Maintain a Yoga Practice to Improve Absences due to Back Pain
By John M. de Castro, Ph.D.
“For people with lower back pain, stretching is very important. For example, stretching the hamstring muscles (in the back of the thigh) helps expand the motion in the pelvis, decreasing stress across the lower back. In addition, stretching with yoga increases blood flow, allowing nutrients to flow in, toxins to flow out, and overall nourishment of the muscles and soft tissues in the lower back.” – Fred Busch
Low Back Pain is the leading cause of disability worldwide and affects between 6% to 15% of the population. It is estimated, however, that 80% of the population will experience back pain sometime during their lives. The pain interferes with daily living and with work, interfering with productivity and creating absences. There are varied treatments for low back pain including chiropractic care, acupuncture, biofeedback, physical therapy, cognitive behavioral therapy, massage, surgery, opiate pain killing drugs, steroid injections, and muscle relaxant drugs. These therapies are sometimes effective particularly for acute back pain. But, for chronic conditions the treatments are less effective and often require continuing treatment for years and opiate pain killers are dangerous and can lead to abuse, addiction, and fatal overdoses. Obviously, there is a need for safe and effective treatments for low back pain that are low cost and don’t have troublesome side effects.
Pain involves both physical and psychological issues. Physically, exercise can be helpful in strengthening the back to prevent or relieve pain. Psychologically, the stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of low back pain. Yoga practice is both an exercise and a mindfulness practice which has been shown to have a myriad of health benefits, including relief of chronic pain and relief of chronic low-back pain. So, it makes sense to further explore the effectiveness of exercise and yoga practice for chronic low back pain.
In today’s Research News article “Effects of yoga, strength training and advice on back pain: a randomized controlled trial.” See summary below or view the full text of the study at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372262/
Brämberg and colleagues recruited adult patients with non-disabling low back pain and randomly assigned them to a strength training exercise, kundalini yoga, or evidence-based education group. Strength training consisted of six weeks of 60-minute supervised strength training with encouragement to practice at least twice weekly at home. Kundalini yoga training consisted of six weeks of 60-minute supervised yoga sessions with meditations, breathing, and posture practice, with encouragement to practice at least twice weekly at home. Evidence-based education consisted of readings that encourage strategies for self-care, information on medication, sick leave and strategies for managing pain. All participants were measured before and after training and 6 and 12 months later for back and neck pain, absences from work, going to work in pain, and adherence to treatment.
They found that yoga had a significantly lower drop-out rate suggesting that it was better liked and tolerated than strength training or education. In addition, neck disability was significantly lower in the yoga and strength training groups than the education group, while back pain was significantly improved in the strength training group. Overall there were no significant group differences in absences from work. But, when the groups were separated into participants who adhered to the recommendations and exercised at least twice a week after training and those who practiced less, the adhering groups had significantly fewer absences, greater than 40% fewer, than the education group or the low adherence participants.
These are interesting results and suggest that exercise is helpful with low back pain and its consequences for work life. Yoga practice did not appear to produce superior results to strength training for pain or absences. This suggests that the exercise component of yoga practice is what is effective. But, yoga appeared to be preferred and better tolerated as fewer participants dropped out. The results also clearly indicate that continued practice is crucial. No matter what the exercise practice was, it had to be continued after active training in order to continue being effective.
So, maintain a yoga practice to improve absences due to back pain.
“And in a new, nationally representative survey from the Consumer Reports National Research Center of more than 3,500 adults, yoga (and tai chi, or the like) was helpful to almost 90 percent of the back-pain suffers who tried it. In comparison, 75 percent of people who saw a physical therapist and 64 percent who saw a primary care doctor said the advice or treatment they received gave them relief.” – Consumer Reports
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Brämberg, E. B., Bergström, G., Jensen, I., Hagberg, J., & Kwak, L. (2017). Effects of yoga, strength training and advice on back pain: a randomized controlled trial. BMC Musculoskeletal Disorders, 18, 132. http://doi.org/10.1186/s12891-017-1497-1
Abstract
Background
Among the working population, non-specific low-back pain and neck pain are one of the most common reasons for sickness absenteeism. The aim was to evaluate the effects of an early intervention of yoga – compared with strength training or evidence-based advice – on sickness absenteeism, sickness presenteeism, back and neck pain and disability among a working population.
Methods
A randomized controlled trial was conducted on 159 participants with predominantly (90%) chronic back and neck pain. After screening, the participants were randomized to kundalini yoga, strength training or evidence-based advice. Primary outcome was sickness absenteeism. Secondary outcomes were sickness presenteeism, back and neck pain and disability. Self-reported questionnaires and SMS text messages were completed at baseline, 6 weeks, 6 and 12 months.
Results
The results did not indicate that kundalini yoga and strength training had any statistically significant effects on the primary outcome compared with evidence-based advice. An interaction effect was found between adherence to recommendations and sickness absenteeism, indicating larger significant effects among the adherers to kundalini yoga versus evidence-based advice: RR = 0.47 (CI 0.30; 0.74, p = 0.001), strength training versus evidence-based advice: RR = 0.60 (CI 0.38; 0.96, p = 0.032). Some significant differences were also found for the secondary outcomes to the advantage of kundalini yoga and strength training.
Conclusions
Guided exercise in the forms of kundalini yoga or strength training does not reduce sickness absenteeism more than evidence-based advice alone. However, secondary analyses reveal that among those who pursue kundalini yoga or strength training at least two times a week, a significantly reduction in sickness absenteeism was found. Methods to increase adherence to treatment recommendations should be further developed and applied in exercise interventions.