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Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: a randomized control study.

Tekur P, Singphow C, Nagendra HR, Raghuram N.

Division of Yoga and Life Sciences, Swami Vivekananda Yoga Research Foundation (SVYASA), Bangalore, India. p_tekur@yahoo.co.in

J Altern Complement Med. 2008 Jul;14(6):637-44

OBJECTIVE: The aim of this study was to compare the effect of a short-term intensive residential yoga program with physical exercise (control) on pain and spinal flexibility in subjects with chronic low-back pain (CLBP). DESIGN: This was a wait-list, randomized controlled study. SETTING: The study was conducted at a residential integrative health center in Bangalore, South India. SUBJECTS: Eighty (80) subjects (females, n = 37) with CLBP, who consented were randomly assigned to receive yoga or physical exercise if they satisfied the selection criteria. Intervention: The intervention consisted of a 1-week intensive residential yoga program comprised of asanas (physical postures) designed for back pain, pranayamas (breathing practices), meditation, and didactic and interactive sessions on philosophical concepts of yoga. The control group practiced physical exercises under a trained physiatrist and also had didactic and interactive sessions on lifestyle change. Both of the groups were matched for time on intervention and attention. OUTCOME MEASURES: Pain-related outcomes were assessed by the Oswestry Disability Index (ODI) and by spinal flexibility, which was assessed using goniometer at pre and post intervention. Data were analyzed using repeated measures analysis of variance (RMANOVA). RESULTS: Data conformed to a Gaussian distribution. There was a significant reduction in ODI scores in the yoga group compared to the control group (p = 0.01; effect size 1.264). Spinal flexibility measures improved significantly in both groups but the yoga group had greater improvement as compared to controls on spinal flexion (p = 0.008; effect size 0.146), spinal extension (p = 0.002; effect size 0.251), right lateral flexion (p = 0.059; effect size 0.006); and left lateral flexion (p = 0.006; effect size 0.171).

CONCLUSIONS: Seven (7) days of a residential intensive yoga-based lifestyle program reduced pain-related disability and improved spinal flexibility in patients with CLBP better than a physical exercise regimen.

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Arch Phys Med Rehabil. 2003 Sep;84(9):E19-E20.

The role of backbuilders exercise program in low back pain.
Vijay Vad, MD (Hospital for Special Surgery-Cornell, New York, NY); Ronald Mackenzie, MD; Leon Root, MD, e-mail: vadv@hss.edu.
OBJECTIVE: To evaluate the efficacy of the Back Builders exercise program on patients with diskogenic low back pain (LBP). Design: Prospective randomized trial. Setting: Outpatient clinical setting at a major university teaching hospital. Participants: Inclusion criteria were documented evidence of disk herniation (by magnetic resonance imaging) with at least 3 months symptoms of LBP and/or leg pain. The exclusion criterion was prior history of back surgery. Interventions: Patients were randomized into 2 groups. Group 1 (n=25) performed, for

15 minutes 3 times weekly, the Back Builders program designed by the principal author, who used the principles of medical yoga and Pilates to minimize disk pressures. In addition to the exercise program, patients took 200mg of celecoxib with hydrocodone and acetaminophen for breakthrough pain. Group 2 (n=25) underwent medication treatment with 200mg of celecoxib with hydrocodone and acetaminophen for breakthrough pain. Both groups were age and sex matched. Main Outcome Measures: Outcome measures included Roland-Morris Disability Questionnaire, numeric pain score, patient satisfaction, and distance from finger to floor (in centimeters). A successful outcome was defined as >50% pain reduction with good or better patient satisfaction. Results: At a minimum of 12 months of follow-up with an average follow-up of 12.3 months (range, 12-14mo), group 1 had 72% (18/25) successful outcomes and group 2 reported 36% (8/22, 3 lost to follow-up) successful outcomes (P=.001). In group 1, 16% (y/25) reported recurrence of acute symptoms versus 50% (11/22) in group 2 (P=.001). Conclusion: A well-designed program for patients with disk problems that minimizes disk pressures while restoring flexibility, strength, endurance, balance, and posture may yield superior results to oral medications with reduction in recurrence of back pain.

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J Am Geriatr Soc 1991 Nov;39(11):1065-70
Effects of exercise training on bone density in older men and women.
Blumenthal JA, Emery CF, Madden DJ, Schniebolk S, Riddle MW, Cobb FR, Higginbotham M, Coleman RE.

Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710.
OBJECTIVES: To determine the effects of up to 14 months of aerobic exercise on measures of bone density in older adults. DESIGN: Randomized controlled trial with subjects assigned to either an aerobic exercise condition, non-aerobic yoga, or a wait list non-exercise control group for 4 months. Aerobic fitness and bone density were evaluated in all subjects at baseline (Time 1) and after 4 months (Time 2). A semi-crossover design was utilized with all subjects completing 4 months of aerobic exercise, followed by another evaluation (Time 3). All subjects were then given the option of 6 additional months of aerobic exercise, after which they had a fourth evaluation (Time 4). SETTING: An outpatient exercise rehabilitation facility at a large, major medical center. SUBJECTS: One-hundred-one healthy men (n = 50) and women (n = 51) over age 60 (Mean age = 67.0), recruited from the community. INTERVENTION: The exercise program included stretching, cycle ergometry, and walking three times per week for 60 minutes throughout the course of the study. OUTCOME MEASURES: Aerobic fitness (VO2max) as assessed by cycle ergometry, and bone density (bone mineral content) measured by single photon absorptiometry. RESULTS: Subjects achieved a 10%-15% increase in VO2max after 4 months of exercise training, and 1%-6% further improvement with additional training. Aerobic fitness was associated with significant increases in bone density in men, but not women, who maintained aerobic exercise for 14 months.

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Clin Proc NIMS 4:4 160-164: 1989
Effect of Yogic Practices in non-specific low back pain.
J.V.S. Vidyasagar, B.N. Prasad, M. Venkat Reddy, P.S. Raju, Madhavi, Jai Shankar and Kalyani Sampath.
Non-specific low back pain is a common orthopedic problem which defies relief with available modes of treatment. The present study aims at analysis of 33 cases of non-specific low back pain treated by Yoga therapy. A majority of cases (75,8%) showed good response. Those with low back pain alone showed early and better response compared to those who had sciatic radiation. Yoga therapy being a holistic approach helps to strengthen the spinal musculature with relaxation of rest of the body and mind, resulting in better quality of pain relief.

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The Journal of The International Association of Yoga Therapists.

Asana-Based Exercises for the Management of Low-Back Pain.
T.V. Ananthanarayanan & T.M. Srinivasan
Low-back pain (LBP) is an endemic disorder afflicting a large percentage of the population. The etiological factors of LBP include psychosomatic factors, postural defects, occupational predispositions and sedentary lifestyles. The present study evaluates a number of simple asanas which may be used as rehabilitative techniques on the basis of biomechanical principles. This study also suggests a set of asanas which work on the back with increasing intensity. A series of tests are presented for assessing the physiological debility of a patient. The assessment results form the basis for the selection of asanas to be prescribed to the patient. A chart is provided to enable the yoga therapist to increase the intensity of asanas so that the muscles of the low-back may be strengthened systematically and progressively. The results of clinical trials on 16 patients using the method of asana selection and rehabilitation indicates the usefulness of this method for the management of LBP. Regular practitioners of these exercises improve while indifferent or improper practice has no rehabilitative value.