To study the effectiveness of Yoga Postures in the management of Chronic Non Specific Low Back Pain.

Low back pain (LBP) is one of the most common causes of pain and disability. Almost 85% people suffer from LBP at least once in their lives and many suffer chronic and recurrent episodes1. Most of the patients undergo conservative management including pain medications, physiotherapy, complimentary and allied medicine techniques, ergonomic changes and lifestyle modification2. Many of these techniques, including yoga, alleviate pain and improve functional disability scores in patients3,4. It is postulated that practice of yoga brings about physical and biopyschosocial changes to achieve positive outcomes5.

Chronic LBP is associated with changes in posture, weakness of muscles, tightness of soft tissue structures around the spine and lumbopelvic complex, reduced stability and proprioception6. These largely result in pain, movement impairments and functional disability. LBP is usually also associated with other problems such as fear avoidance, sleep disturbances, anxiety or depression7,8. Though categorized as a single diagnosis, the condition is more like an umbrella term to describe a range of dysfunctions and impairments. Improvements in patient outcomes in the management of chronic LBP have been suggested with sub-categorization of patients and tailor made exercise prescriptions9,10. Past studies that have evaluated the effectiveness of yoga for management of LBP have used varied yoga techniques and generic yoga postures for all subjects irrespective of underlying pathomechanics. No studies till date have explored the effects of yoga postures on posture, rhythm and symmetry of lumbopelvic movement and associated muscle activity.

The current project shall study the effects of yoga postures on lumbopelvic kinematics and muscle activity in subjects with and without back pain. This assessment will provide information beyond the effects of yoga intervention on pain and functional disability and a possible reasoning for the same.

c. Relevant references

1.        Balagué, F., Mannion, A. F., Pellisé, F. & Cedraschi, C. Non-specific low back pain. Lancet 379, 482–491 (2012).

2.        van Tulder, M. W., Koes, B. W. & Bouter, L. M. Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine (Phila. Pa. 1976). 22, 2128–56 (1997).

3.        Cramer, H., Lauche, R., Haller, H. & Dobos, G. A Systematic Review and Meta-analysis of Yoga for Low Back Pain. Clin J Pain 29, 450–460 (2013).

4.        Holtzman, S. & Beggs, R. T. Yoga for chronic low back pain: Analysis of randomized controlled trials. Pain Res. Manag. 18, 267–272 (2013).

5.        Sherman, K. J. et al. Comparison of yoga versus stretching for chronic low back pain: protocol for the Yoga Exercise Self-care (YES) trial. Trials 11, 36 (2010).

6.        Laird, R. A., Gilbert, J., Kent, P. & Keating, J. L. Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis. BMC Musculoskelet. Disord. 15, 229 (2014).

7.        Andersson, G. B. Epidemiological features of chronic low-back pain. Lancet 354, 581–585 (1999).

8.        Stubbs, B. et al. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries. Gen. Hosp. Psychiatry 43, 63–70 (2016).

9.        Brennan, G. P. et al. Identifying subgroups of patients with acute/subacute "nonspecific" low back pain: results of a randomized clinical trial. Spine (Phila. Pa. 1976). 31, 623–31 (2006).

10.      Karayannis, N. V, Jull, G. a & Hodges, P. W. Physiotherapy movement based classification approaches to low back pain: comparison of subgroups through review and developer/expert survey. BMC Musculoskelet. Disord. 13, 24 (2012).