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Back Pain And Yoga. By Kim Rider , DPT Doctorate of Pysical Therapy. What is back pain?. Who is at risk?. Over 30 y/o Fall , accident, lifting “Weekend warriors” Infection or tumor. L oss of normal patterned spinal motion Spinal instability .
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Back Pain And Yoga By Kim Rider, DPT Doctorate of Pysical Therapy
What is back pain? Who is at risk? Over 30 y/o Fall, accident, lifting “Weekend warriors” Infection or tumor • Loss of normal patterned spinal motion • Spinal instability Handout on health: back pain. (n.d.). Retrieved September 22, 2011, from the National Institute of Arthritis and Musculoskeletal and skin disease, http://www.niams.nih.gov/Health_Info/Back_Pain/default.asp Panjabi, M. M. (2003). Clinical spinal instability and low back pain. Journal of Electromyography and Kinesiology13,371-379. Panjabi, M. (1992). The stabilizing system of the spine. Journal of Spinal Disorders & Techniques, 4, 992-997.
70-80% of people get back pain at least once 20-25% of all medical claims It cost $34 billion annually Prevalence Cholewicki, J., & McGill, S. (1996). Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Clinical biomechanics, 11, 1-15. Evsenck, H. (1991). Personality, stress, and disease: an Interactionist perspective. Psychological Inquiry , 3, 221-232 Handout on health: back pain. (n.d.). Retrieved September 22, 2011, from the National Institute of Arthritis and Musculoskeletal and skin disease, http://www.niams.nih.gov/Health_Info/Back_Pain/default.asp Radebold, A., Cholewicki, J., Panjabi, M., & Patel, T. (2000). Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain. Spine, 25, 947-954. .
Improve Chronic: Surgery Non-surgical: heat/cold, exercise/PT, traction, braces, medication, injections, acupuncture, chiropractic, massage. Acute: • Heat/cold • NSAIDS • Hard beds for sleep • Exercise/PT Hides, J., Jull, G., & Richardson, C. (2001). Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine, 26, 243-248. Cholewicki, J., & McGill, S. (1996). Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Clinical biomechanics, 11, 1-15. Omkar, S., & Vishwas, S. (2007). Yoga techniques as a means of core stability training. Journal of Bodywork and Movement Therapies, 13, 98-103. PadminiTekur, ChametchaSingphow, HongasandraRamaraoNagendra and NagarathnaRaghuram. The Journal of Alternative and Complementary Medicine. July 2008, 14(6): 637-644.
Acute Unsafe: over 3000N Safe: under 3000N Quad single-leg raise, 2000-2300N (lumbar extensors at 20% of maximum) Side bridge on ankles, 2600N Curl up, 2000N • Sit-ups bent knee, 3300N (730 lbs.) • Roman chair, 4000N (890 lbs.) • Prone superman, up to 6000N (over 1300 lbs.) Liebenson, C. (2004). What’s all the buzz about spinal stability? Dynamic Chiropractic, 22, 242-248.
Chronic • Multifidii are not recovering • Transverse abdominus is delayed • Stability of neutral spine absent • Cholewicki, J., Panjabi, M., & Khachatryan, A. (1997). Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture. Spine, 22, 2207-2212. • Hides, J., Richardson, C., & Jull, G. (1996). Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine, 21, 2763-2769. • Hodges, P., Richardson, C. (1996). Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of the transversusabdominis. Spine, 21, 2640-2650. • MannicheC, Lundberg E, Christensen I, et al. Intensive dynamic back exercises for chronic low back pain. Pain 1991;47:53-63. • Panjabi, M. M. (2003). Clinical spinal instability and low back pain. Journal of Electromyography and Kinesiology, 13,371-379.
Chronic • Motor control and endurance needed • Strength not as necessary • Slow submaximal intensity training Liebenson, C. (2004). What’s all the buzz about spinal stability? Dynamic Chiropractic, 22, 242-248
Flexibility Primarily above and below lumbar spine Panjabi, M. (1992). The stabilizing system of the spine. Journal of Spinal Disorders & Techniques, 4, 992-997.
Yoga Better focus Better movement (77%) • Less pain (at least 64% less) • Less medicine (88% less) • Less anxiety • Better balance Saper, R. B., Sherman, K. J., Cullum-Dugan, D., Davis, R. B., Phillips, R. S., & Culpepper, L. (2009). Yoga for chronic low back pain in a predominantly minority population: a pilot randomized controlled trial. AlternTher Health Med., 15, 18-27. Slade, S., & Keating, J. (2007). Unloaded movement facilitation exercise compared to no exercise or alternative therapy on outcomes for people with nonspecific chronic low back pain: a systematic review.Journal of Manipulative and Physiological Therapeutics, 30, 301-311. Williams, K., Abildso, C., Steinberg, L., Doyle, E., Epstein, B., Smith, D., et al. (2009). Evaluation of the effectiveness and efficacy of Iyengar yoga. Exercise Physiology, 34, 2066-2076.
Compare McKenzie Technique Yoga Clare, H. A., Adams, R. & Maher, C. G. (2004). A systematic review of efficacy of McKenzie therapy for spinal pain. Australian Journal of Physiotherapy, 50, 209-216.
Depression • Substance abuse (94%),anxiety disorders (95%),and depression (54%) preceded back pain • Back Pain, strongest predictor of major depression • GABA neurotransmitter 27% increase after yoga Currie, S., & Wang, J. (2003). Chronic back pain and major depression in the general Canadian population. Pain, 107, 54-60. Polatin, P., Kinney, R., Gatchel, R., Lillo, E., & Mayer, T. (1993). Psychiatric illness and chronic low-back pain. The mind and the spine—which goes first? Spine, 18, 66-71. Sorosky, S., Stilp, S.,& Akuthota, V. (2008). Yoga and Pilates in the management of low back pain. Curr Rev Musculoskelet Med., 1, 39-47.Streeter, C., Whitfield, T. H., Owen, L., Rein, T., Karri, S., Yakhkind, A., et al. (2010). Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study. The Journal of Alternative and Complementary Medicine, 16, 1143-1145. Williams, K., Abildso, C., Steinberg, L., Doyle, E., Epstein, B., Smith, D., et al. (2009). Evaluation of the effectiveness and efficacy of Iyengar yoga. Exercise Physiology, 34, 2066-2076.
Red Flags • Trouble urinating • General weakness • Pain/numbness in L/E • Fever • Unexplained weight loss 3. Handout on health: back pain. (n.d.). Retrieved September 22, 2011, from the National Institute of Arthritis and Musculoskeletal and skin disease, http://www.niams.nih.gov/Health_Info/Back_Pain/default.asp
Graves, N., Krepcho, M., & Mayo, G. (2004). Does yoga speed healing for patients with low back pain? Journal of Family Practice, 53, 8-12.