Got back pain? Try yoga
Published on 05 January 2012
The UK’s largest-ever study into the benefits of yoga for low back pain has proved what yoga practitioners have known anecdotally for years: that specialist yoga works. Jane Tadman reports on the outcome of Arthritis Research UK’s multi-centre yoga trial.
People who practise yoga have known instinctively for a long time that it helps with improving their posture, reduces stiffness and makes them more able to cope with the stress of everyday life.
Many yoga teachers have been aware that the ancient practice can also help manage a range of musculoskeletal conditions, hence the availability, in some places, of ‘therapeutic’ yoga classes for people with low back pain, for example. But there was little scientific proof.
Five years ago Arthritis Research UK began a collaboration with the University of York and a number of experienced yoga teachers. They set up a clinical trial with the aim of establishing a solid evidence base that yoga could help people with low back pain lead more active lives and manage their condition more effectively.
The trial involved two groups of people who were both receiving GP care for chronic or recurrent back pain. A 156-strong group were offered group yoga classes specially designed to improve back function, while a second control group of 157 people were offered GP care alone.
The results of the study, published towards the end of last year in the Annals of Internal Medicine, showed that yoga can indeed provide more effective treatment for chronic low back pain than the usual care provided by GPs. There was a 30 per cent difference at three months between the two groups, favouring those offered yoga, in people’s ability to do a range of everyday tasks.
Specifically, people offered the specially designed 12-week yoga programme experienced greater improvement in back ‘function’ and had more confidence in performing everyday tasks than those offered the usual forms of GP care. Function means people’s ability to undertake activities without being limited by back pain.
Although improvements in back function were more pronounced at three months, there was still an improvement in people’s ability to walk more quickly, get dressed without help or stand up for longer periods of time even nine months after the classes had finished.
Chief investigator Professor David Torgerson, director of York Trials Unit, in the university’s department of health sciences, said: “Our results showed that yoga can provide both short and long-term benefits to those suffering from chronic or recurrent back pain, without any serious side-effects.”
The trial also showed that there was more reduction in pain in the yoga group than the usual care group, although this was of marginal statistical significance. However, many of the people who took part in the trial clearly found that if they felt their back pain recurring, they then had the knowledge to prevent further attacks.
“When I feel a twinge and my back starts to stiffen, I know what to do,” says Neil Tarbitt, a 39-year-old IT manager, who had intermittent back pain for years.
“Yoga has quite a subtle effect. My back has been much better since taking part as it taught me two or three useful stretching exercises which really help loosen up my back. As I do the exercises I can feel my back loosening and stretching, and then when I wake up the next day, I feel a lot better again.”
Kevin Hall, aged 51, who has taken up sea canoeing since his chronic back pain eased, concurs. “In the past I would be out of action for two or three months if my back went, but that doesn’t happen now as I know how to prevent episodes with focused exercises,” he says. “I’m also not as reliant on painkillers as I used to be.
“The course was my first experience of yoga and after the three months I felt more positive as I realised that I could take control of the problem I had experienced before.
“I learnt quite a few exercises that I could use during the working day, whether I’m sitting in a meeting or on a bus. It taught me to look after my body better and to look out for the trigger points. For me, yoga was a helpful stepping stone to recovery.”
The yoga programme, which involved 20 experienced yoga teachers, was designed and delivered by Iyengar yoga teacher Alison Trewhela, in collaboration with Anna Semlyen, a British Wheel of Yoga teacher. The classes were designed for complete beginners, with yoga teachers given extra training in back care. Classes were held in Cornwall, London, York and Manchester. Those attending the specially-designed programme, which involved step-by-step gentle classes, were encouraged to become self-sufficient in the long-term. Classes were supported with four home practice sheets, a manual, and a four-track audio CD teaching how to relax physically and mentally.
Says Alison: “The yoga programme offers poses for pain-relief and mental calming; mobilising, stretching, strengthening and relaxation; improving awareness of posture; education about how a healthy back functions; and positive mental focus. Yoga aims to treat the whole person – not just the physical.
“As most back pain conditions recur, these lifelong self-management skills are likely to be useful as a preventative measure. Having taught courses such as the Yoga for Healthy Lower Backs programme to people for 20 years, I’ve seen how people can motivate themselves to practice with amazing results, when they have the skills and a reason to do so.”
Participants in the yoga programme were surveyed nine months after classes had finished and more than half of those who responded were still regularly practising yoga, mostly at home, twice a week.
Alison, who has been teaching yoga since 1983, believes that regular practice is the way forward. “The best case scenario is to practise two to three times a week, to maintain and improve the health of their backs for their lifetime,” she says. “People who are prepared to make a real commitment to learning the yoga programme are likely to find the yoga more effective.“
Even those trial participants who haven’t maintained regular practice feel they have benefited in the long-term. Fifty-two-year-old Paul Jenkins hasn’t practised yoga since the course ended but says the legacy is a new-found respect for his back and much more awareness of his posture.
“I really loved the yoga course and found the exercises very energising. It was also an opportunity to be calm; relaxing in a structured way was a real joy,” he says.
Alison is now training more yoga teachers in how to deliver the Yoga for Healthy Lower Backs programme, so that many other people with low back pain can benefit.
The Yoga for Healthy Lower Backs book and copies of the trial’s special relaxation CD are both available, and some of the royalties go to Arthritis Research UK.
The trial’s yoga experts have set up www.yogaforbacks.co.uk about their research-proven back care courses and resources with a list of qualified teachers. They are advising people to find a yoga teacher, as learning from a specially trained teachers will maximise the healing gained from the back care sequences.
“I’m so excited about the results of this study,” says Alison. “It’s great news for people with back pain and for the future health of their backs. And GPs and the NHS will be pleased because we can replicate this yoga programme, so it’s not just a vague message that ‘some yoga may help’.”
For more information on the Yoga for Healthy Lower Backs programme and trial go to www.yogatrial.co.uk
“If I feel signs that my back isn’t happy I know what to do, and having that knowledge is important as it stops it becoming a problem.” – Ruth Perrin
Ruth Perrin, now 44, spent about 12 months suffering from back pain. Painkillers had little effect and after much prompting she finally had an MRI scan which revealed that she was suffering from a herniated (slipped) disc.
“However, by then I was ten weeks into the 12 week yoga course, and I was able to tell the neurosurgeon who rang me with the scan results that I was 95 per cent better!” says Ruth, from Gweek, near Helston in Cornwall.
Ruth found it debilitating and depressing during the 12 months she suffered from back pain. “It was frustrating not knowing what was wrong and not being able to do anything about it,” she says. “I had limited movement. I was unable to walk far or stand straight without the pain worsening.”
Within a month of starting the course Ruth started to notice an improvement in her back pain. She was in less pain, able to stand up straighter and became more mobile. She found a couple of the yoga poses uncomfortable at first but they became less so within a short time.
Since then she has had few problems with her back. It has been nearly four years since she completed the course.
“I’m not attending regular yoga classes presently but I do practise at home and often use the course manual to refer to,” she says. “If I feel signs that my back isn’t happy I know what to do, and having that knowledge is important as it stops it becoming a problem.”
» Eighty per cent of the UK population suffers from lower back pain at some point in their lives. Few effective, evidence-based treatments exist.
» More than 300 people between the ages of 18 and 65 with chronic back pain were recruited for the three-year Arthritis Research UK £285,000 trial.
» Postures were specially devised from two of the most popular types of yoga, Iyengar and British Wheel of Yoga.
» The results have delighted Arthritis Research UK’s medical director Professor Alan Silman, as the charity is committed to funding studies of non-conventional therapies. “There are compelling explanations why yoga may be helpful and this trial lends powerful support to the wider use of this approach,” he said.