Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 49  |  Issue : 2  |  Page : 68-75

Effects of yoga as a therapy for physical and psychological hazards in dentists in Wardha region


Department of Public Health Dentistry, DMIMS (DU), Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India

Date of Web Publication7-Dec-2017

Correspondence Address:
Shravani G Deolia
Department of Public Health Dentistry, DMIMS (DU), Sharad Pawar Dental College and Hospital, Sawangi (M), Wardha, Maharashtra
India
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DOI: 10.4103/ym.ym_17_17

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  Abstract 

Introduction: Yoga is an ancient science of body and mind coordination and is widely practiced as well as researched globally. Various yoga postures are considered therapeutic and can be used to treat physical hazards which have direct relation to dentistry procedures such as musculoskeletal complications and to reduce stress. The ultimate goal of this study is to evaluate the therapeutic potential of yoga in the treatment of psychological and physical hazards among dentists in Wardha region.
Objective: This study aims to understand the effect of yoga as a therapeutic aid for the treatment of psychological and physical hazards among dental interns aged between 21 and 24 years in Sharad Pawar Dental College, DMIMS (DU), Wardha region, Maharashtra (India).
Method: In this study, dental interns aged between 21 and 24 years were examined to understand the effect of yoga as a therapeutic aid for the treatment of psychological and physical hazards of dental practice. They were subjected to a pretest questionnaire, and then, they were trained and made to undergo yoga session for a month under a trained supervision, after which they were given a posttest questionnaire assessing if there is a reduction in the levels of stress and relief from their musculoskeletal ailments.
Results: There was a significant improvement in the quality of life of the participants. Earlier, 64.3% of the interns complained of not being able to provide quality treatment to their patients due to stress and 54.3% could not cope up with their workload previously; after a month of yoga therapy, 62.9% of the interns felt a significant change in the quality of treatment they were providing to the patients and 62.9% of the interns found it easier to cope up with their workload. Previously, 40% of the interns had complained about backaches due to long-standing work hours and 42.9% of the interns had complained of headaches; after the therapy, 44.3% of the interns claimed that their backache had reduced significantly and 42.9% of the interns claimed that the number of times they suffered a headache has reduced.
Conclusion: Considering the results, a fair conclusion can be drawn that practicing yoga on a daily basis can have a significant change in the lifestyle of a dentist by allowing them to maintain their health as well as relieving them from their day-to-day stress.

Keywords: Musculoskeletal pain, physical hazards, stress, yoga


How to cite this article:
Deolia SG, Rizhana A, George J, Ingle H, Bonde R. Effects of yoga as a therapy for physical and psychological hazards in dentists in Wardha region. Yoga Mimamsa 2017;49:68-75

How to cite this URL:
Deolia SG, Rizhana A, George J, Ingle H, Bonde R. Effects of yoga as a therapy for physical and psychological hazards in dentists in Wardha region. Yoga Mimamsa [serial online] 2017 [cited 2019 Jun 17];49:68-75. Available from: http://www.ym-kdham.in/text.asp?2017/49/2/68/220185


  Introduction Top


Every profession has its own set of occupational hazards associated with it. Occupational hazards can be termed as a risk due to the nature of work (Reddy, Bennadi, Satish & Kura, 2015). Dentistry is a demanding occupation because the dentist is required to work in smaller areas, strained working postures, and needs constant focus and a lot of precision which causes discomfort and ailments in the long run. For better access and visibility of the oral cavity, dentists work in certain postures which tend to become detrimental to their health, especially affecting the musculoskeletal tissues. This combined with the long working hours, high concentration, and constantly being in the same posture leads to health issues among dentists (Bhushan, Gautam, Bhushan & Kumar, 2016). Furthermore, circumstances which cannot be controlled, such as pressure for staying on schedule and having to deal with patient discomfort, have an impact on the stress levels. When occupational stress is combined with personal stress, it leads to physical and emotional strain which contributes to injury and debilitated health. In dentistry, occupational stress usually relates to musculoskeletal disorders (MSDs), illness, and career burnout. Occupational health must aim at maintaining and promoting the highest degree of wellbeing in all aspects in workers, preventing deviation from good health which is caused by the conditions at work, and protecting them from risks that result from adverse factors to health. It is important for the practitioners to be healthy for a successful dental treatment and patient wellbeing (Reddy et al., 2015).

Commonly seen occupational hazards in the dental profession are MSDs, anxiety and stress, eye- and ear-related problems, etc. Physical hazards may be defined as a subtype of occupational hazards which will cause harm irrespective of contact. Dentists are subjected to a strained posture at work which involves group of joints and muscles that leads to a disturbance of their musculoskeletal alignment in turn leading to a stooped posture. Vibration and noise emanating from the dental handpieces can also lead to hearing problems. In recent literature which studied the prevalence and risk factors of MSDs in dentists found that the frequency of musculoskeletal pain in dentists ranges from 64% to 93%. As suggested by other researches, about 84% of dental practitioners experience lower back pain (LBP) at some point in their profession; its risk factors include depression, job dissatisfaction, and history of back pain and knee pain (Sumathi, Sangeetha & Tharani Kumar, 2014).

Neck pain is a very common complaint among dentists around the world. Dental professionals often tend to keep their heads rotated and bent to one side while performing dental procedure which causes muscle imbalances. This leads to overstretching of the muscles in the neck, and the contractions of these lengthened muscles cause pain and develop trigger points (Yogitha & Ebnezar, 2012).

Mental stress is an important hazard that the dentists face. Stress is the abnormal reaction that the organism displays against threatening environmental elements (Sumathi et al., 2014). Many studies have proven that dentists face a greater amount of stress in their profession than any other job, thus making stress one of the leading psychological conditions. Bernadino Ramazzini, Father of Occupational Medicine, recognized the role of occupation in the dynamics of health and medicine (Reddy et al., 2015).

Mind–body techniques are the crux of managing stress. They recognize the connection of the mind to the body so that soothing the body soothes the mind and vice-versa (Woodyard, 2011).

Yoga is an ancient science of body and mind coordination and is widely practiced as well as researched globally. As a method of healing, it primarily promotes prevention or retaining one's health by practicing daily (Ramamoorthy et al., 2015). Indians have been practicing yoga dating back to as early as 3000 BC. Various yoga postures are considered therapeutic in nature and can be used to treat physical hazards which have direct relation to dentistry procedures such as musculoskeletal complications and to reduce stress. Therapeutic yoga is characterized as the usage of yoga stances and practice for the betterment of health (Ramamoorthy et al., 2015).

Yoga is a type of complementary and alternative medicine (CAM) which yields a physiological order of events in the body, thereby reducing the response to stress; hence, it is also regarded as a “holistic stress management technique.” In recent years, a number of studies and clinical trials designed to evaluate the therapeutic effect of yoga have substantially increased (Woodyard, 2011).

With the growing dissatisfaction of the conventional therapies, there is a certain need for additional measures and yoga seems promising with its multifaceted approach toward healing (Yogitha & Ebnezar, 2012).

So far, very few studies have been aimed at evaluating the effects of yoga in the treatment of physical and psychological hazards among dentists. This prospective study was designed to evaluate the effect of adoption of yoga as a therapy for the treatment of psychological and physical occupational hazards among dentists in Wardha region.


  Method Top


The study was conducted on 120 dental interns aged from 21 to 24 years, who are working in the central region of India.

Subjects with any kind of systemic disorder which can affect the musculoskeletal system and any neurological disorders and who are previously practicing yoga were not considered for evaluation; therefore, a total of 50 participants were excluded.

Before the research commenced, a synopsis of the research was sent to the ethical committee and an ethical consent was provided by them.

Informed consent was attained from the participants after clarifying the purpose of the study to them.

The reference for the psychological part of the questions was taken from a perceived stress scale which is given by Sheldon Cohen (Cohen, Kamarck & Mermelstein, 1983). A validation on the physical hazards part of the questionnaire was done. First, the questionnaire was given to experts who had an understanding about the topic for the face validation and they were made to read through the questionnaire and evaluate it. After the experts were done evaluating it, the questionnaire was then passed on to a psychometrician for the expert validation who checked the questionnaire for errors such as confusing, leading, and double-barreled questions.

The participants were given a pre- and a post-test questionnaire. The participants were asked to gather in a room where they were first subjected to a pretest questionnaire, for which a time of 15–20 min was given to fill in the forms. The participants were then trained and they underwent yoga session for a month under a trained supervision. The gym instructor of our institution who is also a qualified yoga instructor was requested to train the participants. The yoga sessions were taken place in a common room of the college from 3.30 to 4 in the afternoon. This timing was chosen because the college timing is from 9 in the morning to 4 in the afternoon, and by 3 in the afternoon, the patient flow decreases, and hence, it was easier for the participants to come for the yoga sessions. Prior permission was taken from the college officials to use the common room for the purpose of conducting the sessions. The yoga sessions were conducted for an hour every day in March in the year of 2017. After that, they were given a posttest questionnaire assessing if there was a reduction in the levels of stress and relief from their musculoskeletal ailments. They were again asked to gather in a room for filling up the forms and a time of 15–20 min was given to them.

A self-validated close-ended questionnaire was used which was divided into three parts. The first part included the demographic profile which included name, age, sex, and address of the participant. The second part of the questionnaire included questions related to psychological hazards which included questions such as how stressed does the participant feel while performing procedures on the patient and if he/she thinks that their quality of treatment is up to the mark and if they are confident enough to treat patients, if they are able to handle their professional and personal life, and are they able to control their irritations and anger toward their patients, coworkers, and circumstances. The third part included questions related to physical hazards which had questions asking them if they experienced backache, headache, neck pain, wrist discomfort, eye troubles, and earache due to long-standing procedures or improper postures while working on the patients. The same questions were asked after a month of yoga therapy to assess for any change in their responses as a result of performing yoga as a therapeutic procedure. The questionnaire was prepared based on the 5-point Likert scale, each question has five possible answers (never, almost never, sometimes, fairly often, and very often). A score (0–4) was assigned to each answer denoting as follows: 0 – never, 1 – almost never, 2 – sometimes, 3 – fairly often, and 4 – very often. The lower limit of the scoring was 0 and the upper limit was 28. Based on the results obtained from each questionnaire, it has been decided whether or not yoga is helpful as a therapeutic procedure to limit the effects of psychological and physical hazards experienced by a dental practitioner. Based on the results obtained from each questionnaire, it has been decided whether or not the individuals suffer from stress, and if they do so, then up to which extent.

The following are some of the common yoga poses for relieving stress and musculoskeletal pain which were taught to the participants. These are a few among the plethora of yoga stances that can be performed to get relief from musculoskeletal pain and reducing anxiety (Bhushan et al., 2016; Care2.com, 2017) [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10].
Figure 1: Easy Pose (Sukhasana)

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Figure 2: Cat Pose (Marjaryasana)

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Figure 3: Cow Pose (Bitilasana)

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Figure 4: Extended Puppy Pose (Uttana Shishosana)

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Figure 5: Child's Pose (Balasana)

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Figure 6: Corpse Pose (Savasana)

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Figure 7: Downward Dog Pose (Adho Mukha Svanasana)

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Figure 8: Cobra Pose (Bhujangasana)

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Figure 9: Triangle Pose (Trikonasana)

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Figure 10: Fish Pose (Matsyasana)

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  1. Easy Pose (Sukhasana)
  2. Cat Pose (Marjaryasana)
  3. Cow Pose (Bitilasana)
  4. Extended Puppy Pose (Uttana Shishosana)
  5. Child's Pose (Balasana)
  6. Corpse Pose (Savasana)
  7. Downward Dog Pose (Adho Mukha Svanasana)
  8. Cobra Pose (Bhujangasana)
  9. Triangle Pose (Trikonasana)
  10. Fish Pose (Matsyasana).


The data collected were entered into Statistical Package for the Social Sciences version 11.5 (SPSS Inc., Chicago, IL) software and statistically analyzed for percentage change with Chi-square test.


  Results Top


The study comprised of 70 dental interns of Wardha district, of which 64 were females and 6 males. Age of the interns ranged from 21 to 24 years. The method used to conduct the research was self-administered questionnaires and yoga therapy for 1 month.

Two separate tables were tabulated, combining the values of the pre- and post-test questionnaire pertaining to the psychological and the physical hazards [Table 1].
Table 1: Analysis of pre- and post-test responses and comparison of their results in regard to psychological hazards

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64.3% of the interns claimed that they sometimes felt that they were unable to provide quality treatment to the patient under stress, while 14.3% of the interns felt that fairly often. 35.7% of the interns often felt stressed and nervous as a result of their work environment, while 41.4% of them claimed to feel it at times. 41.4% of the interns fairly often felt that they were not confident about their ability to handle their personal and professional problems while 37.1% sometimes felt so. 20% of the interns fairly often felt that they could not cope with their workload and 54.3% sometimes felt so. 31.4% of the interns claimed that they fairly often found it difficult to control their irritations in their professional life while 44.3% of them sometimes felt so. 37.1% of the interns claimed that they were fairly often angered because of poor cooperation from their coworkers, patients, or circumstances while 34.3% of them sometimes felt so. 51.4% of the interns claimed to have sometimes felt stressed due to piling of workload.

After conducting yoga therapy for a month, the results changed as follows: 62.9% of the interns almost never felt that they were unable to provide quality treatment under stress. 44.3% of the interns almost never felt stressed and nervous as a result of their work environment. 44.3% of the interns almost never felt that they were not confident about their ability to handle their personal and professional problems. 62.9% of the interns almost never felt that they could not cope with their workload. 58.6% of the interns almost never felt that they found it difficult to control their irritations in their professional life. 51.4% of the interns almost never felt angered because of poor cooperation from their coworkers, patients, or circumstances. 72.9% of the interns almost never felt stressed due to piling of workload [Table 2].
Table 2: Analysis of pre- and post-test responses and comparison of their results in regards to physical hazards

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21.4% of the interns have very often experienced backache due to long-standing dental procedures and improper posture, while 40% of them have sometimes felt so and 32.9% of the have felt it fairly often. 11.4% of the interns have very often experienced headaches due to long working hours, while 42.9% of them have experienced it fairly often and 31.4% have experienced it sometimes. 24.3% of the interns have fairly often experienced leg and knee problems due to work and 51.4% of them have experienced it sometimes. 11.4% of the interns have very often experienced neck ache due to long working hours, while 42.9% of them have experienced it sometimes. 30% of the interns have sometimes experienced wrist discomfort due to work. 38.6% of the interns almost never experienced eye problems due to work. 30% of the interns have almost never experienced earache due to work.

After conducting yoga therapy for a month, the results changed as follows: 44.3% of the interns almost never experience backache due to long working hours and improper postures. 32.9% of the interns almost never experienced headache due to long working hours. 48.6% of the interns almost never experienced leg and knee problems due to work. 25.7% of the interns never experienced neck ache due to long working hours while 51.4% of the interns experienced it almost never. 34.3% of the interns never experienced wrist discomfort due to work, while 50% of the interns experienced it almost never. 50% of the interns never experienced eye problems due to work. 61.4% of the interns never experienced earache due to work; the p-value suggested that there is an insignificant change before and after yoga therapy (P = 0.546).


  Discussion Top


Dentistry is a profession which demands lengthy fixed positions with limited movement. Daily long static postures at work are believed to initiate a sequence of events that accounts for aches and injuries in dentists. This puts dentists in a higher risk of musculoskeletal, occupational, and postural problems. It is necessary for the dentist to counter and balance these positions which they are required to be in day-in and day-out. Furthermore, the stress involved due to working over a long list of patients, and restrictions in movement during the procedures, has made the need to introduce yoga a necessity to aid in a healthy and balanced lifestyle (Khokhar, Bhargava & Sharma, 2016).

Comparing the present study to a study done by Sumathi et al. on 394 dentists, 38% often face occupational hazards, 34% of them face it rarely, and 28% never face this problem (Sumathi et al., 2014). In another study by Reddy et al., which comprised of 66 dentists with their age ranging from 25 to 65 years, majority of dentists (92.4%) faced with physical hazards followed by psychological hazards (78.7%). Moreover, it was reported that MSDs showed a prevalence rate of 59.7% in dentists working in Indian private institutions. In addition, among physical hazards, pain in the neck region was a common symptom (Reddy et al., 2015), while in this study, 27.1% of the dentists often experience neck pain. Another study conducted by Shaik et al. showed that 6.6% dental surgeons always experienced shoulder pain, while 83.3% dental surgeons sometimes experienced back pain. and 70% sometimes experienced neck pain (Shaik, Rao, Husain & D'sa, 2011). This proves that dentists have a higher risk prevalence of musculoskeletal pain and stress.

Patient-related stress (42.2%) is common in psychological hazard. Dentists face a lot of stressful situations in their professional as well as personal lives (Reddy et al., 2015). In this study, we have found that very often, often, and sometimes, 82.9% of the dentists were stressed because of their workload and were unable to provide quality treatment to their patients.

This study is limited to dentists ranging between 21 and 24 years of age; the selection of this particular age group can be backed up by another study by Leggat & Smith, which states that dentists who have <5 years of clinical experience have greater prevalence of physical hazards (93.3%) in the form of musculoskeletal pain in the neck region, followed by psychological hazards commonly patient-related stress (86.2%). A study of dentists in Queensland, Australia, found that younger and less experienced dentists were more likely to report musculoskeletal pain of the neck, upper back, and shoulders. It may be due to the fact that more experienced dentists are well versed with their techniques and working postures (Reddy et al., 2015; Leggat & Smith, 2006).

The results of a study conducted by Vijay & Ide demonstrate that neck and back pain constitutes a major problem in the daily lives of undergraduate dental students who were surveyed (Vijay & Ide, 2016).

In this study, regular yoga sessions over a period of 1 month have shown a notable improvement in the quality of life and temperament in the enrolled participants. 91.4% of the interns have reported a substantial reduction of their patient-related stress and 85.4% could cope up with their workload better. More than half of the participants have reported that they experienced a notable reduction in their musculoskeletal ailments. In a study done by Tekur et al. on patients with chronic low back pain, a short-term intensive residential yoga program was compared with an intensive residential physical exercise program; the yoga group showed comparatively better improvement in pain-related disability and spinal flexibility (Yogitha & Ebnezar, 2012; Tekur, Singphow, Nagendra & Raghuram, 2008).

The research conducted by Linton clearly indicates a link between psychological variables with neck and back pain. Results of this study showed that the psychological variables were related to onset of pain (Linton, 2000). As quoted from the study done by Tekur et al., tension that is associated with stress is stored mainly in the neck muscles, diaphragm, and nervous system. If these areas are relaxed, stress gets reduced, minimizing the impact of stress on the individual. It has so been proposed that the incidence of depressive symptoms foretells future MSDs but not vice versa (Yogitha & Ebnezar, 2012; Tekur et al., 2008). Yoga is therapeutic for stress, anxiety, as well as musculoskeletal pain, effecting one, thereby treating the other simultaneously.

Taimni and Nagarathna state that as per the yogic texts, the root cause of multiple diseases can be traced back to lifestyle and amplified likes and dislikes at the mind level which may percolate into the physical frame manifesting as diseases (Nagarathna, 1999; Pollard, 1984). Hence, yoga is apt as an effective therapeutic tool in physical and psychological disorders as it includes the practice of specific postures, regulated breathing, and meditation (Yogitha & Ebnezar, 2012; Taimni, 1961).

William et al. reported that yoga significantly improved functions and reduced pain in participants with chronic LBP and showed significant improvement in pain-related outcomes and depression (Bhushan et al., 2016).

Sherman et al. reported the effectiveness of 12 weeks of yoga sessions over conventional therapeutic exercise classes (Bhushan et al., 2016; Sherman, Cherkin, Erro, Miglioretti & Deyo, 2005).

A research conducted by Koneru & Tanikonda, reports that prevalence of musculoskeletal pain was 10.5%, 21.7%, and 45.6% in dentists with regular yoga practice, other physical activity, and no physical activity, respectively. There was, statistically, a significant difference in the prevalence of musculoskeletal pain among dentists who were practicing yoga when compared with those in no regular activity group (Koneru & Tanikonda, 2015).

The yoga poses which the participants were made to perform were a few among a lot of yoga poses that are performed for the relief from MSD and stress. These poses are selected based on the ease of doing, simplicity and to have a maximum effect. These can be performed regularly by the dentist and are simple and less time-consuming (Bhushan et al., 2016).


  Conclusion Top


Occupational hazards such as musculoskeletal pain and stress are common among dental practitioners, particularly in younger age groups and dentists, as medical professionals do not recognize the health benefits of yoga to treat these occupational hazards. Hence, awareness should be created among dental practitioners about benefits of yoga, through continuing dental education programs to effectively manage these occupational hazards. It is likely that biased answering and lack of physical investigation to confirm the hazards reported may have influenced the results. More research is required on the musculoskeletal problems in dentists, stressing on larger sample size and correlating other factors such as age and sex of the dentists, duration of practice, years of practicing yoga, and working hours per week to generalize the results and conclusions, thereby formulating some guidelines to prevent or minimize work-related MSDs in dentists. Increased student awareness of the risks of chronic musculoskeletal pain (CMSP) is needed to reduce CMSP in the future by enhancing ergonomics education and incorporating CAM, such as yoga stretches, into the classroom and clinic routine. On an average, an individual should allot at least 30 min per day for yoga exercise. That will be sufficient to undo the likely damage which happens to our musculoskeletal tissues after a long day of work. The study proves that yoga can be used as a therapeutic aid; however, since many do not believe in the likely benefits of yoga, its usage is less.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]
 
 
    Tables

  [Table 1], [Table 2]


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[Pubmed] | [DOI]



 

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