Bridging the Gap: Physical Therapy and Yoga Therapy for Low Back Pain

Meryle Richman, PT, DPT, MS, CST, 500 Hour- RYT, Advanced Teacher of Therapeutic Yoga

An estimated eight out of every ten people will suffer from back pain at least once in their lives. In addition to receiving physical therapy for chronic low back pain, recent studies find yoga therapy to be promising as a complementary treatment for chronic low back pain. According to a systemic review of the literature for chronic low back pain no single therapy stands out as being the most effective.1,4

Integrating the two professions are helpful in preventing back injuries and in treating chronic back conditions without medication and/or prevent surgery. Medication can relieve symptoms, but frequently does not address the causes of chronic pain, which can result in costly side effects. It is important for individuals that are subject to chronic pain to educate themselves and be an advocate for their well-being. Always discuss with your health professional about what types of movement may be contraindicated for you based on your diagnosis, injury, or pain condition. Make sure that modifications are made for your exercises and yoga poses so you do not injure yourself.

Here are some key points to help in your recovery and prevention:

Physical therapists are skilled at helping you develop specific methods to improve your back’s ability to withstand physical stress and to enhance fitness. They are knowledgeable in treating individuals with modalities and instructing in stretching, postural, core and gradual strengthening exercises, as well as body mechanics to help your back condition.

Yoga therapists can provide the tools of integrating mindfulness (body awareness) into your daily routine by teaching breathing techniques, postural alignment, yoga postures (asanas) and guide you in body awareness and guide you in changing “habitual habits” that might be contributing to your chronic back pain.

• Muscular Flexibility:

This is necessary to allow for easy movement for activities of daily living such as bending, reaching, and lifting. Muscles quickly become adaptively shortened when allowed to be inactive for long periods of time. A shortened muscle is less elastic and flexible and more vulnerable to stress and injury. Relieving the tightness of fascial tissue can be taught by learning “body awareness” and noticing how you are performing movements. Perform gentle stretches slowly and carefully, rather than quickly or bouncing. Use yoga props such as yoga blocks, straps, or towel roll or mat if you have restrictions in performing or holding a pose. Always stop any movement if pain increases or radiates. A stretch can be held from 30 – 60 seconds and
performed 1 – 3 times.

• Muscular Strength:

Good core strength is important to develop and allows tasks to be accomplished without heavy effort or fatigue. By design, our low back muscles are relatively small and thin. In comparison, the abdominal muscles are large and broad. A simple way to strengthen your abdominal muscles is to engage (pull in) the lower segment between the belly button and pubic bone. Hold for 10 seconds (without holding your breath) and repeat often throughout the day with your exercising or with activities.

•  Improved Postural Alignment:

Improved alignment results in decreased muscle tension, all of which contribute to a healthy back, neck, shoulders, hips, and knees. Concentrate on keeping the natural inward curve in your lower back when standing or sitting. A totally flat back is not correct in your activities or yoga poses. The spine’s natural curves - a slight inward curve of the lumbar spine (lower back), a slight outward curve of the thoracic spine (upper/middle back) and a slight inward curve of the cervical spine (neck). When practicing alignment, think of keeping your chest held high, with your shoulders broad and in line with your hips. Tadassana (Mountain pose), is a simple standing yoga pose that you can use when practicing standing during the day, for postural alignment and engaging your core muscles.

• Breath Awareness:

Check in with your breathing and notice if you are holding your breath or breathe shallowly with your activities or performing yoga asanas (postures). This can contribute to unconscious muscle contractions. Diaphragmatic breathing reduces muscle tension throughout the body, giving freedom of movement to the joints, and encouraging the use of proper muscles in movement. Learning proper breathing techniques will help relieve stress. This can also be combined with learning relaxation techniques and tools for meditation in your practice.

• Use Good body Mechanics:

Be close to the object you are lifting, bend with your knees and lift with your legs, while engaging your abdominal muscle and maintaining a slight arch in your low back. Do not twist your body when lifting. This is important to be “mindful” and focus on the task that you are performing.

• Maintain Emotional Boundaries:

Changing your mindset and brain biology can help your brain — and lessen your pain. The American College of Physicians’ 2017 suggests guidelines for individual’s psychological attitudes and outlooks and recommend yoga therapy, progressive relaxation techniques and mindfulness-based programs as being helpful in addressing the psychological distress, personal health beliefs and coping strategies.4

• Monitor your sitting time:

Prolonged sitting in one position is a back hazard you might not expect. A lumbar support and periodic breaks to move around are essential. Stand up from sitting every 30 – 45 minutes to take a break walk around. If this is not possible, start to become aware how you are sitting on the chair. Ask yourself: 1) “Am I crossing my legs or am I aware of both feet on the ground”, 2) “Do I feel equal weight in my buttocks or do I tend to lean to one side?”, 3) “Am I maintaining the curves in my spine or slouching?”, and 4) “Is my laptop or desktop computer screen positioned straight ahead or is it off to the side?” . This is also a good time to practice breathing techniques.

Caring for your back means developing healthy movement habits. This can be practiced with awareness, proper breathing, and safe postures. In addition, learning to perform safe and gentle stretching and exercises (yoga poses, core exercises, gradual strengthening exercises), can build the muscle strength that will give your spine the support that it needs.

Check with the American Physical Therapy Association, The International Association of Yoga Therapists or Yoga Alliance to find a qualified therapist that can that can help you live a healthier lifestyle.

References:
1. Yoga as a treatment for chronic pain: A systemic review of the literature; 2016;
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878447/
2. The International Association of Yoga Therapists (IAYT) www.iayt.org
3. Yoga Alliance: https://my.yogaalliance.org
4. “Noninvasive Treatment for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians”, Qaseem, Amir, MD et al, Annals of Internal Medicine, Clinical Guidelines, April 4, 2017, https://www.acpjournals.org/doi/10.7326/M16-2367