1. Yoga in therapy for chronic non-specific low back pain (CLBP) – a short term intensive yoga program for in-patients (project)
Aleš Kubát MD
Department of Neurology, Military Hospital Olomouc
Department of Physiotherapy, Palacky University Olomouc
Czech Republic

2. Background – CLBP guidelines
Chronic non-specific low back pain (CLBP):
- pain below costal margin and above gluteal folds
- without specific spinal pathology
- persisting more than 12 weeks.
Conservative non-pharmacologic treatments:
cognitive behavioral therapy (CBT)
supervised exercise therapy
brief educational interventions
multidisciplinary (bio-psycho-social) treatment (1).
- Yoga - one of other possible non-pharmacologic therapies (2).
1. Airaksinen et al. European guidelines for the management of chronic nonspecific low back pain
2. Chou et al. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. 2007

3. Background – yoga and CLBP
Systematic review in yoga and CLBP:
- yoga is an effective treatment method in the management of patients with chronic low back pain compared with other care modalities
- only four papers met the inclusion criteria for critical appraisal and more randomized controlled trials are warranted (4).
Recent recommendations:
- how to conduct further yoga studies (5)
- inclusion criteria for reviewing this trials for example in the Cochrane database (6).
4. Hill Ch, Is yoga an effective treatment in the management of patients with chronic low back pain compared with other care modalities – a systematic review, Journal of Complementary and Integrative Medicine. 2013; 10(1): 1-9.
5. Ward L at all. Establishing key components of yoga interventions for musculoskeletal conditions: a Delphi survey. BMC Complementary and Alternative Medicine. 2014; 14: 196
6. Wieland LS at all.. Yoga treatment for chronic non specific low-back pain. Cochrane Database of Systematic Reviews Issue 7. Art. No.: CD010671

4. Aim/ Hypothesis
All of the reviewed trials were conducted as out-patients programs in duration about 12 weeks, mostly one yoga lesson per week.
Our aim:
- to complete a short term intensive yoga program for in-patients with CLBP (one lesson per day, 8 lessons in total) and verify its effectiveness.
Hypothesis:
- we could consider yoga as a special form of multidisciplinary therapy which can affect biological, psychological and social levels of health.
- yoga should have better results than usual care in each monitored parameter.

5. (Proposed) Methods
Randomized controlled trial in a pragmatic form – a therapy in common conditions for in-patients during an 11-day intensive treatment program at the Department of Neurology.
The admitted patients will be randomly divided into two groups:
1. the control group: usual care – infusion analgesic therapy, usual rehabilitation care, daily activity recommendation to avoid back pain.
2. the yoga group: infusion analgesic therapy, a short intensive yoga program
(moral principles of yoga, relaxation and concentration, preparatory and breathing exercises, asanas, recommendation for home practice with an exercise schedule).
Assessment: rise leg test, forward bend test, visual analog scale (VAS) for pain, the Oswestry Disability Index (ODI), Short Form Healthy Survey (SF-12) before and in the end of the therapy program, after 12 and 24 weeks

6. (Anticipated) Results
Better results in each monitored parameter in the yoga group immediately after the short yoga program
(? will it be enough time for effect of yoga ?).
We are expected patients to practice yoga at home and thus the better results after both 12 and 24 weeks.

7. Discussion 8 components of Yoga (Patanjali – Yoga Sutra):
- moral restraints (yama), moral observations (niyama)
- postures (asana), controlled breathing (pranayama)
- sensory withdrawal (pratyahara), concentration (dharana)
meditation (dhyana), self-actualization (samadhi)
Sherman (3) – model of three major pathways for possible yoga effect:
- cognitive appraisal about back pain
- physical functioning of the back
- general effect on stress
3. Sherman et al. Compariosn of yoga versus stretching for CLBP. 2010

8. Conclusions
Our trial will have a slightly different design compared with previous studies (short term, in-patient, pragmatic trial in common conditions of CLBP therapy) and should meet the criteria as mentioned above.
Yoga offers a complex approach to health and comprises the elements from CBT, supervised exercise and multidisciplinary therapy.
So it could be one of the alternative methods for therapy such a chronic condition as a non-specific CLBP.
Further trials are necessary for verification both effectiveness and safety of the yoga practice in different conditions.

9. Thank you for your attention