Director, Morarji Desai National Institute of Yoga, New Delhi
Project Coordinator (On Contract), WHO-CC,
Morarji Desai National Institute of Yoga, New Delhi
Back pain is one of the most common and costly medical conditions in modern society normally condition improves within a few weeks or months. Commonly the pain occurs in the Lower back although it may occur anywhere in the spine starting from neck to hip. According to the locality of the pain its commonly called lower back pain and upper back pain or Neck pain. Improper or poor postures lead to muscle imbalances around the muscles flexor-extensor and rotator) of the lower back, upper back and neck region.1 These muscle imbalances create unequal distribution of forces around and weaken the vital joints of the trunk and upper limbs, thus making the person more susceptible to muscle strain, stress and pain. Currently, several non-invasive modalities used to treat Acute and chronic back pain like transcutaneous electrical nerve stimulation, hot packs, ice packs, massage and other conventional treatments which helps to provide symptomatic temporary relief. Back supporting devices may provide short-term external support for the back, but continuous use leads disadvantageous, as the back muscles weaken and the spine becomes more susceptible to injury.
Yoga is a art and science of living with a history of more than 4,700 years and increasingly popular in India as well as all over the world. Yoga is now emerging as a promising mode of treatment for chronic back pain. Yoga offers a holistic approach to health and considered as a form of mind-body medicine. Recent Research studies have revealed a reduction in pain and functional disability in subjects with chronic lower back pain who undergo a yoga intervention.Main principle in treating backache is rest and physical therapy Yoga helps in both. Yoga gives rest to the body, postural stability, increases strength, increases flexibility and awareness on the proper posture. This article aims to discuss how Yoga can be used to help in correcting postural alignment problems that leads to chronic back pain.
Backpain is commonly classified into Lower back and upper back pain or Neck pain. The low back pain is the commonly seen condition and mostly occupation oriented. International guidelines for the management of low back pain recommend an initial diagnostic classification process, a diagnostic triad, that differentiates among possible serious spinal pathology, nerve root problems, and nonspecific Low Backpain. It is estimated that 85% of low backpain patients seen in primary care have nonspecific low backpain. The lower back is made up of several complex structures including vertebral ligaments, facet joints, paravertebral musculature and fascia, annulus fibrous fibres, blood vessels, and the roots of the spinal nerves. Disease or injury affecting any of these structures can lead to the patient experiencing low backpain.
LOW BACK PAIN:
The lower back is made up of several complex structures including vertebral ligaments, facet joints, paravertebral musculature and fascia, annulus fibrous tissues, blood vessels, and the roots of the spinal nerves. Disease or injury affecting any of these structures can lead to the patient experiencing low backpain. A widely accepted definition of low back pain is pain is, stiffness or muscle tension in the lower back, below the costal margin and above the inferior gluteal folds (approximately, between the lower ribs and the top of the legs), without or with leg pain. If the sensation of pain or discomfort is also experienced downwards and towards the leg, it is termed sciatica.
Conditions Associated with Low Back Pain:
Sciatica, Osteoporosis, Skeletal irregularities, Fibromyalgia, Spondylitis, Herniated Disc (Slipped Disc), Spinal Stenosis (Lumbar) and Spondylo- listhesis.
UPPER BACK PAIN:
There are many different reasons for developing neck pain/upper back pain. Upper back pain may be caused by heavy lifting, over bending, improper sitting posture, and poor use or over use of upper back muscles. Main symptoms are muscle spasms, pain when a take deep breath, pain when back is touched or moved, pain when moving the shoulders or bending neck forward. Not only the pain be present in the neck itself, but symptoms such as headaches or pain, tingling, and/or numbness into the upper extremity, can be related to the neck.
Poor posture, age, arthritis any degenerative disorders, herniated disc neck injury like whiplash, sometime due to viral infection of the throat and swelling in the neck, the aetiology and backs pain more of less same.
The prevalence of back pain in the adult population varies with age. There are a number of surveys in multiple countries that reveal a point-prevalence of 17–30%, a 1-month prevalence of 19–43% and a lifetime prevalence of 60–80%. The likelihood that an individual will recall on survey that they have experienced back pain in their lifetime reaches 80% by the age of 60 years, and there is some evidence that the remaining 20% have simply forgotten prior episodes of back pain or considered such episodes as a natural part of life and not worth reporting. At the age of 40 years, the prevalence is slightly higher in women, while, after the age of 50, it is slightly higher in men. Low back pain affects people of all ages from children to the elderly, and required very common cause or need for medical consultations. The 2010 Global Burden of Disease Study by WHO estimated that low back pain is among the top 10 diseases and injuries that account for the highest number of DALYs (Disability Adjusted Life Years) worldwide.
Identifying cause of the backpain is important for in treating or managing the backache. The cause of backpain may be to Trauma, Tumours, any inflammation, age related degeneration on Backbone, pregnancy, any intra-abdominal disorders, any psychogenic disorders associated with depression.
Other causes are:
- Bending awkwardly or for long periods
- lifting, carrying, pushing or pulling weight objects incorrectly
- Stooping in chairs
- Twisting body improperly
- Driving in a curved position or driving for long periods without taking a break
- Overuse of the muscles, usually due to sports or repetitive movements (repetitive strain injury)
Certain risk factors increase the chances of developing back pain. They are as follows,
- Smoking with unhealthier lifestyles
- Pregnancy the extra weight of carrying a baby may give additional strain on the back
- Long-term use of medication- weaken the bones
- Stress may be responsible for tension in the back muscles which can result in back pain
- Depression – back pain can make people feel depressed, sometimes result in back pain
- Weight gain which leads to increased pain and worsening depression
Recent years, numerous factors, such as physical characteristics, psychological characteristics, lifestyle factors, employment, social factors and genetic components, have been considered risk factors for developing low backpain.
CLASSIFICATION OF BACKACHE (BASIS OF DURATION)
- Acute- pain continues few days to 12 weeks
- Sub-Acute- Second half 6-12 weeks
- Chronic- continues more than 12 weeks
SIGNS AND SYMPTOMS OF BACK PAIN MAY INCLUDE:
- Muscle Pain
- Stiffness, Stabbing or Shooting pain
- Pain that radiates down to Shoulder and arms
- Pain that radiates down to legs
- Limited flexibility or lessened range of motion of the back
DIAGNOSIS OF BACKACHE
- X-ray imaging
- Ultrasound imaging
- Computerized Tomography(CT-Scan)
- Magnetic Resonance Imaging(MRI)
- Bone scans
YOGA AND BACKACHE:
Yoga is a widely practiced for physical, mental, and spiritual well-being which focuses on specific body postures or asanas while incorporating with mindful breathing and meditation. Its popularity has dramatically grown in India as well as over the world due to its positive effects on mental and physical health, helps in stress reduction, improves flexibility of joints and strength, gives pain relief from common musculoskeletal disorders.
Yoga is an excellent way to prevent and cure back pain. Yoga works on improving the elasticity of the muscle & strengthens the muscles thereby improving the condition of the spine in totality. The performance yoga postures and techniques are designed to strengthen the body and increase flexibility in a manner that creates and maintains balance between opposing muscle groups. Breathing techniques (Pranayama’s) consists of inhalation, exhalation and suspension of breath, helps to links the postures together and strengthen the respiratory muscles to improve ventilation. One of the first steps in practising yoga is to correct postural dis-alignment, which should help in alleviating pain. Yoga can selectively stretch shortened, tightened muscles and strengthens the weak, elongated muscles Stiffness in the body & lack of movement makes the muscles rigid due to which even the slightest movement often leads to a back injury or perpetual back pain. Yoga softly stretches the muscles, soothes the nerves, enhances blood circulation & strengthens the muscles as well.
The best practice for managing backache problems is to do Yogic sukshma vyayamas (special techniques for joint movements) to ease the ache & then do a few asanas to flex the respective muscles & ease the pain. This followed by pranayama would help in enhancing blood circulation in the body. Meditation & relaxation also play a vital role in pacifying the vata.
RESEARCH IN YOGA AND BACKACHE:
Yoga has been proven an effective in Low backache and neck pain treatment through many studies published in indexed and peer-reviewed scientific Journals.
Galantino ML et al. (2004) conducted a study on impact of modified hatha yoga practice on low back pain, administered daily one-hour hatha yoga twice a week for 6 weeks after 6 weeks functional measurement score showed improved balance and flexibility and decreased depression and disability. And improved relaxation and fastened awareness/Learning in the subjects.14 Tekur etal. (2008) conducted a residential yoga program with physical exercise (control) on low back pain patients with pain and spinal flexibility problems. I week intensive Yoga based lifestyle intervention program improved spinal flexibility and reduction in pain when compared to physical exercise group.
Cramer H et. Al in 2013 systematically reviewed and done a meta-analysis on Yoga for low back pain. They are taken 10 randomized clinical trials with total 967 chronic low back pain patients. In these eight studies were with low bias risk and provided very strong evidence for the effectiveness of yoga in the management of Low Back Pain.In a RCT on Chronic neck pain by Cramer et al (2013) randomly assigned yoga or exercise program in 51 patients for a 9-week program. After the completion of the study period yoga group reported less disability and improved quality of life when compared to the exercise group. Range of motion and pressure pain threshold also improved in Yoga Group.
YOGA PROTOCOL FOR BACKACHE
- Om Chanting/ Prayer.
- Neck and Spinal Exercises: The simple spinal movements facilitate the practice of further range of Yogic techniques by loosening the joints and muscles.
- Sukshma Vyayama: Kati-Sakti-Vikasaka (Strengthening the back) 1,2,3,4 & 5.
- Yogasanas: Tadasana, Urdhwa Hastottanasana, Katichakrasana, Ardhachakrasana, Parivritta trikonasana, Uttanpadasana, Sethu bandhasana, Ustrasana, Vakrasana, Konasana, Marjariasana, Sarala Matsyasana, Bhujangasana, Shalabhasana, Saral Dhanurasana Makarasana, Shavasana.
- Pranayamas: Nadi Shodhana Pranayama, Shitali Pranayama, Bharamari Pranayama.
- Special Practices: Yoga Nidra.
- Dhyana: Meditation.
YOGIC PRACTICES FOR THE MANAGEMENT OF BACKACHE
Weight gain, poor posture, improper lifestyle and few other reasons are the main causes results in back pain are becoming gradually more prevalent nowadays due to the sedentary modern lifestyle nature. Abundant Number of studies have found yoga to be beneficial for certain back problems. The physical postures used in Yoga are a method of therapeutic application that integrates the balance between mind and body, coordination, flexibility and core strength of the human body. Yoga is now emerging as a hopeful means of alleviating backache like upper back (Neck), lower back and scapular pain and may be of great benefit to patients, particularly when performed in conjunction with or without (in some conditions) other established conventional and alternative treatments, such as lifestyle modification, exercise, massage and physiotherapy, exercise therapy and other types manipulations. Yoga, when practiced in a safe and planned way, it can be a very useful mode of therapy in the management of acute and chronic back pain.