Going With The Yoga Flow

Is yoga the new cure for back pain? A recent study seems to suggest so.

The study, published last month in the Annals of Internal Medicine, found that yoga can be as helpful as physical therapy for relieving moderate back pain.

The research, conducted by the Boston Medical Center, recruited over 300 participants in the Boston area to compare the benefits of regular physical therapy, specially designed yoga classes and education in treating chronic low back pain. The skinny: The yoga and physical therapy groups showed almost the same amount of improvement in pain.

At the end of the study participants still using pain medication had dropped to 50 percent, compared to 70 percent at the beginning of the study. “It’s a significant reduction,” the study’s author, Dr. Rob Saper, director of integrative medicine at Boston Medical Center, told NPR.

This comes as welcome news in the U.S., where chronic back pain reportedly affects 5 to 10 percent of adults annually and costs $50 billion a year in direct health care expenditures, as well as at a time when interest in nonpharmacological treatments is on the rise.

Physicians are quick to point out that the published trial does not tout yoga as the cure-all, but rather as a treatment option that can offer tangible benefits without significant risks, often at a much lower cost than PT or prescription medication.

“Chronic pain is so vexing, and everyone always wants to announce that one treatment is great and another is no good,” Dr. Stefan Kertesz, a physician who has done research into back pain, told The Jewish Week. “For a while we put far too much confidence in medications, only to find that they worked for some people and not for all. I think we can say pretty much the same for yoga.”

Manuals published with the study outline a yoga protocol that recommends gentle, low-intensity poses and avoids more difficult ones, like inversions. It also offers helpful tips to modify poses and encourages use of props like chairs, bolsters or straps for assistance.

Dr. Lori Zucker, a physical therapist and certified yoga instructor who runs a private practice in New Jersey and lectures widely on anatomy and injury prevention, said the exercises outlined are in line with typical exercises she would give clients with low back pain. “I would say that yoga for low back pain in older people is probably as good or better for people than physical therapy,” she told The Jewish Week. “Of course, I’d much prefer the yoga teacher have a strong anatomy background or special training in low back pain.”

She’s not alone. Whitney Chapman, fitness production manager and yoga instructor at the JCC Manhattan, said the protocol “absolutely supports” what she has been teaching for 20 years. “It codifies it.” She plans to incorporate the protocol into her classes, along with some modifications based on her wealth of teaching experience.

She said many people come to yoga looking to repair an injury or relieve stress in certain areas of the body. “It takes [an instructor] who will be diligent in their practice in terms of what’s adding stress or eliminating stress and creating balance in the body,” she said.

At JCC Manhattan’s facility on the Upper West Side, many baby boomers and older adults already take advantage of the weekly classes, including SPRY yoga (using weights), gentle yoga and restorative yoga, among others. (The facility has over 10,000 members in its community, fitness and pool categories.) An ELDOA class it offers, though not yoga-based, is specifically geared to spinal health and uses spinal stretches that target every vertebra to increase stability and mobility in the spine.

Following the release of the study, the JCC Manhattan will offer a new specialized class in the fall specifically geared for back health. Caroline Kohles, senior director of health and wellness programming at the JCC, said she expects the course to fill up quickly, what with the heightened awareness of the ramifications of sitting-culture coupled with growing interest in staying active in older years.

“There’s a lot of people wanting to be active as they get older,” she said. “Not only in reaction to back pain but in relation to Alzheimer’s and all kinds of other diseases and ailments.”

As seniors are looking to stay active, many go to JCC Manhattan seeking an individualized, safe environment to try out new exercise regimens. “We’re looking to promote intelligent fitness. Fitness that works with the body, not against it, and promotes longevity,” she said. “It’s very prescriptive medicine.”

At the aligned-flow yoga class this reporter took part in, half of the participants were seniors and the teacher provided one-on-one adjustments and modifications as needed. The pacing was slower than a typical power-flow class.

With the increase in physical activity comes the larger concern of injury. Dr. Erik Groessel, who conducted research in 2013 into how lower-income older adults could benefit from yoga, found that there were significant decreases in pain and depression. He says that while yoga may produce some soreness, it can likely prevent much more significant decline in the long run. “The more exercise an older person does, the more soreness they will likely have, but the more benefit they will get too,” he told The Jewish Week. He recommends practicing modified versions of the poses in a chair, and then progressing gradually.

Perhaps, as Kohles said, “Exercise is the new prescription.”