N.E. Physical Therapy Plus

Ask The Therapist Issue No. 2: Yoga and Back Pain

Is Yoga A Useful Tool In Physical Therapy Treatments?

ASK THE THERAPIST

 By Carol Pietromonaco, PTMBA

Question: 

I am 60 years old and have struggled with back pain for several years. I suffer from low back achiness and stiffness. I do not have leg pain or what my doctor calls “sciatica”. I read a lot and have found that several studies have shown yoga to be helpful with back pain. Do you feel yoga could help me? Do you have to be flexible to try yoga? There are many different kinds of yoga classes, which king of yoga should I try?

Curious, in .

Dear Curious in ,

You are indeed correct! Yoga is a wonderful way to help decrease back pain. In fact, a double blind study published in the December 2005 edition of the Annals of Internal Medicine showed that 3 months of a specifically designed yoga practice provided significant relief for subjects suffering from chronic back pain.

What is Yoga?

Yoga is approximately 4,000 years old and is a methodology aimed at uniting the mind, body, and spirit. Yoga is said to bring about not only physical benefits, but mental benefits as well. This unique characteristic has prompted many back pain patients to incorporate yoga as part of their treatment program.

There are many different types of yoga including Hatha, Kripalu, Svaroopa, Viniyoga and Power Yoga. The types of yoga I would suggest for back pain are Hatha, Kripalu, Svaroopa yoga. Each type of yoga stresses a particular theory or mindset, and each is comprised of numerous postures and areas of focus. While the actual practice of yoga is extremely extensive and detailed, in its essence yoga focuses on three main components:

◦ Body position/posture/strength & flexibility

◦ Breathing

◦ Meditation/state of mind

How does Yoga help your back pain?

We all have stress in our daily lives. This stress often makes muscles tense and can worsen back pain. Learning how to relax and decrease stress can help your back muscles relax. Hatha and Kripalu yoga are done slowly. Stretches and yoga positions are held for several minutes. Holding these postures helps develop strength in your core, legs and arms. It is important to distinguish what type of back pain can be relieved by Yoga. I have found that yoga is most helpful for chronic conditions. It is most helpful when the pain is localized to your back, and not sharp or shooting into your legs. A good Yoga instructor will shows you different adaptations to the postures. There are beginner, moderate and advanced levels to the postures. There are also variations based on age or if you have complicating medical problems. Let your yoga instructor know that you have back problems before starting the class and ask her if she could point out variations to the postures as you go along. Sometimes back pain is the result of mal-alignment in your hips and pelvis. Yoga can help stretch tight muscles and realign your spine. For people with lower back pain, stretching is very important. For example, stretching the hamstring muscles (in the back of the thigh) helps expand the motion in the pelvis, decreasing stress across the lower back

What if I’m not flexible? What if my balance is poor?

A good yoga instructor will tell you to “honor” your body and listen to it. You should only stretch as far as you can. You can also use equipment such as yoga stretching belts and yoga blocks to assist you. If your balance is compromised, use a chair. Most postures can be modified to be performed with a chair. Again, check with your instructor at the beginning of class and let her know that you would like the postures to be modified secondary to your balance problems. Either way, if your flexibility or your balance is an issue, Yoga will help you increase your flexibility and your balance gradually with practice and time. Consistent practice and application will result in improved posture. Proper body alignment and good posture, which helps maintain the natural curvature of the spine, is an important part of reducing or avoiding lower back pain.

In general, yoga is a very safe form of exercise for most people. For those with specific back conditions, it is advisable to speak with a physician prior to starting yoga (or any exercise program). Anyone with severe or ongoing back pain should be evaluated by a physical therapist for an accurate diagnosis and treatment program before beginning yoga. Many physical therapists, such as me, practice yoga and are now incorporating it into their treatment plans for back care. This could be a good opportunity for you to begin your practice with a gradual transition into a yoga class.

Thank you for your question. I hope this helped.

Carol Pietromonaco, Physical Therapist

Please contact Carol at 617.770.2224 to ask any questions you may have about using Yoga in the treatment of your patient’s back pain.

UPDATE: