Chronic lower back pain (LBP) presents a threat to human prosperity by transforming everyday activities, such as running errands, working at a desk, or moving around one’s home, into demanding tasks. By infusing stress and pain into every aspect of daily life, LBP transforms simple necessities into painful ventures, yet for such a prevalent issue, treatment options aren’t universally effective and are often quite vague (4). The majority of LBP reports are nonspecific, meaning that medical professionals cannot find a specific cause for one’s pain. As a result, targeted treatment plans are difficult to prescribe, so general exercise is recommended (2). Though contemporary medical literature affirms that exercise reduces symptoms of LBP and prevents future injury, the non-specificity of “exercise” may leave patients confused about exactly where to start. Some modes of exercise, like walking, have proven to have a neutral effect on LBP, while more extreme modes of exercise, like heavy weight lifting, may worsen back pain (2). However, recent studies support that practicing yoga is an efficacious exercise regimen to alleviate LBP. 

Yoga is rooted in ancient Indian philosophy; however, contemporary yoga in the United States is defined by syncing one’s breath to their movement as they flow through physical postures, occasionally holding poses to build strength (6). Self-proclaimed “yogis” often claim that practicing yoga brings the body into balance, therefore reducing chronic pain, yet a team led by Dr. Robert Saper at Boston University wanted to evaluate this claim scientifically before jumping to any conclusions (6). They conducted a study in which a sample of 320 participants with LBP were assigned one of three LBP treatment options: use of prescription opiates, attending physical therapy, and practicing yoga. They found that the two groups participating in yoga and physical therapy reported significantly greater improvement in pain reduction and mobility (6), leaving scientists and consumers alike to wonder: What about yoga makes it as efficacious of a treatment for LBP as personalized physical therapy programs created by medical professionals? Further research has identified yoga’s unique combination of prolonged muscle stretching, mental engagement, and core and back strengthening as the elements responsible for effectively alleviating LBP symptoms (8). 

Stretching core and back muscles helps align the body properly, alleviating excess pain in the lower back. Many yoga poses, such as downward dog and mountain pose, work to lengthen the spine, alleviating stress from the paraspinal muscles that bend the spine and the multifidus muscles that stabilize the vertebrae (7). Poses that stretch the hamstrings, like ragdoll poses, increase the mobility of the pelvis, in turn, decreasing stress on the lower back. Stretching improves flexibility by increasing blood and nutrient flow to the soft tissue in the back which reduces stiffness to alleviate LBP (1). 

Additionally, practicing yoga actively engages the mind, reducing the psychological contributors of LBP. Yoga has been proven to work as a complementary medical therapeutic treatment for stress and anxiety, initiate relaxation, and reduce irritability (9). Though yogis attribute these psychological benefits to the mindfulness that rises from pairing breath and motion, scientists are only beginning to understand the mechanisms behind this phenomenon. Mindfulness and relaxation could potentially alleviate lower back pain, considering that LBP both creates stress and results from stress (9). For instance, high stress levels can worsen lower back pain while experiencing incapacitation from LBP can make everyday activities difficult, causing further frustration. This positive feedback loop can increase the severity of LBP; therefore, including stress management into one’s LBP treatment plan appears to be beneficial (9). Yoga provides a way to fuse physical strengthening and mobility treatment with relaxation; furthermore, it presents itself as a self-manageable treatment option for LBP. 

Finally, back and abdominal muscles are significant components of the spine’s muscular network and, therefore, are heavily involved in mitigating LBP. Specifically, “core” muscle groups, consisting of the transversus abdominus, multifidus, diaphragm and pelvic floor muscles, stabilize the lumbar spine (5). A study examined core muscle recruitment during movement in both a control group and an experimental group of participants who suffer from LBP. In both groups, all core muscles were engaged during extremity movements, proving that these muscles are directly involved in stabilizing the spine during movement 3). They also found that a significant number of participants with LBP experienced delayed engagement in the transversus abdominus (3). Many yoga poses engage the core, including boat pose, chaturanga, and high plank. Holding these poses can strengthen core muscle groups; therefore, increasing abdominal muscle engagement during everyday movement to stabilize the lower back. To help patients monitor the efficacy of these core stabilizing exercises, Esurgi’s Bio Stabilizer provides clear biofeedback to patients. This allows patients to manage their LBP through exercises like yoga while monitoring their progress with real-time feedback.

References: 

1. Busch, F. (2004, January). How yoga helps the back. Retrieved February 08, 2021, from https://www.spine-health.com/wellness/yoga-pilates-tai-chi/how-yoga-helps-back

2. Gordon, R., & Bloxham, S. (2016). A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain. Healthcare, 4(2), 22. doi:10.3390/healthcare4020022

3. Huxel Bliven, K. C., & Anderson, B. E. (2013). Core stability training for injury prevention. Sports Health: A Multidisciplinary Approach, 5(6), 514-522. doi:10.1177/1941738113481200

4. National Institute of Neurological Disorders and Stroke. (2020, April 27). Low back pain fact sheet. Retrieved February 08, 2021, from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

5. Princeton University Athletic Medicine. (n.d.). Lumbar/Core Strength and Stability Exercises. Retrieved from https://uhs.princeton.edu/sites/uhs/files/documents/Lumbar.pdf

6. Saper, R., Lemaster, C., & Delitto, A. (2017). Yoga, physical therapy, or education for chronic low back pain. Annals of Internal Medicine, 167(2). doi:10.7326/p17-9039

7. Solan, M. (2018, April). Yoga for people with back pain. Retrieved 2021, from https://www.health.harvard.edu/blog/yoga-and-back-pain-2018041413652#:~:text=The%20practice%20helps%20to%20stretch,also%20helps%20stabilize%20your%20spine

8. Vardigan, B. (2020, October 26). Yoga and pain relief. Retrieved February 08, 2021, from https://consumer.healthday.com/encyclopedia/holistic-medicine-25/mis-alternative-medicine-news-19/yoga-and-pain-relief-646210.html

9. Woodyard, C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International Journal of Yoga,4(2), 49. doi:10.4103/0973-6131.85485

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