Yoga included as a non-invasive treatment
The latest NICE guidelines (published 6/1/17) for low back pain and sciatica recommend group yoga or tai chi classes as a main component of non-invasive treatment! This is brilliant news as it means the evidence is finally there to support what many yogis have known for years: yoga can be a very effective treatment for back pain. But what is it about yoga that makes it so powerful? For answers we need to look at the body's response to pain a little more deeply.
Unfortunately because it is hard to pin down a cause of back pain it is often challenging to treat, leading to chronic pain conditions for millions of people. Once the pain becomes chronic a number of changes occur in the nervous systems, muscles affected and psychological state. These changes cause feedback loops which amplify or even cause pain even if the original cause has healed.
How yoga helps with back pain
One of the most significant feedback loops is the interplay between fear/hypervigilance of pain, muscle tension as a result of the fear, and ongoing pain which creates further inflammation and more pain. A schematic of this relationship can be seen in Figure 1, which clearly shows how treatment is unlikely to be successful unless these secondary factors are also addressed. The NHS and NICE now view chronic back pain as a multifaceted condition which requires a multifaceted treatment package.
|Figure 1. Chronic pain cycle|
The good news is yoga can form a major part of that multifaceted treatment package in one go! One key piece of advice to those with chronic back pain is 'keep moving'. Yoga definitely helps with that, improving both core strength and flexibility. Increasing core strength is key because it reduces the load on the spine and back muscles, increasing flexibility and allowing people to move more freely.
But, that's not all. At the heart of yoga is the connection of mind and body through breath which promotes relaxation and much greater internal awareness. Or in medical terms, yoga stimulates the parasympathetic nervous system or PNS (the system responsible for rest, digestion and healing). Different elements of yoga stimulate the PNS in different ways allowing all the elements of the secondary chronic pain feedback loop to be targeted simultaneously (see Figure 2).
- Pranayama connects mind and body, promoting relaxation.
- The asanas teach the body how to regulate and reduce muscle tension in key areas
- Meditation: teaches the mind to draw away from hypervigilance, easing over-sensitised neural pathways and decreases inflammation in the body.
|Figure 2. How yoga targets the chronic pain cycle.|
Reducing cost & the use of opiates
Additionally the shift away from painkillers and towards yoga as a first line intervention for back pain could dramatically reduce the amount of opiate painkillers prescribed. This is a huge benefit to patients as it avoids the potential side effects, and addiction risks of opiates. It also benefits the NHS in terms of reduced drug costs and demands on clinician time.
To conclude, the inclusion of yoga in the NICE guidelines for low back pain and sciatica is a huge breakthrough for patients and for those of us who dream of seeing yoga thoroughly integrated into the NHS. Yoga has great potential as an intervention for many conditions and I hope this will be the first of many more NICE.
This blog was written in conjunction with the Minded Institute who are running a course on yoga therapy for low back pain and sciatica in April.