In the journals
Yoga therapy helps relieve chronic lower back pain
Once regarded as an esoteric Eastern discipline, yoga is now a
familiar part of the health and fitness scene in the United
States. A national survey released in 2008 found that nearly 16
million Americans — more than 11 million of them women —
currently practice yoga. Another nine million Americans say they
plan to try yoga within the year. Although many people adopt the
practice to ease stress and improve overall health, a growing
number have specific medical aims and are following the
recommendations of their clinicians.
According to a study in the journal Spine (Sept. 1,
2009), yoga therapy can reduce pain and functional impairment in
people with chronic (lasting more than three months) low back
pain. This condition is notoriously difficult to treat, and not
surprisingly, one of the most commonly reported reasons for
turning to alternative and complementary therapies. Yoga has
shown promise in treating the condition, but not all studies have
looked at the same form of yoga. The Spine study is the
second of two randomized trials to test a form called Iyengar
(pronounced eye-en-gar) yoga, which is based on the teachings of
the eponymous nonagenarian B.K.S. Iyengar.
What is Iyengar yoga?
Most yoga taught and practiced in this country is hatha yoga,
which combines three elements: classic poses (asanas), controlled
breathing, and deep relaxation or meditation. Iyengar is a type
of hatha yoga involving the use of props such as blankets,
blocks, benches, and belts to help people perform the poses to
the fullest extent possible even if they lack experience or have
physical limitations. The emphasis is on precise physical
alignment, with trained teachers adjusting everything from the
position of the shoulders to the angle of the toes.
Iyengar adjustments to classic yoga poses
Iyengar yoga uses blocks, belts, and other props to help
students perform classic yoga poses such as those shown
in the grey insets above: parivrtta trikonasana, or the
revolved triangle pose (A), and ardha
uttanasana, or the standing half forward bend
(B). Instructions are individualized,
with adjustments made for age, experience, body type,
physical condition, and medical problems.
With funding from the National Institutes of Health's National
Center for Complementary and Alternative Medicine, researchers at
West Virginia University enrolled 90 adults (75% of them women)
to participate in a yearlong trial comparing the effects of
Iyengar yoga therapy with those of standard medical care.
Participants ranged in age from 23 to 66, and all were suffering
chronic low back pain. About half of them were assigned to 24
weeks of a twice-weekly, 90-minute regimen approved by B.K.S.
Iyengar and taught by a certified Iyengar yoga instructor and two
assistants with experience in teaching yoga therapy to people
with chronic low back pain. On days when they didn't have a yoga
class, they were instructed to practice at home for 30 minutes
using a DVD, props, and an instruction manual. The rest of the
participants (the control group) continued with usual medical
care and were followed with monthly telephone calls to gather
information about their medications or other therapies.
All subjects reported on functional disability, pain intensity,
depression, and medication use at the start of the study, midway
through (12 weeks), immediately afterward (24 weeks), and at a
follow-up six months later. Compared with the control group, the
Iyengar group experienced a 29% reduction in functional
disability, a 42% reduction in pain, and a 46% reduction in
depressive symptoms at 24 weeks. There was also a greater trend
toward lower medication use in the yoga group. There were no
reports of adverse effects.
Six months after the trial ended, 68% of the yoga group were
still practicing yoga — on average, three days a week for at
least 30 minutes. Their levels of functional disability, pain,
and depression had increased slightly but were still lower than
those of the control group.
The study had limitations — a small number of participants, as
well as reliance on the participants' own reports of symptoms and
disability. Also, the control group, on average, had been
suffering back pain longer than the yoga group. Still, the
results are consistent with findings from other studies of yoga
for low back pain.