Yoga for Back Pain Yoga Alliance Webinar July 20, 2020 Sat Bir S. - PowerPoint PPT Presentation

Brigham & Women’s Hospital Harvard Medical School Scientific Research on Yoga for Back Pain Yoga Alliance Webinar July 20, 2020 Sat Bir S. Khalsa, Ph.D. Assistant Professor of Medicine, Harvard Medical School Director of Yoga Research, Yoga Alliance Director of Research, Kundalini Research Institute Editor in Chief, International Journal of Yoga Therapy Research Associate, Benson Henry Institute for Mind Body Medicine Research Affiliate, Osher Center for Integrative Medicine

https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm685152a5-H.pdf

https://www.who.int/bulletin/volumes/97/6/18-226050.pdf?ua=1

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

Risk Factors Age Job-related factors Fitness level Mental health Weight gain Smoking Genetics Psychological factors Causes Congenital Nerve and spinal cord problems Non-spine sources Skeletal irregularities Nerve compression, inflammation, injury Kidney stones Spina bifida Sciatica Endometriosis Injuries Spinal stenosis Fibromyalgia Sprains Spondylolisthesis Tumors Traumatic Injury Herniated or ruptured discs Pregnancy Degenerative problems Infections Intervertebral disc degeneration Cauda equina syndrome Spondylosis Osteoporosis Arthritis or inflammatory disease https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

Spinal injections Treatments Trigger point injections Epidural steroid injections Medications Radiofrequency ablation Analgesics and NSAIDs Traction Opiods Surgery Anticonvulsants Vertebroplasty and kyphoplasty Self-management Spinal laminectomy Hot or cold packs Discectomy and microdiscectomy Resuming normal activities Foraminotomy Exercises Nucleoplasty Complementary therapies Radiofrequency denervation Acupuncture Spinal fusion Behavioral approaches Artificial disc replacement Biofeedback Interspinous spacers Relaxation techniques Implanted nerve stimulators Cognitive therapy Spinal cord stimulation TENS Dorsal root ganglion stimulation Physical therapy Peripheral nerve stimulation Chiropractic Rehabilitation programs Massage https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

“[progressive aerobic training] and [progressive resistance training] decreased pain intensity in individuals with CNSLBP although neither mode was superior.” “A more prudent approach however, would be to prescribe a combination of aerobic and resistance exercise training for CNSLBP, which might prove more beneficial through a broader range of physical and psychological adaptations than possible with either modality in isolation.”

Exercise and Relaxation for cLBP From: The impact of modified exercise and relaxation therapy on chronic lower back pain in office workers: a randomized clinical trial. Shariat A, Alizadeh R, Moradi V, Afsharnia E, Hakakzadeh A, Ansari NN, Ingle L, Shaw BS, Shaw I. Journal of Exercise and Rehabilitation, 28;15:703-708, 2019. https://www.ncbi.nlm.nih.gov/pmc/arti cles/PMC6834712/pdf/jer-15-5- 703.pdf

Low Back Pain and Fascia From: Reduced thoracolumbar fascia shear strain in human chronic low back pain. Langevin HM, Fox JR, Koptiuch C, Badger GJ, Greenan-Naumann AC, Bouffard NA, Konofagou EE, Lee WN, Triano JJ, Henry SM, BMC Musculoskeletal Disorders, 19;12:203, 2011. https://bmcmusculoskeletdisord.biomedcentral.com/track/pdf/10.1186/1471-2474-12-203

Stretching, Inflammation and Fascia “In vivo tissue stretch mitigated the inflammation-induced changes leading to restored stride length and intrastep distance, decreased mechanical sensitivity of the back and reduced macrophage expression in the nonspecialized connective tissues of the low back.” “This tissue stretch research is relevant to body- based treatments such as yoga…” From: Stretching of the back improves gait, mechanical sensitivity and connective tissue inflammation in a rodent model, Corey SM, Vizzard MA, Bouffard NA, Badger GJ, Langevin HM, PLoS One, 7(1):e29831, 2012. https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0029831&type=printable

Stretching and cLBP From: Effect of a muscle stretching program using the global postural reeducation method for patients with chronic low back pain: A randomized controlled trial. Lawand P, Lombardi Júnior I, Jones A, Sardim C, Ribeiro LH, Natour J. Joint Bone Spine 82:272-7, 2015.

From: Indian Journal of Palliative Care, 16:1-7, 2010. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936076/?report=printable

Yoga and Pain Tolerance From: Insular cortex mediates increased pain tolerance in yoga practitioners, Villemure C, Ceko M, Cotton VA, Bushnell MC, Cerebral Cortex, 24:2732-40, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153807/pdf/bht124.pdf

Yoga and Pain Tolerance From: Insular cortex mediates increased pain tolerance in yoga practitioners, Villemure C, Ceko M, Cotton VA, Bushnell MC, Cerebral Cortex, 24:2732-40, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153807/pdf/bht124.pdf

MBSR for Back Pain …treatment with MBSR or CBT, compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. From: Effect of Mindfulness-Based Stress Reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: A randomized clinical trial, Cherkin DC, Sherman KJ, Balderson BH, Cook AJ, Anderson ML, Hawkes RJ, Hansen KE, Turner JA, Journal of the American Medical Association, 315:1240-9, 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4914381/pdf/nihms781082.pdf

MBSR for cLBP From: Mindfulness-Based Stress Reduction for Treating Low Back Pain: A Systematic Review and Meta-analysis. Anheyer D, Haller H, Barth J, Lauche R, Dobos G, Cramer H. Annals of Internal Medicine 6;166:799-807, 2017.

Yoga Practices Postures, Breathing, Relaxation, Meditation Self-Regulation Awareness Spirituality Fitness ↑Flexibility ↑Attention ↑Unitive State ↑Stress Regulation ↑Strength ↑Emotion Regulation ↑Mindfulness ↑Transcendence ↑Coordination/Balance ↑Resilience ↑Concentration ↑Flow ↑Respiratory Function ↑Equanimity ↑Cognition ↑Transformation ↑Self -Efficacy ↑Self -Efficacy ↑Meta -cognition ↑Life Meaning/Purpose Global Human Functionality ↑Physical & Mental Health, ↑Physical Performance ↑Stress & Emotion Regulation, ↑Awareness/Mindfulness, ↑Meta -cognition ↑ Positive Behavior, ↑Wellbeing, ↑Values, ↑Life Purpose & Meaning, ↑Spirituality

A Model of Yoga for cLBP From: Comparison of yoga versus stretching for chronic low back pain: protocol for the Yoga Exercise Self-care (YES) trial, Sherman KJ, Cherkin DC, Cook AJ, Hawkes RJ, Deyo RA, Wellman R, Khalsa PS, Trials 11:36, 2010. https://trialsjournal.biomedcentral.com/track/pdf/10.1186/1745-6215-11-36

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5294833/pdf/CD010671.pdf

Yoga for cLBP From: Comparing yoga, exercise, and a self-care book for chronic low back pain, A randomized, controlled trial, Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA, Annals of Internal Medicine, 143:849-56, 2005.

Yoga for cLBP Oswestry Disability Index (ODI) Visual Analogue Scale (VAS) Functional Disability Pain Intensity From: Evaluation of the Effectiveness and Efficacy of Iyengar Yoga Therapy on Chronic Low Back Pain, Williams K, Abildso C, Steinberg L, Doyle E, Epstein B, Smith D, Hobbs G, Gross R, Kelley G, Cooper L, Spine 34:2066 – 2076, 2009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393557/pdf/nihms139323.pdf

Yoga for cLBP Back Pain Characteristics 8 RMDQ Bothersomeness Average Score 6 Pain Intensity 4 2 0 Baseline End Program From: Evaluation of a Yoga Program for Back Pain, Schultz LH, Uyterhoeven S, Khalsa SBS, Journal of Yoga and Physical Therapy, 1:2, 2011. https://www.longdom.org/open-access/evaluation-of-a-yoga-program-for-back-pain-2157-7595.1000e103.pdf

Yoga for cLBP From: A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Sherman KJ, Cherkin DC, Wellman RD, Cook AJ, Hawkes RJ, Delaney K, Deyo RA. Archives of Internal Medicine, 12;171:2019-26, 2011. https://www.ncbi.nlm.nih.gov /pmc/articles/PMC3279296/ pdf/nihms354570.pdf

Mediators of Yoga for cLBP “Both yoga and stretching were superior to self -care, and our mediator analyses suggest that increased participation in back exercise and self- efficacy was responsible for most of these benefits. However, these are both complex interventions and qualitative data suggesting that relaxation and increased awareness may have contributed to the benefits of yoga…” http://downloads.hindawi.com/journals/ecam/2013/130818.pdf

Yoga for cLBP From: Comparing Once- versus Twice-Weekly Yoga Classes for Chronic Low Back Pain in Predominantly Low Income Minorities: A Randomized Dosing Trial, Saper RB, Boah AR, Keosaian J, Cerrada C, Weinberg J, Sherman KJ, Evidence Based Complementary and Alternative Medicine, 2013:658030. http://downloads.hindawi.com/journals/ecam/2013/658030.pdf