How yoga can help your patients with low back pain

About 85% of people experience low back pain at some point in their lives, and 25% to 75% will have low back pain that recurs, said Stacey Pierce-Talsma, DO, during an OMED presentation on prescribing yoga for low back pain on Sunday.

The causes of low back pain are still not well-understood, and interventions such as injections and physical therapy often fail, said Dr. Pierce-Talsma, a registered yoga teacher and an associate professor at the Touro University California College of Osteopathic Medicine (TUCOM) in Vallejo.

One of the pitfalls of low back pain treatment is that health care professionals often focus on a precise anatomic structure such as a disc or a facet joint, missing the bigger picture of functional anatomic relationships and kinematic chains.

“We have to come at low back pain from a more holistic perspective,” Dr. Pierce-Talsma said. “When we retrain, we shouldn’t be focused on retraining just one muscle or retraining a specific range of motion. We should be retraining these muscles to work together synergistically in kinematic chains.”

Enter yoga. Numerous studies have shown that yoga can improve or heal low back pain, Dr. Pierce-Talsma noted, in part because practicing yoga is a more comprehensive way to stretch and strengthen the muscles and fascia of the entire body.

“Yoga engages all of the fascial systems that help to snug and hold everything together, providing stability to the lumbar spine, sacrum and pelvis,” she said.

Patients with low back pain also often have related anxiety and depression—and yoga can help reduce these as well, Dr. Pierce-Talsma noted. The breathing and mindfulness components of yoga assist with this.

“Breathing is a doorway into you controlling your autonomics,” Dr. Pierce-Talsma said. “You can’t do that in any other way. But if you slow your breath down, you can tap right into that parasympathetic relaxation response, which can decrease cortisol and calm the mind. It also alters fascial tensions.”

Some patients have low back pain that has limited their mobility, and physicians may wonder if it’s possible to prescribe yoga to them. Dr. Pierce-Talsma says yoga is for every body—patients who are able to sit in a chair can participate in chair yoga, which involves adapting traditional yoga poses for a seated position in a chair. Over time, as they improve, patients may be able to transition to other forms of yoga. Other patients may benefit from yoga nidra, which is a guided deep meditation that often doesn’t require physical movement.

Here are Dr. Pierce-Talsma’s tips for helping patients find yoga teachers:

• “Hatha,” “beginner” and “anusara” yoga are all good options for patients with low back pain.
• Patients new to yoga should avoid “hot,” “Bikram,” “ashtanga” and “power” yoga.
• It’s a good idea to search for a teacher who can provide private lessons.
• Patients should be sure to look into their prospective teacher’s credentials. RYT means registered yoga teacher, and teachers list the number of hours of training they received, for example: RYT-200 or RYT-500. ERYT means the teacher has extensive teaching experience.