Yoga and Chronic Back Pain: To Practice or Not to Practice and Why
Chronic pain can range from low grade, episodic to intense and persistent, and all points in between. While there is some evidence to support yoga’s usefulness for individuals with low back pain, people’s perceptions of the benefits and barriers of yoga practice are often what motivates them to either pull up a mat and give it a try, or steer away from the practice altogether.
More than 80% of American adults will experience low back pain at some point in their lifetime. In fact, chronic low back pain is the second most common cause of disability among adults in the US, and one of the most likely causes for a visit to the doctor. Annual treatment costs in the United States are well into the billions of dollars. Sadly, these expensive treatments pose a significant risk of side effects and many provide little ongoing relief.
Early evidence suggests that yoga may benefit adults with chronic low back pain, however we know little regarding why some choose yoga and others do not.
A study examined the facilitators and barriers to yoga use in a population of adults with chronic low back pain.
Participants in the study included 102 residents of a college town in Western Alabama ranging in age from 19-84 years (mean age = 50.5 years), with self-reported chronic low back pain resulting from an injury or condition that had persisted for 6 months or more. They were asked to complete semi-structured interviews and questionnaires regarding their perceptions of yoga for relieving chronic low back pain.
The sample was predominantly female (60.8%), well educated (47.1% with a college degree), and over half (57.8%) had never tried yoga. The average duration of their pain was 11.96 years. No data was provided regarding the sample’s ethnic identity or socioeconomic status.
Why people try yoga
This study identified a number of factors that motivated these adults to adopt a yoga practice. These were divided into physical, cognitive/affective, motivational, informational, and practical and social issues.
Physical issues. Physical issues were listed by 44.3% of respondents as the primary reason for attempting a yoga practice. The main physical motivators for trying yoga among those with chronic back pain included seeking relief from pain, a desire for improvement, and the need for exercise.
Cognitive Affective Issues. A number of psychological factors were identified by approximately 16% of respondents in support of beginning a yoga practice. These included stress relief, mood improvement, and creating positivity and an open mind.
Motivational Issues. Several issues were attributed to motivation to adopt a yoga practice were identified among 13.4% of adults with chronic low back pain. There included curiosity, a desire to try something fun, new or different, and fun and enjoyment.
Informational Issues. Accurate information also had a large bearing on 15.5% of the sample’s evaluation of whether or not yoga might be right for them. These included the availability of accurate information about the nature of the practice and a clear explanation of its benefits, clarification of potential misconceptions regarding the intention of yoga or its possible religious roots, as well as positive testimonials.
Practical and social issues. Lastly, about 8% and 14% of respondents identified practical and social issues respectively as being important to yoga’s feasibility and social desirability. These included having the opportunity to attend free or demonstration classes, receiving incentives to trying yoga, making classes affordable, accessibility and convenience, cultivating a positive class environment, and a having friend to go with.
Why people avoid trying yoga
This sample identified an equally diverse set of barriers to beginning a yoga practice that mapped onto the categories above (physical, cognitive affective, motivational, informational, and practical and social).
Physical Issues. Thirty-one percent of respondents identified one or more physical reasons for avoiding yoga practice. These included chronic pain, poor balance or poor flexibility, being overweight, or in poor health, and having other medical problems.
Cognitive affective Issues. Nearly one third of participants (31.3%) endorsed mental or emotional factors as impeding their decision to adopt a yoga practice. The most prevalent of these emotional responses centered around fear: fear of trying, fear of pain, or getting hurt, of being embarrassed or judged by others, of not being able to do the postures correctly, as well as general intimidation about performing a new activity in a foreign context.
Motivational Issues. Concerns around motivation were identified by 11% of participants as a potential obstacle to trying yoga. These included laziness, lack of motivation and interest, boredom, the perception that yoga is “not a good enough exercise,” and a general aversion toward physical activity.
Informational Issues. Perhaps one of the most interesting findings of this study revolved around a lack of information about yoga as being a primary barrier identified by over 1/3 (36.4%) of participants. Common themes included a lack of sufficient information regarding the practices and their benefits, the amount of physical activity required, disbelief regarding yoga’s potential to improve their condition, a lack of knowledge regarding what yoga involves, it’s potential religious “new age”, “hippy” or “cultish” orientation, and other stereotypes, and a general narrow-mindedness about the practice.
Practical Issues. Lastly, practical issues such as cost, financial limitations, time constraints, availability, and lack of convenience were identified by 12% of respondents as impeding their ability to explore a regular yoga opportunity.
The role of pain and attempting a yoga practice
After looking at the qualitative reasons for adopting or resisting yoga practice in a sample of adults with chronic low back pain, the authors examined the specific relationship between the intensity and duration of pain and a person’s willingness to examine yoga as a potential option.
The overall average pain intensity for this sample was 5.85 (moderate) on a scale of 0 (no pain) to 10 (extreme pain) scale. The average duration of pain for this sample was 12 years.
Participants who considered yoga as a potential option for pain management had an average pain intensity rating of 6.75 (higher than average) and duration of 6.5 years (lower than average). Those who endorsed pain as being a major barrier to yoga had higher mean pain intensity ratings (7.67) as well as a considerably longer duration of chronic pain (18 years). Unfortunately the authors did not report whether or not intensity or duration of pain was related to participant age or overall health, so it is impossible to determine whether these factors may have influenced participant perceptions.
In sum, pain intensity predicted participant’s willingness to engage in yoga, with greater pain intensity being associated with beliefs that yoga might be harmful. There was no relationship between the duration of chronic pain and adult’s perceptions of yoga’s benefit.
To practice or not to practice
This study points to the fact that the reasons for adopting or avoiding yoga practice among adults with chronic low back pain are complex and multifaceted. Rather than being based on pain or physical factors alone, important socio-emotional factors such as mood, social support, and perceptions of the practice of yoga likely serve as powerful incentives or deterrents depending upon who you ask.
Unfortunately these data provide only a partial snapshot of this complex picture. We have no idea as to the socio-demographic and ethnic composition of this sample, and no sense as to whether this picture would be different for adults with less education, privilege, financial resources, access, or beliefs that might further influence their perceptions of yoga and its philosophical underpinnings.
Perhaps the most important lesson from this work is the need for the dissemination of information regarding what yoga is, for whom it is most beneficial, how, and under what conditions.
There was a general consensus among many of the respondents that a lack of information prohibited them from making educated decisions regarding whether or not yoga was right for them in the treatment of their chronic low back pain. A foundation of high quality, empirically rigorous studies regarding the effects of yoga for back pain must be conducted, and their findings made accessible and understandable to yoga educators and students to cultivate an informed, empowered yoga community.
B Grace Bullock, PhD, E-RYT 500 is a psychologist, research scientist, educator, author, yoga and mindfulness expert and creator of BREATHE: 7 Skills for Mindful Relationships. Her mission is to reduce stress, increase health and wellbeing and improve the quality of relationships. She offers classes, workshops, writing and research that combine the wisdom of applied neuroscience, psychophysiology, psychology and contemplative science and practice. Her goal is to empower individuals, groups, leaders and organizations to reduce chronic stress and increase awareness, attention, compassion, mindfulness and effective communication to strengthen relationships, release dysfunctional patterns and unlock new and healthy ways of being. Dr. Bullock is a Certified Viniyoga Therapist and Faculty at the Integrated Health Yoga Therapy (IHYT) Training program. She is the former Senior Research Scientist at the Mind & Life Institute and former Editor-in-Chief of the International Journal of Yoga Therapy. For more information see www.bgracebullock.com.