Yoga by prescription: Doctors treat back pain with yoga

After months of agonizing back pain, Suellen Rinker was at a loss.

A surgeon suggested a range of options: painkillers, medication injected into the spine, back surgery. An MRI scan revealed a herniated spinal disk, and the pain, like a stabbing ice pick, filled her days with misery and robbed her nights of sleep.

“I was taking massive amounts of ibuprofen,” the 51-year-old Portland woman says. “I did have one of the spinal shots. It wasn’t particularly effective.”

Suspicious of surgery, Rinker decided to try a therapy her surgeon hadn’t offered but her primary care physician enthusiastically endorsed: yoga. Working one-on-one with a physical therapist yoga instructor, Rinker learned to practice three simple stretching positions along with breathing exercises and meditation. After about a month of daily practice, Rinker no longer felt crippled by back pain.

“Now I’m back to hiking. I went snowshoeing this winter,” she says.

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Her back pain isn’t gone, but she’s gained the upper hand. “I still feel it. I can usually go home, do one of these stretches and I don’t seem to have a problem.”

With clinical trials now backing up many uses of yoga as therapy, physicians and other mainstream health professionals are giving serious consideration to the 5,000-year-old practice. In the latest national survey by the magazine Yoga Journal, 6.1 percent of U.S. adults said a doctor or therapist had recommended yoga to them. It’s part of a broader acceptance of non-Western healing traditions by U.S. medical schools and health systems. Oregon Health & Science University and Providence Health & Services offer yoga in addition to standard medical care for cancer and other diseases, and both health systems employ physicians who are also yoga teachers.

“I’ve started recommending it to patients pretty regularly for a large number of issues,” says Dr. Meg Hayes, an avid yoga practitioner and an associate professor of family medicine at Oregon Health & Science University. Hayes recently co-authored a journal article reviewing results of clinical trials with yoga and offering advice to physicians interested in prescribing it.

Time, cost pose problems

In Hayes’ experience, most patients are happy to try yoga. The biggest barrier she’s found is the cost and time commitment needed to learn and practice yoga. Group classes range from $10 to $25 a session, less for a package of classes. Private instruction ranges from $50 to hundreds of dollars an hour. And health insurance generally won’t pay for yoga classes.

During office visits, Hayes routinely teaches yoga moves to patients who aren’t familiar with the ancient practice. “If they have low back pain, I might show them a half-pigeon pose,” she says. “Often if we do a little bit of that stretching they start to see right away that they feel better, that there is a move or posture that is available to them and will give them some pain relief right away.”

Unlike medical therapies aimed at fixing one problem, yoga works on many levels at the same time. “You get stronger muscles, you get more flexible joints, you get joints that are better lubricated, the spine lengthens, you breath more deeply,” Hayes says. “All of those benefits combined really help you to be strong, function better and have a sense of emotional well-being.”

In recent clinical trials, yoga improved symptoms of asthma and obstructive pulmonary disease when added to conventional care. Yoga breathing can help lower blood pressure. There’s some evidence that yoga practice during pregnancy can reduce the risk of pre-term labor and low birth weight.

Helping people cope with chronic pain that defies conventional treatment may be yoga’s most significant medical benefit.

Fibromyalgia trial

Bobbie Wethern, who’s lived with fibromyalgia for 20 years, reached a low in 2008. Physical activity became so exhausting she couldn’t climb stairs, clean house or carry laundry. “There were days I couldn’t get dressed,” says the 57-year-old. Wethern, who grew up in South Dakota, never considered yoga a good fit.

“I thought it was for really pretzel-like people,” she says. “I thought it was kind of weird.”

But a trusted therapist suggested she enroll in a clinical trial offering a yoga program tailored for people with fibromyalgia. Wethern volunteered.

Kimberly Carson and her husband James Carson, a clinical health psychologist at OHSU, eliminated some potentially stressful yoga movements and adapted standing poses so they could be performed sitting or lying down. Weekly sessions also included extensive instruction on applying yoga principles to cope with illness. The Carsons and their research colleagues published the clinical trial results earlier this year in the journal Pain.

After eight weeks, women in the yoga group showed significant improvement in measures of pain, fatigue, stiffness, sleep quality, depression, memory, anxiety and balance, while the control group showed none. Wethern cut her pain medicine doses by half. Pain interfered less with sleep. She regained enough stamina to walk five miles and to resume gardening.

“The poses are very, very important and have helped me become more flexible and have more strength, but it’s much more than that,” she says. Yoga breathing techniques help her relax rather than tense up during bouts of pain. While her pain, fatigue and other symptoms are far from cured, meditation has changed her response.

“Yoga teaches you to work through it or allow it to take place rather than resist it,” she says. “That experience was very foreign to me. It felt like years of pressure being removed from my body.

“It’s taken the power of pain away.”

-– Joe Rojas-Burke

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