Relieve Low Back Pain with Yoga
By John M. de Castro, Ph.D.
“reductions in disability and pain intensity were found despite the reductions in opioid use and other medical and self-help pain treatments at six months. The trial confirms the findings of two prior randomized controlled trials with non-veterans showing that yoga is safe and can reduce pain and disability among adults with chronic low back pain.” – National Pain
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. But active military and veterans have a higher rate than the general population. 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. 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 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. So, it makes sense to further explore the effectiveness of yoga practice for chronic low back pain in military veterans.
In today’s Research News article “Yoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399016/), Groessl and colleagues recruited military veterans with chronic low back pain and randomly assigned them to receive either 12 weeks, twice a week, 60-minutes of hatha yoga practice or to a wait-list control condition. Yoga practice consisted of postures, breathing practice, and focused meditation. They were measured for back-specific functional limitations, pain intensity, and medication use before and after treatment and 3 months later.
They found that the veterans who practiced yoga had decreases in functional limitations due to back pain and pain intensity that were significant 3 months after the end of formal yoga practice. Opiate use declined over the trial period, but this was true for both yoga and control groups. Hence, yoga practice was found to be a safe, effective, and lasting treatment for back pain and disability in military veterans who have high rates of chronic low back pain. These results are similar to those seen in other groups of patients suffering from chronic low-back pain. It would be interesting in future research to compare yoga practice to other forms of exercise in relieving back-related disability and pain in a similar group.
So, relieve low back pain with yoga.
“By demonstrating that yoga is an evidence-based treatment for cLBP in military veterans, complementary and integrative health researchers and [Veterans Affairs] administrators are in a position to begin implementing yoga programs more formally,” – Erik Groessl
CMCS – Center for Mindfulness and Contemplative Studies
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Groessl, E. J., Liu, L., Chang, D. G., Wetherell, J. L., Bormann, J. E., Atkinson, J. H., … Schmalzl, L. (2017). Yoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial. American journal of preventive medicine, 53(5), 599–608. doi:10.1016/j.amepre.2017.05.019
Chronic low back pain (cLBP) is prevalent, especially among military veterans. Many cLBP treatment options have limited benefits and are accompanied by side effects. Major efforts to reduce opioid use and embrace nonpharmacological pain treatments have resulted. Research with community cLBP patients indicates that yoga can improve health outcomes and has few side effects. The benefits of yoga among military veterans were examined.
Participants were randomized to either yoga or delayed yoga treatment in 2013–2015. Outcomes were assessed at baseline, 6 weeks, 12 weeks, and 6 months. Intention-to-treat analyses occurred in 2016.
One hundred and fifty military veterans with cLBP were recruited from a major Veterans Affairs Medical Center in California.
Yoga classes (with home practice) were led by a certified instructor twice weekly for 12 weeks, and consisted primarily of physical postures, movement, and breathing techniques.
Main outcome measures:
The primary outcome was Roland–Morris Disability Questionnaire scores after 12 weeks. Pain intensity was identified as an important secondary outcome.
Participant characteristics were mean age 53 years, 26% were female, 35% were unemployed or disabled, and mean back pain duration was 15 years. Improvements in Roland–Morris Disability Questionnaire scores did not differ between the two groups at 12 weeks, but yoga participants had greater reductions in Roland–Morris Disability Questionnaire scores than delayed treatment participants at 6 months −2.48 (95% CI= −4.08, −0.87). Yoga participants improved more on pain intensity at 12 weeks and at 6 months. Opioid medication use declined among all participants, but group differences were not found.
Yoga improved health outcomes among veterans despite evidence they had fewer resources, worse health, and more challenges attending yoga sessions than community samples studied previously. The magnitude of pain intensity decline was small, but occurred in the context of reduced opioid use. The findings support wider implementation of yoga programs for veterans.