|Year : 2015 | Volume
| Issue : 1 | Page : 6-9
Yoga reduces chronic low back pain: An innovative approach
Jalandhara Bhatta1, Padmini Tekur1, Sham Ganpat Tikhe2, Hongasandra Ramarao Nagendra3
1 Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) University, Bengaluru, Karnataka, India
2 Department of Yoga Education, Morarji Desai National Institute of Yoga, New Delhi, India
3 Chancellor, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) University, Bengaluru, Karnataka, India
|Date of Web Publication||9-Dec-2016|
Sham Ganpat Tikhe
Assistant Professor, Department of Yoga Education, Morarji Desai National Institute of Yoga, New Delhi - 110 001
Background: Although yoga is an effective treatment for chronic low back pain (CLBP), little is known about the mechanisms responsible for its benefits.
Objective: To study the effect of Integrated Approach of Yoga Therapy (IAYT) on disability, depression, and pain in patients with CLBP.
Method: Seven days intensive residential IAYT program in a single group pre-post study was conducted in a holistic health centre at Bengaluru, India. Thirty-five patients (22 females, 13 males) with CLBP were selected conveniently to undergo the IAYT program. The IAYT program was a combination of Asanas (physical postures), Pranayama (breathing practices), and meditation, apart from interactive sessions on the philosophical concepts of yoga. The modified Roland-Morris Disability Questionnaire (RMDQ), Beck Depression Inventory (BDI), and Straight Leg Raising (SLR) Test were administered before and after the IAYT program.
Statistical Analysis: The Statistical Package for the Social Sciences version 16 was used for statistical analysis. The Shapiro–Wilk test showed that the data was normally distributed. Paired samples t-test was used to compare the means.
Results: The data analysis showed significant change (p< 0.001, in all cases) with 54.13% decrease in the RMDQ scores (t = 0.759), 36.46% increase in right (t = 0.887) and 36.04% (t = 0.884) in left SLR scores, and 71.47% decrease in BDI scores (t = 0.797).
Conclusion: The present study suggests that 7-day intensive residential IAYT program reduces disability and depression and improves spinal mobility in patients with CLBP. Thus, yoga may play a vital role in the management of CLBP. Additional randomized control trials are needed before a strong recommendation can be made.
Keywords: Chronic low back pain, depression, disability, Integrated Approach of Yoga Therapy
|How to cite this article:|
Bhatta J, Tekur P, Tikhe SG, Nagendra HR. Yoga reduces chronic low back pain: An innovative approach. Yoga Mimamsa 2015;47:6-9
|How to cite this URL:|
Bhatta J, Tekur P, Tikhe SG, Nagendra HR. Yoga reduces chronic low back pain: An innovative approach. Yoga Mimamsa [serial online] 2015 [cited 2019 Oct 19];47:6-9. Available from: http://www.ym-kdham.in/text.asp?2015/47/1/6/195460
| Introduction|| |
Chronic low back pain (CLBP) is a global health problem (Lee, Moon & Kim, 2014), and is one of the most common reasons to visit one's primary care doctor(Singh, 2014). CLBP has been identified as perhaps the major cause of disability and absenteeism from workplace worldwide and it is much more worse and disturbing for information technology (IT) professionals due to their long sitting job (Stein, Weinberg, Sherman, Lemaster, & Saper, 2014). A variety of treatments such as educational interventions, exercise, various classes of oral medication including nonsteroidal anti-inflammatory drugs and opiates, spinal and trigger point injections, behavioral therapy, physical therapy, and major surgery are commonly used to manage CLBP (Deyo, Mirza, & Martin, 2006; Licciardone, 2008; Guo, Tanaka, Halperin, & Cameron, 1999; Saper, Eisenberg, Davis, Culpepper, & Phillips, 2003). Often there is no complete relief from these problems and patients turn to complementary practices such as yoga for a better solution to minimize their CLBP (Wolsko, Eisenberg, Davis, Kessler, & Phillips, 2003; Barnes, Powell-Griner, McFann, & Nahin, 2004; Barnes, Bloom, & Nahin, 2008). Previous studies reported that yoga is useful to reduce pain in a diverse population (Tekur, Singphow, Nagendra, & Raghuram, 2008; Saper et al., 2009; Saper et al., 2013). However, the effect of yoga for patients with CLBP using modified Roland-Morris Disability Questionnaire (RMDQ) has not been studied adequately, and therefore, the present study was designed to determine this.
| Method|| |
Thirty-five patients (22 females, 13 males) with CLBP and age ranging from 18 to 60 years were selected conveniently to undergo the Integrated Approach of Yoga Therapy (IAYT) program.
(1) Current nonspecific CLBP persisting ≥3 months, (2) Having average low back pain intensity ≥4 for the previous week on a 10-point numerical rating scale where 0 = no pain and 10 = worst possible pain and sufficient English fluency to understand yoga class instructions and complete questionnaires.
(1) Known specific back pain pathologies, (2) Pregnancy, (3) Critically ill.
Single group pre-post study.
Source of participants
Patients who were admitted to the yoga therapy residential health home (Arogyadhama) at Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), University, Bengaluru, India.
An informed consent was obtained from all the participants and the study was approved by the Institutional Review Board of S-VYASA University, Bengaluru.
The intervention consisted of 7-day intensive residential IAYT program developed by S-VYASA University, Bengaluru which comprised Asana (physical postures) designed for back pain, Pranayama (breathing practices), meditation, healthy life-style program, and interactive sessions [Table 1] and [Table 2] on the philosophical concepts of yoga (Barnes et al., 2008). The data were collected before and after 7 days of IAYT.
The modified Roland-Morris Disability Questionnaire (RMDQ), (Saper et al., 2013) Beck Depression Inventory (BDI) (Tekur, Nagarathna, Chametcha, Hankey, & Nagendra, 2012) and Straight Leg Raising (SLR) Test (Hsieh, Walker, & Gillis, 1983; Tekur, Chametcha, Hongasandra, & Raghuram, 2010) were administered before and after the IAYT program. The RMDQ (24 items) is a valid and reliable assessment of physical function in patients with back pain (Saper et al., 2013). Similarly, BDI (21 item), one of the most widely used instruments for measuring the severity of depression, is also a standard and valid test (Tekur et al., 2012).
The SPSS-16 was used for statistical analysis. The Shapiro–Wilk test showed that the data was normally distributed. Paired samples t-test was used to compare the means between pre and post measurements.
| Results|| |
Data analysis showed significant change (p < 0.001, in all cases) with 54.13% decrease in RMDQ scores, 71.47% decrease in BDI scores, and 36.46% increase in right and 36.04% in left SLR scores [Table 3].
| Discussion|| |
The CLBP is a life-style related disease (Tekur et al., 2010) and the conventional biomedical system alone cannot bear the burden of CLBP (Haldavnekar, Tekur, Nagarathna, & Nagendra, 2014). It is worth to note that around 38.4% of CLBP patients turn to Complementary and Alternative Medicine including yoga (Fleming, Rabago, Mundt, & Fleming, 2007). Previous studies on yoga for CLBP have been successful in establishing the beneficial effects by reducing chronic pain, disability, anxiety, and depression and also increasing flexibility and quality-of-life (Barnes et al., 2008; Hsieh et al., 1983; Tekur, Chametcha, Hongasandra, & Raghuram, 2010; Williams et al., 1993; Sherman, Cherkin, Erro, Miglioretti, & Deyo, 2005; Williams et al., 2009). Similarly, it was reported that yoga is effective for moderate to severe CLBP in diverse predominantly lower socioeconomic status populations. In addition, it was revealed that a race, income, and body mass index do not affect the potential for a person with CLBP to experience benefit from yoga (Stein et al., 2014). In a study to assess pain-related connection between yoga and neuromodulators, it was proposed that brain-derived neurotrophic factor may be one of the key factors mediating beneficial effects of yoga in patients with CLBP (Lee et al., 2014).
Yoga has the potential to favorably impact health in a predominantly low-income minority population with CLBP (Keosaian et al., 2016). It was reported that IAYT is feasible, had no adverse effects, and was useful in alleviating pain, disability, and perceived stress in patients with CLBP (Patil et al., 2015). In one study, it was found that the poor physical health at baseline is associated with greater improvement from yoga in CLBP. The results from the present study are consistent with previous research findings and support the idea that yoga is associated with overall improvement of the participants undergoing IAYT.
| Conclusion|| |
The present study suggests that seven days intensive residential IAYT program reduces disability, depression and improves spinal mobility in patients with CLBP. Thus, yoga may play a vital role in the management of CLBP. However, randomized controlled trials with larger sample are needed to strengthen the findings of present study. 
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Barnes, P. M., Bloom, B., & Nahin, R. L. (2008). Complementary and alternative medicine use among adults and children: United States, 2007.
Barnes, P. M., Powell-Griner, E., McFann, K., & Nahin, R.L. (2004). Complementary and alternative medicine use among adults: United States, 2002. Seminars in Integrative Medicine 2
Deyo, R. A., Mirza, S. K., & Martin, B. I. (2006). Back pain prevalence and visit rates: Estimates from US national surveys, 2002. Spine (Phila Pa 1976), 31
Fleming, S., Rabago, D. P., Mundt, M. P., & Fleming, M. F. (2007). CAM therapies among primary care patients using opioid therapy for chronic pain. BMC Complementary and Alternative Medicine
Guo, H. R., Tanaka, S., Halperin, W. E., & Cameron, L. L. (1999). Back pain prevalence in US industry and estimates of lost workdays. American Journal of Public Health
Haldavnekar, R. V., Tekur, P., Nagarathna, R., & Nagendra, H. R. (2014). Effect of yogic colon cleansing (Laghu Sankhaprakshalana Kriya) on pain, spinal flexibility, disability and state anxiety in chronic low back pain. International Journal of Yoga
Hsieh, C. Y., Walker, J. M., & Gillis, K. (1983). Straight-leg-raising test comparison of three instruments. Physical Therapy
Keosaian, J. E., Lemaster, C. M., Dresner, D., Godersky, M. E., Paris, R., & Sherman, K. J.,... Saper, R. B. (2016). “We're all in this together”: A qualitative study of predominantly low income minority participants in a yoga trial for chronic low back pain. Complementary Therapies in Medicine
Lee, M., Moon, W., & Kim, J. (2014). Effect of yoga on pain, brain-derived neurotrophic factor, and serotonin in premenopausal women with chronic low back pain. Evidence-Based Complementary and Alternative Medicine
Licciardone, J. C. (2008). The epidemiology and medical management of low back pain during ambulatory medical care visits in the United States. Osteopathic Medicine and Primary Care
Patil, N. J., Nagarathna, R., Tekur, P., Patil, D. N., Nagendra, H.R., & Subramanya, P. (2015). Designing, validation, and feasibility of integrated yoga therapy module for chronic low back pain. International Journal of Yoga
Saper, R. B., Boah, A. R., Keosaian, J., Cerrada, C., Weinberg, J., & Sherman, K. J. (2013). Comparing once-vs. Twice-weekly yoga classes for chronic low back pain in predominantly low income minorities: A randomized dosing trial. Evidence Based Complementary and Alternative Medicine
, 2013, 1-13
Saper, R. B., Eisenberg, D. M., Davis, R. B., Culpepper, L., & Phillips, R. S. (2003). Prevalence and patterns of adult yoga use in the United States: Results of a national survey. Alternative Therapies in Health and Medicine
Saper, R. B., Sherman, K. J., Cullum-Dugan, D., Davis, R. B., Phillips, R. S., & Culpepper, L. (2009). Yoga for chronic low back pain in a predominantly minority population: A pilot randomized controlled trial. Alternative Therapies in Health and Medicine
Sherman, K. J., Cherkin, D. C., Erro, J., Miglioretti, D. L., & Deyo, R. A. (2005). Comparing yoga, exercise, and a self-care book for chronic low back pain: A randomized, controlled trial. Annals of Internal Medicine
Singh, S. (2014). Low back pain and yoga. Journal of Pain and Palliative Care Pharmacotherapy
Stein, K. M., Weinberg, J., Sherman, K. J., Lemaster, C. M., & Saper, R. (2014). Participant characteristics associated with symptomatic improvement from yoga for chronic low back pain. Journal of Yoga & Physical Therapy, 4
Tekur, P., Chametcha, S., Hongasandra, R. N., & Raghuram, N. (2010). Effect of yoga on quality of life of CLBP patients: A randomized control study. International Journal of Yoga
Tekur, P., Nagarathna, R., Chametcha, S., Hankey, A., & Nagendra, H. R. (2012). A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain patients more than exercise: An RCT. Complementary Therapies in Medicine
Tekur, P., Singphow, C., Nagendra, H. R., & Raghuram, N. (2008). Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: A randomized control study. The Journal of Alternative and Complementary Medicine
Williams, A. D., Nicholas, M. K., Richardson, P. H., Pither, C. E., Justins, D. M., & Chamberlain, J. H., … Dieudonné, I. (1993). Evaluation of a cognitive behavioural programme for rehabilitating patients with chronic pain. British Journal of General Practice
Williams, K., Abildso, C., Steinberg, L., Doyle, E., Epstein, B., & Smith, D, … Cooper, L. (2009). Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain. Spine (Phila Pa 1976) 34
Wolsko, P. M., Eisenberg, D. M., Davis, R. B., Kessler, R., & Phillips, R. S. (2003). Patterns and perceptions of care for treatment of back and neck pain: Results of a national survey. Spine (Phila Pa 1976)
[Table 1], [Table 2], [Table 3]