Yoga - Can it Banish Back Pain?

Reproduced by kind permission of the Arthritis Research Campaign

The ancient practice of yoga goes back thousands of years. Now an exciting new Arthritis Research Campaign clinical trial hopes to find out if its powers can be harnessed to improve that most  modern of painful complaints; low back pain.

Now academics, yoga teachers and practitioners have joined forces to run a three-year multi-centre clinical trial, funded by nearly £285,000 from arc, to find out if yoga can reduce low back pain; the scourge of the western world in the 21st century, it is exacerbated by sedentary lifestyles and poor posture.

“Yoga offers a combination of physical exercise with mental focus that may make it a suitable therapy for the treatment of low back pain,” explained Professor Torgerson. “The main limitation with the previous US trial was that only one yoga teacher delivered the class, which makes it unrepresentative of all yoga teachers.”

Up to 280 people aged between 18 and 65 who have had chronic low back pain in the past 18 months will take part in the trial; half of whom will be randomised into 12 weekly 75-minute classes to be run in five sites; north and central London, Penryn in Cornwall, Manchester and York. They, and the control group, who will receive the usual care, will be assessed at three months, six months and 12 months. Both groups will also be given a copy of The Back Book, which provides positive messages about self-management and coping with back pain.

Alison Trewhela

The sequence of poses to be used for the trial has been devised by experienced Iyengar yoga teacher Alison Trewhela, who has run seven-week “Better Back” courses in Cornwall, and will train the yoga teachers.

Yoga develops flexibility and muscular endurance by allowing the muscles to be stretched and strengthened, and the joints to be mobilised and lubricated. This leads to improved posture, a sense of balance and less wear and tear on the joints. It also enables patients to feel less passive and more confident about exercise and movement.

“My students find the yoga really useful for learning how to help themselves to feel better and it gives them confidence in moving their bodies and keeping their joints healthy,” explains Alison. “One of the greatest benefits is that it helps them to feel empowered, to look after their own bodies. Chiropractic and osteopathy might be helpful, but they are both passive treatments. In yoga you’re not being done to, you are taking control of your condition. Yoga is the toolkit to help you help yourself, and although the trial course will concentrate on the lower back, it should also positively affect many other areas of the body, as well as the mind.”

The yoga back pain classes will be carefully structured for people who are complete novices and will not involve any difficult poses. They will be graded over the 12 week period, starting off gently and becoming more demanding as the weeks progress. There will be a combination of stretches, bends, lying, sitting standing and relaxing poses.

“Yoga is the toolkit to help you help yourself”

Students will also be encouraged to practice almost daily, and will be given a CD of relaxation techniques for use at home. Relaxation is am important part of any therapeutic application of yoga.

“”We’ll be encouraging people to do daily exercises at home, except in the day of the class. Regular yoga practice dramatically increases its benefits, and once a week is not ideal,” says Anna Semlyen, a British Wheel of Yoga expert, and also a health economist, who will be helping to write the manuals, train the yoga teachers and run classes herself.

“We give them a suggested practice diary to encourage them to do this, and we’d hope that at the end of the 12 weeks they would carry on with yoga, and find another class suitable for them from among existing therapeutic or beginners’ classes.”

An important aspect of the arc trial is that participants will be followed up at three, six and 12 months.  “Existing trials have been small and short-term, and it would be useful to see whether the effects of yoga are long-lasting,” says David Torgerson. “The potential for yoga to have a longer-term influence is more likely, for example, than in manipulation, as the yoga participants will be encouraged to practise the technique at home, between classes, and to continue with home practice after the classes have been completed. Therefore it is reasonable to suppose that initial yoga training may have very long-term benefits on back pain.”

The team is also hoping to find out if attending yoga classes to alleviate back pain is a cost-effective type of treatment.

Yoga teachers are to be trained over the summer, patient recruitment from GP surgeries will begin in September and the classes will run for 12 weeks from November. The results will be known within three years. “If our trial shows yoga to be effective, then this low cost-treatment will have a considerable impact on the quality of life of patients with back pain,” adds David Torgerson.