Yoga and Low Back Pain: The World Spine Care Yoga Project
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1 Yoga and Low Back Pain: The World Spine Care Yoga Project April 21, 2016 Erin Moon Barrie Risman
2 Yoga Mindfulness Postures Breathing
3 Methodology of Yoga Mindfulness - Bringing attention and awareness to what is happening right now in the body and mind - Practicing passive observation - Managing relationship to emotions and sensations Breath - Centering attention on the breath - Decreasing BPM through continued deeper, longer breaths - Building more effective patterns for breathing Postures - Increasing awareness of the body and negative movement patterns - Increasing ROM, building strength and improving balance - Re-patterning negative habitual movements/ alignment
4 Why Yoga for Chronic Low Back Pain? Therapies addressing mental, physical and emotional dimensions may be more helpful than treatments addressing only one dimension.
5 Summary of Literature to date RCTs for nonspecific clbp - 6 Large RCTs (N= ) - 6 smaller RCTs (N= 12-80) 5 Reviews (1 with meta analyses) At least 3 large studies in progress (2 with veterans) Recommendations for clbp in 2 guidelines
6 Meta-analyses: Primary Outcomes In the short term, strong evidence that yoga: - Reduced pain - Improved back-related functional disability At longer-term follow-ups, moderate evidence that yoga: - Reduced pain - Improved back-related functional disability
7 Meta-analyses: Secondary Outcomes Several RCTs of patients with chronic LBP found that the yoga group showed improvements in: - Mood (Williams et al., 2009; Tekur et al., 2012) - Self-efficacy (Tilbrook et al., 2011, Sherman et al., 2013) Tekur et al (2008, 2010) reported increased active and passive range of motion when assessing lumbar spine flexibility and straight leg raise test, respectively Physical activity has known benefits for clbp (Hayden et al., 2005). Reduces maladaptive movements/postures and assist soft tissue remodelling (Langevin et al., 2006)
8 Relief of physical & mental stress Evidence of effectiveness for: Stress and Anxiety (Vollestad et al. 2012) Depression (Balasubramaniam et al., 2012) Insomnia (Afonso et al., 2012; Khalsa, 2004)
9 Reduction in Pain Hypothesis: Regular & Long term yoga practice improves pain tolerance by teaching different ways to deal with sensory inputs and potential emotional reactions attached to those inputs. (Villamure et al. 2013) Structural underpinnings: Thicken areas of the brain associated with pain tolerance (Villamure et al. 2013) Increase levels of GABA, the main inhibitory neurotransmitter of the brain (Streeter et al., 2007, 2010, 2012)
10 Hypothetical Model Mindfulness Yoga Postures Breath Increased physical activity Increased ROM Improved mood Positive mental strategies Decreased stress/ anxiety Improved self care/ sense of control Decreased back pain
11 The World Spine Care Yoga Project
12 What is the WSC Yoga Project? WSC has created a yoga teacher training program to be implemented in association with our clinics. It will be implemented at WSC clinic locations to offer yoga to patients and the communities. Local teachers will be trained to teach yoga to their communities in their own language and cultural context.
13 Why is it unique? Capacity building Building from the ground up addressing unique requirements Direct measurable outcomes Research oriented outcomes of the program will be measured and published In collaboration with a major health care organization We are creating a model that can be implemented by any organization that wishes to build yoga capacity in any community. In the future creating and disseminating this model to expand its reach underserved people worldwide suffering from spinal disorders and musculoskeletal pain, who can benefit from yoga. It s launch is in Botswana next week
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