during a flare. The therapies in the Cochrane review came from different styles or schools of yoga, just as my own practice does, but all of the therapies were delivered by experienced yoga teachers. If you are thinking of using yoga to treat back pain, please consult a professional in the field, who can help minimize your risk of injury and maximize your chances of finding relief. You can find certified yoga therapists, C-IAYT, all over the world at http://www.iayt.org/search/custom.asp?id=4160 .
I’m so thankful for yoga therapy. It has truly saved my life.