Not long ago, the number one treatment for chronic back pain was rest and more rest. Today, people are more active in the recovery process -- and open-minded about the methods used. While a few days of rest are a key step in recovering from pain and injury, modern medicine emphasizes getting back in motion sooner rather than later. This "use it or lose it" approach is right in line with yoga, an ancient form of exercise being used more and more to help relieve many types of pain, whether from back problems, arthritis, or fibromyalgia.
Is yoga effective in treating pain?
Until recently, there were few studies to test yoga's safety and success in treating chronic low back pain. But as patients and some physicians turned to complementary therapies to help manage pain and illness, mind-body medicine techniques once considered dubious are now being tested in the same ways traditional therapies are.
In one encouraging study published in the Annals of Internal Medicine, researchers at Group Health Cooperative and the University of Washington took a pool of 101 patients suffering from back pain and randomly prescribed one of three 12-week treatment plans: a gentle yoga routine (known as viniyoga), a self-care handbook, or an exercise regimen designed by a physical therapist.
The researchers concluded that yoga was the most effective of the three methods over the half-year, with patients in the yoga group reporting the most mobility and the least pain. Also encouraging was this group's lowered reliance on pain medications: Only 21 percent were taking any drugs at the end of the study, compared with more than twice that in the other two groups.
A smaller study published in the journal Pain bears out these conclusions as well. Researchers at West Virginia University found that 60 participants who completed a 16-week yoga program reported significantly lower levels of back pain.
In addition, yoga appears to help with knee pain as well. A review of studies of yoga and osteoarthritis found that even two weeks of yoga sessions involving stretching resulted in improved pain relief and mobility.
What types of yoga are best for treating pain?
When your body is injured or hurting, you definitely want a slow-paced, gentle practice. Viniyoga is an adapted form of yoga that focuses on slow stretches and deep breathing. This type of yoga is often used to ease back pain and arthritis pain.
Iyengar yoga is another slow-paced type of yoga, one that focuses on precise bodily alignment. Different props -- like straps, blocks, blankets, and bolsters -- are used in Iyengar classes, which can be especially helpful if you have limited mobility or need a little extra support.
If you have any questions about whether a particular class will be too vigorous, call the studio and ask which classes are best for you.
How does yoga ease chronic pain?
"Yoga works on stretching and strengthening, and the key to long-term healing is strength," says Liz Owen, who studied with B.K.S. Iyengar, founder of the Iyengar yoga discipline. Owen, who has been teaching yoga for many years and runs classes in Arlington and Cambridge, Massachusetts, noticed that many people taking her classes had various injuries and all manner of back issues. Working with them, she came to develop a gentle yoga protocol for back pain. By building strength, releasing muscle tension, improving flexibility, and bolstering joints and bones, yoga can bring the body into balance, thereby alleviating pain. And the therapeutic benefits of yoga are not just physical, Owen says.
"There are the other levels, the mental and emotional levels," she explains. "When we give ourselves the time to do these slow, deep, but gentle stretches, we bring all the parts of the body into balance. Then the mind can find a positive focus, instead of focusing on the pain." Deep breathing also results in both physical and psychological benefits, she adds. Since the emotional effects of chronic pain are often devastating, the calming, grounding benefits of yoga can be very therapeutic.
Iyengar yoga classes (and other alternative therapies) are being integrated into traditional medical centers as well: The clinical staff at UCLA's Pediatric Pain Program employs an Iyengar instructor, and the program takes an integrated mind-body approach to pain management that features yoga, biofeedback, art therapy, and more. As part of its mission to "treat the whole person -- body, mind, and spirit -- not just the cancer," the Seattle Cancer Treatment and Wellness Center offers yoga classes along with acupuncture and nutritional counseling. And many older, disabled, and underserved residents of Baltimore, Maryland, were eligible for yoga classes thanks to a pilot program from the American Pain Foundation (APF). With a grant from a local charitable fund, the APF trained the medical staff at two Baltimore rehab facilities in the use of yoga to manage pain -- a move that received accolades from some of the elder residents.
"When you're sick or incapacitated, you lose a lot," a veteran living in a geriatric center told the American Pain Foundation. "I think you lose the respect and the quality of life. My disability is the [wheel]chair ... but the mind has to exercise. Yoga and meditation stimulate the brain. Think about it: You are trying to regulate your breathing, and that helps everything -- the brain, the heart. After the stroke and before yoga, my lungs were weak. Breathing deeply helps my lungs. It helps the body and the mind in so many ways."
Are there any risks associated with practicing yoga for pain management?
As with any physical exercise that involves an injured part of your body, caution is key. It's also a good idea to take it slowly at first, especially if you're entirely new to the practice of yoga. Even if you're a yoga veteran, it may be wise to start out at a beginner's level to see how your injury or painful area responds. And if a certain stretch or pose causes you pain, stop immediately.
Although yoga can help with the aches and pains of pregnancy, pregnant women should check with their doctors before beginning a class. Look for a prenatal yoga class (because those will not be excessively rigorous) led by a certified instructor. And talk with the yoga instructor beforehand to make sure he or she will be able to accommodate your needs.
Is yoga inappropriate for treating some types of pain?
Always check with your doctor before beginning yoga classes. If an injury is fresh, or if you're having an especially painful flare-up, you may need to wait until your body has healed enough to benefit from yoga. And when you do begin taking classes, be sure to let the instructor know about your injury or condition, so she can let you know which poses to avoid and can modify others for you if necessary.
How can I find a yoga practitioner?
Yoga classes are offered at yoga studios, gyms, and health clubs, so it shouldn't be hard to find an instructor in your area. Finding one who specializes in pain management, however, may be more of a challenge. Some styles of yoga have strict certification requirements, so for those disciplines, check with the corresponding association to find out if a local instructor is certified. For example, the Iyengar Yoga National Association has a list of certified practitioners available online at: http://www.iynaus.org/.
Kan, L., et al. The Effects of Yoga on Pain, Mobility, and Quality of Life in Patients with Knee Osteoarthritis: A Systematic Review. Evidence-Based Complementary and Alternative Medicine.
Interview with Liz Owen, Iyengar yoga instructor
Sherman, K et al. Comparing Yoga, Exercise, and a Self-Care Book for Chronic Low Back Pain -- A Randomized, Controlled Trial. Annals of Internal Medicine. http://www.annals.org/cgi/content/full/143/12/849
Department of Health and Human Services. An Update of NIH Pain Research and Related Program Initiatives.
Department of Health and Human Services. More Than One-Third of U.S. Adults Use Complementary and Alternative Medicine, According to New Government Survey.
Alternative Therapies in Health and Medicine. Prevalence and patterns of adult yoga use in the United States: results of a national survey.
Effect of Iyengar yoga therapy for chronic low back pain. Pain.
UCLA Pediatric Pain Program. http://www2.healthcare.ucla.edu/pedspain/clinical.htm
American Viniyoga Institute. FAQs. http://www.viniyoga.com/index.php?cn=faq
Iyengar Yoga Resources. What Is Iyengar Yoga? http://iyengar-yoga.com/iyengaryoga/
Seattle Cancer Treatment and Wellness Center. Patient Empowerment Medicine. http://www.seattlecancerwellness.com/patientempowerment.html
American Pain Foundation. Yoga for Chronic Pain: New Professional Curriculum Guide and Poster.
Iyengar Yoga National Association. Iyengar Yoga Certification. http://www.iynaus.org/OurTeachers/Credentials/about.aspx