Program: Virtual yoga for low back pain

Tegan Taylor: Norman, welcome to my yoga studio. I'm here to talk you through some chair yoga today. 

Norman Swan: Okay, well, I'm sitting on a chair.

Tegan Taylor: Great start, well done.

Norman Swan: What do I do now?

Tegan Taylor: All right, take your left leg and lift it up so that you can cross left ankle over right knee. 

Norman Swan: I thought you were going to…so it's not behind my right ear? It's actually just…okay…

Tegan Taylor: We're starting slow this morning. 

Norman Swan: Okay, yeah, okay, I'm kind of there.

Tegan Taylor: And now you're going to sit tall from your hip bones, let the top of your head rise up towards the ceiling, and then just lean forward slightly, and you'll feel a very deep stretch in your left glute. How does that feel for you?

Norman Swan: Yeah, I've got left buttock stretch, big time. What do I do next, because I'm stuck now. Can somebody come to the studio and help me out here? 

Tegan Taylor: Un-pretzel-ify yourself. I'll let you do your right leg in your own time, so that we're not wasting people's time listening. But I think the point of this is that chair yoga sounds gentle and actually can be quite intense, and that's why it can actually be a really useful intervention for lower back pain. 

Norman Swan: Yeah, and the study that we're going to talk about in a minute is a study of people with chronic low back pain, so they've had it for a long time, and yoga face-to-face has been shown to improve low back pain outcomes. The thing is that not everybody can get to a class. Is it scalable? Not every yoga teacher has been trained therapeutically. If you did it on a screen with almost unlimited people tuning in, could you get the same sort of benefit? And that's the study that this particular group have looked at. And the researcher I spoke to was Dr Hallie Tankha who is a clinical pain psychologist at the Cleveland Clinic in the United States.

Hallie Tankha: We have conducted multiple studies on yoga for chronic low back pain, and what we know is that it is highly effective for back pain, it improves the experience of pain, it improves function, improves sleep. And this is all when people attend in-person yoga classes.

Norman Swan: And just before we go on, when you say chronic low back pain, how long did people have their back pain? Just give us a sense of what people were experiencing before they went into the study. 

Hallie Tankha: It's anywhere from people that have back pain from anywhere from three to six months, all the way up to 15 and 20 years. 

Norman Swan: And there are lots of different flavours of yoga. What yoga were they getting in the face-to-face?

Hallie Tankha: Hatha Yoga.

Norman Swan: And where does that fit in the yoga spectrum? Is it upside down with 40-degree temperatures, or just fairly straightforward?

Hallie Tankha: Sometimes participants or patients get confused, they think they're going to be getting hot yoga, or the kind of yoga that you would normally get at a gym. This is very different. So our yoga instructors are yoga therapists, and so it's very therapeutic. So Hatha Yoga is modified, so a lot of it is sitting in chairs, a lot of chair poses, things that are very safe, calming, relaxing, gentle stretching and gentle movement that builds in intensity over the course of the 12 weeks.

Norman Swan: So what you did in this study was you did it…rather than face-to-face, it was live streamed, wasn't it.

Hallie Tankha: Exactly, and the participants could all see each other and could see the yoga instructor. 

Norman Swan: So there was an interaction here. What sort of dose did they have of the yoga over time? 

Hallie Tankha: Each live class was 60 minutes and it was over 12 weeks. 

Norman Swan: What were the findings?

Hallie Tankha: People that engaged in the yoga, their pain was almost cut in half. We measured their pain at three months, and then again at six months. And people started, on average, at a six out of 10 pain rating scale. And at three months, directly after the yoga intervention, they reported about a four out of 10. And then three months later after that, they reported a three out of 10 pain. So their pain was cut in half. 

They also improved in functioning, so their ability to climb stairs, carry groceries, things that their low back pain would normally interfere with on a day-to-day basis, they improved their functioning. And they also improved sleep. And we saw that yoga potentially reduced the reliance on pain medication, because people in the yoga condition were using 30% less pain medications at 12 weeks. 

Norman Swan: There are lots of elements to this. There's the yoga, there's the love and attention from an online instructor, and there's a sense of group and group identity about this. How much of it is actually the yoga? 

Hallie Tankha: That's a wonderful question. And as you know, I'm a clinical pain psychologist by training, so I'm very interested in the psychological effects of yoga, and also of social support and being with other people with your same condition, so with low back pain, who understand what you're going through and know how challenging the condition is. And so there's an element of that social support, of the psychological effects of yoga, of the breath work, of sitting with hard things, both emotionally and physically, and yoga gives an opportunity to touch on all of that, in addition to physical strengthening and stretching. 

Norman Swan: And you got involved in the chair yoga because you wanted to tone yourself up as an office worker.

Hallie Tankha: Absolutely. So, as a researcher, I'm constantly sitting in my office chair. I have a standing desk, but I often feel like I get stuck in my chair a lot. So these poses are just so accessible and so easy and so simple to do, just even when I'm sitting and even in meetings and on a call, to do some gentle stretching. 

Norman Swan: Was there any harm? 

Hallie Tankha: We did not find any harm. The instructors and the therapists were giving people modifications. So, for example, if they were in a downward dog position, or if they were doing a pose on one leg and someone did not feel safe or sturdy enough to do so, the yoga instructor would say, hey, grab a chair, balance yourself, you could do this modified pose, and that was a way to really prevent any sort of harm, and also wanting to keep people's confidence in their yoga abilities if they can't do some certain positions that the therapist was asking them to do.

Norman Swan: There are lots of people with chronic low back pain. How practical is this to scale up, and how safe is it to scale up, given that there's lots of virtual yoga online, not live?

Hallie Tankha: We really believe that this is scalable, and the barriers that we have seen in the United States is a lack of providers and patients knowing about yoga for low back pain and knowing about the evidence for low back pain. And so what we're hoping is that yoga can really be added to these primary care providers' list, like a menu. And so that is our goal, to get some insurance on board and to get our providers on board, to really give more patients access.

Norman Swan: And just finally, somebody listening to this might go out into the marketplace and Google 'therapeutic yoga', so are there any risks in just trying out an app?

Hallie Tankha: It all depends on your condition, and so the recommendation we always give is really talking to your primary care provider if this is a safe treatment for you.

Norman Swan: Thank you very much for joining us.

Hallie Tankha: Thank you so much for having me. 

Norman Swan: And that was Dr Hallie Tankha, who's a clinical pain psychologist at the Cleveland Clinic.