Sandra Uyterhoeven, MS, E-RYT, Sat Bir S. Khalsa, PhD, Lisa Whittemore Yoga for Mainstream People, LLC Spaulding Rehabilitation Hospital, Medford, MA Brigham & Women’s Hospital Harvard Medical School Evaluation of a Yoga Program for Back Pain

Introduction 4/5 adults experience back pain Prior studies show that yoga improves back pain Need to study protocol by different teachers Little know about effectiveness of yoga for more severe back pain Objective: test hypothesis that participants would improve in back-related functionality, bothersomeness of symptoms, and related characteristics in a wider range of disorders 2

Methods: Participants Adults (18+ years) Enrolled in yoga program for back pain at Boston teaching hospital Able to perform yoga safely Able to follow class instructions 3

Yoga Program 12-week program ( hour classes) T. Krishnamacharya therapeutic yoga tradition Asana, pranayama, core strengthening, bhavana, meditation Weekly intake circle Asked to practice 5x/week Record practice details and turn in journal 4

Baseline and Follow-up Assessments Pain Intensity and Bothersomeness, modified to address all types of back pain Roland Morris Disability Scale (RMDS) Qualitative questions [In what way(s) are you hoping that yoga will help your back problem? & In what way(s), if at all, do you think yoga helped your back problem?] 5

Results N=8 persons; age (mean) 54 years range, 36 to 63 years 8/8 reported back pain Sites of primary complaint at baseline: 6 Upper back, N=3 Lower back, N= 5 Neck, N=2 Shoulder, N=4 Postural misalignment, N=1 Buttock pain, N=3 Muscle spasms, N=2 Spondylolisthesis, N=3 Leg numbness, N=2

Neck & shoulder pain underreported at baseline Weekly focus as part of breathing, centering Modified back pain sequences to also stretch, strengthen neck & shoulders Added more subtle practices on cue from participants (meditation, visualization, affirmation; concepts from Patanjali’s yoga sutra-s) Adapted Posture Sequences to Individual Needs

Modified back pain sequences for 3 persons with spondylolisthesis Flexion replaced extension postures Concurrent sequences performed side-by- side Adapted Posture Sequences to Individual Needs

Adap tations for Spondylolisthesis

11 Core Strengthening Techniques Focused on Diaphragm, Pelvic Floor, Transversus Abdominus, Lumbar Multifidis Included core strengthening in most postures thereafter before after

Results: Mean + SD 12 BaselineFollow-Up Back pain intensity3.1 (+1.9)0.6 (+1.1) Bothersomeness3.5 (+2.4)1.0 (+1.4) Disability5.6 (+3.4)1.3 (+2.1) * Change from baseline to follow-up for each measure was statistically significant

Results 13 People hoped yoga program would bring Flexibility(N=6) Strength(N=5) Reduction in pain(N=4) Reduced stress(N=2) Improvements attributed to Strengthening (core, overall)(N=4) Flexibility/stretching(N=2) Relaxation(N=2) Sense of peace(N=1)

Conclusions 14 Yoga program reduced back pain and associated musculoskeletal symptoms, improved function, strength, and flexibility Participants reported feeling more relaxed, peaceful, balanced Although not captured by questionnaires, changes in participants’ demeanor were striking

Strengths & Limitations 15 Confirms results from randomized controlled trials of yoga for low back pain Results applicable to persons with upper, lower, and middle back pain as well as those with relatively severe musculoskeletal conditions (e.g. spondylolisthesis, leg numbness and tingling) No comparison group, not randomized

16 Future Plans Evaluate efficacy of yoga over wider range of back pain disorders Conduct 12-class series each Spring and Fall Increase number of subjects Facilitate yoga to gain wider acceptance among clinicians as a method of treating back pain