Improve Chronic Low Back Pain in Low Income Patients with Yoga
By John M. de Castro, Ph.D.
“Yoga’s focus on balance and steadiness encourages your body to develop defenses against the causes of back pain, which include weak abdominal and pelvic muscles, as well lack of flexibility in the hips. When you strengthen these muscles, you improve your posture, which reduces the load on your back, and thus reduces the aches you feel. In addition, stretching can increase flexibility by increasing blood flow to tight muscles.” – Annie Hauser
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. 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. 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 has been shown to have a myriad of health benefits. These include relief of chronic pain. Yoga practice has also been shown to be effective for the relief of chronic low-back pain. Many forms of yoga focus on the proper alignment of the spine, which could directly address the source of back and neck pain for many individuals. The majority of the research, though, has focused on relatively affluent populations. There is a need to study the effectiveness of yoga practice for low back pain in low-income populations.
In today’s Research News article “Physical and Physiological Effects of Yoga for an Underserved Population with Chronic Low Back Pain.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746048/), Colgrove and colleagues recruited adult low-income minority group members who had chronic low back pain and assigned them to a wait-list control condition or to receive yoga training twice a week for 60 minutes for 12 weeks. They were measured before and after training for pain, disability, muscle strength, and flexibility. Blood was drawn and the inflammatory marker TNF-α was measured. Finally, they underwent Magnetic Resonance Imaging (MRI) of their brains.
They found that in comparison to baseline and the wait-list control group, the yoga group had significantly lower levels of pain, improved abdominal strength, and improved spinal and hip flexibility. Although trends were present there were too few participants to detect significant changes in TNF-α levels or in the brain scans.
This was a pilot study assessing feasibility and as such enrolled only a small number of patients. Nevertheless, the results showed that yoga practice improves the pain levels, core strength, and flexibility of low-income minority patients with chronic low back pain. These results are similar to those seen with affluent non-minority populations. These encouraging results support conducting a large randomized controlled clinical study.
So, improve chronic low back pain in low income patients with yoga.
“Yoga is one of the more effective tools for helping soothe low back pain. The practice helps to stretch and strengthen muscles that support the back and spine, such as the paraspinal muscles that help you bend your spine, the multifidus muscles that stabilize your vertebrae, and the transverse abdominis in the abdomen, which also helps stabilize your spine.” – Matthew Sloan
CMCS – Center for Mindfulness and Contemplative Studies
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Colgrove, Y. M., Gravino-Dunn, N. S., Dinyer, S. C., Sis, E. A., Heier, A. C., & Sharma, N. K. (2019). Physical and Physiological Effects of Yoga for an Underserved Population with Chronic Low Back Pain. International Journal of Yoga, 12(3), 252–264. doi:10.4103/ijoy.IJOY_78_18
Yoga has been shown useful in reducing chronic low back pain (CLBP) through largely unknown mechanisms. The aim of this pilot study is to investigate the feasibility of providing yoga intervention to a predominantly underserved population and explore the potential mechanisms underlying yoga intervention in improving CLBP pain.
The quasi-experimental within-subject wait-listed crossover design targeted the recruitment of low-income participants who received twice-weekly group yoga for 12 weeks, following 6–12 weeks of no intervention. Outcome measures were taken at baseline, preintervention (6–12 weeks following baseline), and then postintervention. Outcome measures included pain, disability, core strength, flexibility, and plasma tumor necrosis factor (TNF)-α protein levels. Outcomes measures were analyzed by one-way ANOVA and paired one-tailed t-tests.
Eight patients completed the intervention. Significant improvements in pain scores measured over time were supported by the significant improvement in pre- and post-yoga session pain scores. Significant improvements were also seen in the Oswestry Disability Questionnaire scores, spinal and hip flexor flexibility, and strength of core muscles following yoga. Six participants saw a 28.6%–100% reduction of TNF-α plasma protein levels after yoga, while one showed an 82.4% increase. Two participants had no detectable levels to begin with. Brain imaging analysis shows interesting increases in N-acetylaspartate in the dorsolateral prefrontal cortex and thalamus.
Yoga appears effective in reducing pain and disability in a low-income CLBP population and in part works by increasing flexibility and core strength. Changes in TNF-α protein levels should be further investigated for its influence on pain pathways.