Yoga Therapy for Low Back Pain

Lower back pain? Yoga therapy can help.

Yoga is a critical tool in my physical therapy practice when working with patients suffering from chronic back pain. Since I have incorporated yoga poses and breathing and relaxation techniques into my interventions, patients return to their activities more quickly and report pain relief faster. Integrating yoga into physical therapy helps patients to relax tense muscles that are unconsciously being contracted to guard their bodies from pain. I think patients like therapeutic yoga because the movements are simple and specific to what needs to be addressed. They can feel a difference in their bodies when they come out of a pose. I keep foam blocks, straps, and bolsters in the treatment room so I can support each patient exactly how they need to be supported in the poses. I use poses similar to the ones shown in this article below. 

My favorite part of working with people is to teach them how to improvise at home to reproduce what we've done together. I don't want my patients to 'need' me to be with them to feel better. Teaching someone in pain how to control their symptoms in between sessions is very rewarding. Even better is when they are confident enough to continue their practice independently. There is too much fun to be had in life to be in therapy 3 times a week!

I hope you enjoy the article below. It is from Harvard University's Medical School health publication. Feel free to ask me more about pairing the manual therapy practices of physical therapy with yoga therapeutics to treat low back pain. 

Best, 

Crystal 

Yoga has become a familiar part of the health and fitness scene in the United States. Nearly 16 million Americans currently practice yoga. Another nine million say they plan to try it within the year. Although many people turn to yoga to ease stress and improve overall health, a growing number have specific medical aims and are following the recommendations of their doctors.

According to a study in the journal Spine (Sept. 1, 2009), yoga therapy can reduce pain and improve function in people with chronic low back pain. Chronic low back pain—defined as pain that lasts more than three months—is notoriously difficult to treat. Not surprisingly, it drives many sufferers to turn to alternative and complementary therapies in search of relief. The Spine study is the second of two randomized trials to test a specific form of yoga called Iyengar (pronounced eye-en-gar) yoga, which is based on the teachings of B.K.S. Iyengar, one of the world's most well-known living yoga teachers.

Iyengar yoga vs. classic hatha yoga

Most yoga taught and practiced in this country is hatha yoga, which combines: classic poses (asanas), controlled breathing, and deep relaxation or meditation. Iyengar is a type of hatha yoga that uses 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.

What the research revealed

With funding from the National Institutes of Health’s National Center for Complementary and Alternative Medicine, researchers at West Virginia University enrolled 90 adults 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 was 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.

Article from: http://www.health.harvard.edu/healthbeat/lower-back-pain-yoga-therapy-can-help

Ignite Your Life's Intention

I had the pleasure today of joining two friends in facilitating an evocative workshop on igniting our life’s intention. Bringing attention to our intentions is a meaningful, but sometimes difficult task. By presenting a myriad of techniques to make intention reality, the participants were able to sample and assemble practices that felt most natural and supportive of their journey for self discovery. The feedback was awesome. Many people shared that they felt more confident their chosen intention was worthy of a new level of commitment. The workshop was effective because we created an environment for the participants to experience their intention in their body and not just in their head. Many of the techniques we used were experiential; they embodied the feeling of living as if their intention was reality and noticed the subtle shift of their experience. The workshop included gentle yoga flow, meditation, and the creation of a vision board. While I can’t reproduce those activities, I can share some of the foundations for starting your own practice of igniting your life’s intention.

Intentions are simply our desires in action. Like most things, we can’t create fulfilling change if we don’t know what we want. We started out by doing a short meditation and grounding our thoughts. Before beginning the practice of choosing an intention, it’s best to create a calm, open container. You can do this by sitting quietly, closing your eyes, and letting your awareness follow your breath for several moments. Notice the sensation of the breath as it travels in through the nose, expands the chest, and inflates the belly. Pause at the top of the breath gently. As you exhale, fully release and soften letting the air slowly exit. By engaging in mindful breathing we actually change our neurochemistry, slow our heart rate and blood pressure, bringing our bodies into a state of homeostasis. The shift is subtle, but in doing this we create a heightened sensitivity of our experience. We can note thoughts as they arise and also note the feelings these thoughts impart. Through the guided meditation, we had a paper next to us that we used to write down things that arose. I asked questions like, “How does thinking of this intention make you feel?” and “How will your life be different when you are living your intention?” It’s important to be specific, subjective, and to language the intention in the present tense. It does little good to remind ourselves that we don’t want to eat refined sugar next week. A much more clear intention will communicate why. When you think you’ve selected your intention, ask yourself, “for what purpose?” A possible revision might be something like, “I will eat foods that are nourishing and support my body to be energetic and balanced so I can be at my best everyday.” Can you feel the difference?

Feeling is another big component. We get so caught up in our hectic lives that we often forget to feel. We just ‘think’ our way through things ignoring our bodies signals until we can’t any longer. Notice the way your stomach feels when you hold the thought of the intention. Does it soften? Does your jaw relax a little? Does the breath slow? After doing these explorations, we each selected a special rock from a basket that was appealing and wrote the word that represented our intention on it. Holding the rock in our clasped hand, we noticed the texture of the rock, the sensations from holding it, and the feelings that thinking of our word elicited. To deepen the experience, we created a mantra by silently repeating the chosen word with the breath. On the inhale say, “I am.” On the exhale say your word. This is a good example of communicating the intention in the first person. It’s natural to only think of ourselves as living our intention in the future, but the truth is that there is no time more pregnant with possibility than this moment. My intention is to have more ease in my life. My mantra was, “I am - at ease.” As I repeated it slowly, I noticed my body eased and tensions diminished. It immediately felt more comfortable to breathe and I felt deeply aligned with my intention. Explore your own mantra and notice the impact on your body physically and emotionally. Of equal importance is to notice where the body feels tense or resistant. Could an area of tension be a place that represents an obstacle or place you hold the emotion of fear that you can’t obtain your intention? We all have an internal critic, a doubter. When you allow yourself to hear the doubting voices, what changes occur in your body. There’s no question they are there. The object is to create enough sensitivity to perceive them. Return to the mantra, repeat the words while focusing on this area of tension. Invite your tensions to subside and keep a gentle awareness on the breath. By repeating these practices to ignite our life’s intention, we strengthen our ability to disregard our doubts, fears, and to overcome obstacles. Just like doing repetitions to strengthen a muscle, it gets easier and easier.  

  

We also got enthusiastic feedback about the Documentary exercise. We imagined we were watching a professionally made documentary highlighting our life as we achieved our intention. By engaging all of our senses (hearing, sight, touch, taste, smell), we become more open to really live the experience. Notice images that arise or memories that are triggered in the documentary. Who are the cast of characters? Are you smiling? What are you saying? Lastly, at the end of the documentary you say a short message to yourself in the current state. What would those words be? How would you report that you overcame your fears and challenges? Would your experience of joy be worth the practice and effort?

By engaging in these practices we learn how to make unconscious habits more conscious. We learn how to bring to our awareness what would be most fulfilling and what stands in our way. We become the authors of our own stories and make dreams reality. We direct our desires into action and live with purpose. I invite you to adopt any of these practices that appeal to you and encourage you on your journey to live with intention. So find a rock or another symbol and keep it in your daily awareness. Write little notes or cut and paste pictures together (vision board) to hang as a symbol of your intention. Practice returning to the physical/emotional feeling of having obtained your intention.

Please let me know if you enjoy these or would like me to share any other techniques. I'm here to get you moving. Let me know how to be a resource for you!