Improve Chronic Low Back Pain with Mindful Movement Practices
By John M. de Castro, Ph.D.
“Tai chi helps with back pain in several ways. It strengthens the muscles in your abdomen and pelvic area that are crucial to supporting the lower back; it improves your balance and flexibility; and it makes you more aware of your posture when you sit, stand, and walk.” – Benjamin Kligler
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. Tai Chi, Qigong, and yoga are both exercises and mindfulness practices that have been found to be effective for back pain. There is accumulating evidence. So, it is useful to take a step back and summarize what has been found.
In today’s Research News article “Are Mindful Exercises Safe and Beneficial for Treating Chronic Lower Back Pain? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571780/), Zou and colleagues review, summarize, and perform a meta-analysis of the effects of the mindful movement practices of Tai Chi, Qigong, and yoga on chronic low back pain. The identified 17 randomized controlled trials that included a total of 2022 participants.
They report that the published research found that both Tai Chi and yoga practices produced significant reductions in pain intensity and back specific disability in patients with chronic low back pain. There were no reported adverse events with Tai Chi practice but there were a few adverse events reported with yoga practice. So, although both are effective in treating chronic low back pain, more care must be taken with yoga practice to protect against injury.
The results of the published research strongly suggests that Tai Chi practice should be prescribed for chronic low back pain, reducing pain and disability. In addition, Tai Chi is a gentle and safe mindfulness practice. It is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion. It is inexpensive to administer, can be performed in groups or alone, at home or in a facility, and can be quickly learned. In addition, it can be practiced in social groups. This can make it fun, improving the likelihood of long-term engagement in the practice. So, Tai Chi practice would appear to be an excellent gentle practice to chronic low back pain.
So, improve chronic low back pain with mindful movement practices.
“On the physical side, tai chi supports or improves balance, coordination, flexibility, muscle strength, and stamina. On the mental side, tai chi helps relieve stress, improves body awareness and, when done in a group setting, reduces social isolation.” – Harvard Health
CMCS – Center for Mindfulness and Contemplative Studies
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Zou, L., Zhang, Y., Yang, L., Loprinzi, P. D., Yeung, A. S., Kong, J., … Li, H. (2019). Are Mindful Exercises Safe and Beneficial for Treating Chronic Lower Back Pain? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of clinical medicine, 8(5), 628. doi:10.3390/jcm8050628
Background: Chronic low back pain (CLBP) is a common health issue worldwide. Tai Chi, Qigong, and Yoga, as the most widely practiced mindful exercises, have promising effects for CLBP-specific symptoms. Objective: We therefore conducted a comprehensive review investigating the effects of mindful exercises versus active and/or non-active controls while evaluating the safety and pain-related effects of mindful exercises in adults with CLBP. Methods: We searched five databases (MEDLINE, EMBASE, SCOPUS, Web of Science, and Cochrane Library) from inception to February 2019. Two investigators independently selected 17 eligible randomized controlled trials (RCT) against inclusion and exclusion criteria, followed by data extraction and study quality assessment. Standardized mean difference (SMD) was used to determine the magnitude of mindful exercises versus controls on pain- and disease-specific outcome measures. Results: As compared to control groups, we observed significantly favorable effects of mindful exercises on reducing pain intensity (SMD = −0.37, 95% CI −0.5 to −0.23, p < 0.001, I2 = 45.9 %) and disability (SMD = −0.39, 95% CI −0.49 to −0.28, p < 0.001, I2 = 0 %). When compared with active control alone, mindful exercises showed significantly reduced pain intensity (SMD = −0.40, p < 0.001). Furthermore, of the three mindful exercises, Tai Chi has a significantly superior effect on pain management (SMD= −0.75, 95% CI −1.05 to −0.46, p < 0.001), whereas Yoga-related adverse events were reported in five studies. Conclusion: Findings of our systematic review suggest that mindful exercises (Tai Chi and Qigong) may be beneficial for CLBP symptomatic management. In particular, Tai Chi appears to have a superior effect in reducing pain intensity irrespective of non-control comparison or active control comparison (conventional exercises, core training, and physical therapy programs). Importantly, training in these mindful exercises should be implemented with certified instructors to ensure quality of movement and injury prevention.