As a physical therapist, my patients frequently ask for guidance on returning to exercise and which exercise routines will be safe and effective for them. “Can I run? Can I golf? Can I do yoga?” Before you roll your eyes at my tendency to say “NO,” it is important to understand that multiple factors weigh into my response. All exercise is not created equal, and no two injuries are the same.
Yoga is a popular form of exercise which emphasizes synchronizing breathing with movements. Yoga has been touted for years to reduce low back pain (1). That must mean yoga is good for all back pain patients, right? (Please say no.) The correct answer is yoga might be appropriate for patients with back pain. If you suffer from back pain, there several things to consider before diving into downward facing dog.
As stated before, no two back injuries are the same. Using a “one size fits all” yoga practice doesn’t work, and could potentially be harmful. Let’s compare two common back injuries: spinal stenosis vs. a bulging disc. People with spinal stenosis (narrowing of the canals in the vertebrae) tend to have pain with standing and back extension (bending backward). These patients benefit from exercise which incorporates forward bending, sitting, and flexion based postures. Conversely, people with a lumbar disc bulge or herniation tend to respond better to standing and backward bending. Bending forward, sitting, and flexion of the spine can exacerbate back pain for these individuals. Typical yoga routines combine both forward and backward bending positions. Can you see how a generic “yes” or “no” response doesn’t work when people ask “Is yoga good for me?”
There are many different types of yoga, which vary in intensity and purpose. Three of the most popular types are Iyengar, Ashtanga, and Bikram yoga. Iyengar yoga is a type of yoga which focuses on correct postural alignment and breathing. This practice uses prolonged poses with the use of yoga blocks and positioning to gain flexibility and strength (1). Ashtanga yoga is a popular, more physically demanding form of yoga which synchronizes breath with movement. Bikram yoga uses a variety of positions with the studio heated to 95-105 degrees to detoxify and restore flexibility.
People who experience chronic low back pain (CLBP) have reported statistically significant improvements in their daily pain and function when using daily sessions of Iyengar yoga over a 12 week period (2). Another study with over 900 participants showed both short and long term reduction in pain levels following at least three months of yoga practice (3). Yoga truly is a mind and body experience. The goal of yoga practice is to improve both physical fitness as well as psychological health. Patients experiencing chronic low back pain often experience significant emotional stress due to prolonged levels of pain. Yoga can provide a healthy outlet for stress management, which is imperative for healing.
Improving strength, flexibility, and balance is essential for all patients suffering from back pain. Overall, practicing yoga can be extremely beneficial for patients with back pain. However, not every pose is suitable for every person. Modifications should be applied as needed. Talking with a yoga instructor or physical therapist for initial guidance is recommended to ensure a pain free practice.
2.Williams K, Abildso C, Steinberg L, et al. Evaluation of the Effectiveness and Efficacy of Iyengar Yoga Therapy on Chronic Low Back Pain. Spine. 2009;34(19):2066-2076. doi:10.1097/BRS.0b013e3181b315cc.
3. , Holger, Romy Lauche, HiedeMarie Haller, and Gustov Dobos. “A Systematic Review and Meta-analysis of Yoga for Low Back Pain.”Clinical Journal of Pain 29.5 (2013): 450-60. Web.