“This evidence-based yoga programme could (or should!) be the way forward for back pain treatment. It is affordable, empowers patients and offers long-term benefits to society.” “Now it has been shown that this once-off self-management 12-week treatment would save costs within an NHS setting – what are we waiting for?”
Click here for our Yoga for Healthy Lower Backs Trifold Info Leaflet vMay2016 (2)
The ‘Yoga for Healthy Lower Backs’ programme offers a multi-modal/combined/mind-body treatment option for chronic / episodic / recurring low back pain. It includes *relaxation *muscle strengthening *stretching * joint mobility and alignment *postural awareness *mindfulness *back education *philosophical aspects for positive attitude * breathing techniques *health promotional techniques that can be integrated into daily life. As an all-round general beginners programme, it is likely to also help improve stress-related conditions, and not just lessen the intensity/duration/frequency of low back pain.
With many GPs, physiotherapists and health professionals now recommending ‘yoga’ generally to those with back pain, we wish to make sure that it is appropriate, safe and effective, quality yoga (preferably EBM) that they signpost or refer to.
We believe this specific, evidence-based, ‘best practice’ yoga programme, with its good structure and educational resources, taught by experienced teachers, offers one of the best self-management patient choices.
NICE Guidelines for Low Back Pain Draft mentions Yoga and Yoga for Healthy Lower Backs. Our University of York / Arthritis Research UK clinical trials research papers (H. Tilbrook, H. Cox, LH Chuang) contributed very significantly to the body of evidence that led to NICE mentioning ‘yoga’ in its Press Statement on 24th March 2016. Copy and paste – https://www.nice.org.uk/news/press-and-media/exercise-not-acupuncture-for-people-with-low-back-pain-says-nice-in-draft-guidance
EBM 12-week course of gentle beginners specialized Yoga
‘Yoga for Healthy Lower Backs’ (YHLB)
An evidence-based, cost-saving, health-promotional, long-term treatment option for a prevalent chronic condition with integrated Health and Social Care potential.
‘Yoga for Healthy Lower Backs’ 12-Week Course – An Introduction for GPs/Health Professionals/GP Surgery Practice Managers/Commissioners www.yogaforbacks.co.uk
‘YOGA for Healthy Lower Backs’ (YHLB) is a 12-week specialised group yoga course. It is an evidence-based, self-management, long-term health promotional programme shown in research to be safe and significantly effective for recurring/chronic/episodic low back pain. Suitable for beginners, but also helpful to those with previous yoga experience, it enables course attendees to appropriately and gently improve their physical and mental health.
*YOGA recommended by NICE as a first step treatment for managing low back pain*
‘Yoga for Healthy Lower Backs’ is the identification name of the ‘best practice’ yoga programme developed by back-care yoga specialists (led by Cornwall-based Alison Trewhela, yoga teacher for 30+ years and University of Exeter Medical School Specialist Tutor), and overseen by medical experts, for a 2007-2010 pragmatic multi-centred randomised control trial (RCT) led by York Trials Unit, Department of Health Sciences, The University of York. Three of the six associated published papers (H. Tilbrook et al, Annals of Internal Medicine 2011, H. Cox et al Complementary Medicine in Clinical Practice 2012, LH Chuang et al Spine Journal 2012) contributed the most significant amount to the body of evidence influencing the NICE group yoga recommendation (*24 March 2016).
Uniquely this same evidence-based YHLB programme is available nationwide in the UK, thanks to the research funding charity, Arthritis Research UK, and a social enterprise (yogaforbacks.co.uk) alongside its associated nationally-accredited training school (The Yoga for Healthy Lower Backs Institute) set up by the yoga researchers.
YHLB offers ‘VALUE’ and fits with NHS Right Care, GP Forward View, NHS 5 Year Forward View, Social Care integrated budget restructuring models, Health Promotion.
- Suitable for those with history of low back pain (in the original research, NHS GP surgeries recruited patients who had presented with back pain within the last 18 months; 10 years of back pain was the average duration). Suitable for those finding it difficult to become more active, and/or to exercise, due to injuries, multiple health issues, general lack of physical fitness, fear/anxiety or Yellow Flags (STarTBACK Questionnaire).
- Benefits for GPs – 75% of back pain patients re-present to GPs within a year (= ‘heart-sink’ patients). YHLB-referring GPs report that it is good to be able to signpost to an evidence-based, community-based, actively positive, gentle and user-friendly mind-body course with long-term outcome and health promotional aims.
- **Cost Benefits to GPs and NHS – When analysing over 117,000 GP patients, London College of Economics and Political Science showed that generally. Back Pain patients cost the NHS twice as much as the typical patient without back pain (£1074 versus £516 per annum).**
- Single ‘once-off’ yoga course – 12 x 75 minute weekly classes motivate attendees to form a habit of appropriate, effective home yoga practice, and encourage positive long-term lifestyle and behavioural changes. Within one multimodal or combination treatment package of care, YHLB addresses the physical, emotional, mental and social aspects of the ‘biopsychosocial’ nature of back pain.
- Group support (YHLB n=7-10) aids motivation and outcomes. (NICE recommends supervised group exercise, including mind/body = yoga.)
- Standardised evidence-based course with patient individualisation via ‘allowable’ yoga modifications. Teachers are taught how to recognize Red Flags and when to refer back, or on.
- Kind and gentle approach to teaching YHLB – Teachers show course attendees how to appropriately progress from extremely gentle pain-relieving positions, and relaxation and breathing techniques on to educative poses that help them to gradually improve posture, mindfulness / mental focus, muscular strength and flexibility, learn well-aligned mobility, healthy breathing and a positive philosophical approach to life.
- Fully-resourced to enable long-term ‘happy and healthy’ outcomes – Patient ‘resilience’ is bolstered not only by the classes themselves, but by the comprehensive evidence-based resources – the student manual (published YHLB book), 4-track relaxations CD, home practice sheets, hand-outs. An evaluation study shows that YHLB is performing better than in the original trial (+3 improvement on RMDQ; +6.1 improvement on RMDQ for those with baseline score of 7+ as per original trial) and that attendance/compliance has increased to mean 8.5 classes. In our trial, a year after beginning the YHLB course, 60% were doing the recommended 30 minutes per week of home yoga practice. Yoga is an enjoyable and popular activity.
- Health and Wellbeing life-long holistic tool-kit – YHLB teaches people with a history of back pain to not only lessen the frequency, duration and intensity of pain episodes, but it also teaches them to take ownership of improving multiple aspects of their health and well-being, e.g. stress-related conditions / MSK conditions / arthritis / diabetes / headaches / IBS / CFS / high blood pressure / respiratory problems / obesity / menopausal or menstrual symptoms / anxiety / depression. They learn to create these positive side-effects themselves by practising gentle holistic yoga at home and by integrating simple yoga techniques into their daily lives – in a recent study there was a 63% improvement in attendees feeling post-YHLB course that they were able to ‘control and cope with their back pain on their own’.
- Continuity of high quality care – the same specialised yoga teacher for 3+ months, plus additional extra-curricular support and contact sessions, e.g. pre-course registration process including phone call, pre- and post-class individual contact time, between class email/phone contact when necessary. Opportunity to refresh motivation, confidence and knowledge by attending extra post-course classes (at a reduced fee).
- The Evidence – Effectiveness YHLB was shown in peer-reviewed published research to significantly improve function at 3 months, and that improvements were maintained at the 12 month follow-up point. It was shown to be a top treatment, when compared with other similarly rigorously-tested, currently-available treatments: via a published ‘Forest Plot’ showing ‘indirect comparison’ to manipulation by physiotherapists/ chiropractors/ osteopaths, physiotherapist exercise classes, manipulation followed by supervised exercise (UKBeam trial), CBT, 6 classes of one-to-one Alexander Technique, massage, educational booklets, ‘usual’ NHS care.
- Evidence – Cost-Effective for NHS – Spine Journal paper showed that YHLB would be cost-effective if offered within the NHS, compared to a package of physiotherapy or a hospital-based group rehabilitation programme.
- Evidence – Cost-effective for Society and the Workplace – YHLB is a dominant treatment from the societal perspective. Reduced work absenteeism by 70% over 12 months studied is evidence of self-management. Those ‘offered’ the YHLB course (intention to treat model) had on average only 3.83 days off work compared to 12.29 in a ‘control’/non-yoga group over 12 months studied. Published cost-effectiveness research shows £817 costs per person over 12 months could be saved by employers in productivity lost for those offered the course (based on average UK salary).
- Knowledge Transfer with Quality Assurance, Regulation and Governance – Uniquely, in order to allow this research to benefit those with back pain and referrers looking for an innovative long-term multifaceted approach, the original yoga trial specialists (Alison Trewhela aided by Anna Semlyen) have enabled the ‘rolling out’ of this evidence-based YHLB course by the setting up of a social enterprise – yogaforbacks.co.uk – and a British Council for Yoga Therapy approved training school – Yoga for Healthy Lower Backs Institute. British Wheel of Yoga (yoga governing body for Sport England and Sports + Recreation Alliance) have accredited the Institute as a ‘Recognized Centre for excellence in training and teaching standards’. This Institute’s Teacher Register (yogaforbacks.co.uk – Find a Teacher Page) only lists already-qualified and experienced yoga teachers who have additionally trained via their 300-hour mentor-supported Yoga for Healthy Lower Backs Teacher Training Course. These teachers are supported by the Institute with mentoring, buddy-up, CPD, professional newsletters (overlaid on that regulation, governance and support offered by their original training schools). Many YHLB teachers are also on the PSA approved CNHC Register.
- Arthritis Research UK continues to support this programme and be peripherally-involved in yogaforbacks.co.uk / YHLB Institute post-research development projects. Business agreements are in place with them and The University of York regarding the income from book and CD sales (to enable more research, potentially into yoga).
- Course Costs – Total of £200-£292 per person, payable in instalments (includes £56 for Registration & Resources which patient might pay for) includes hall hire costs, pre-course Registration process, course information sheets (specific course and trifold general information leaflet), comprehensive educational resources (book, CD, handouts, etc.), continuity of support, teacher travel time/costs, pre- and post-course outcome measure collation. This is currently provided at a reduced rate in order to reach more people, as it was valued at £292 in 2012 published Spine Journal research).
- Guaranteed 12 classes – if students miss classes, they can generally ‘catch up’ by attending future course classes (Normally maximum of 12 students at each class.)
How can GPs / health professionals introduce the ‘Yoga for Healthy Lower Backs’ (YHLB) 12-week course to patients?
– Give patients a YHLB Trifold leaflet (paper and/or digital version… The YHLB Trifold Information Leaflet is available in digital version on the Promotions page of the www.yogaforbacks.co.uk and we can provide them). Guide them to the www.yogaforbacks.co.uk website which includes a course overview video.
– Explain that with a YHLB course they will get exactly the same as in the successful research and that YHLB Institute teachers are self-employed, well trained and experienced with extra specialised back-care yoga training.
– Explain that NICE guidelines (low back pain draft March 2016) recommends supervised group exercise as a ‘first step to managing back pain’ and that this cost-effective once-off course (especially compared to reliance on regular/repeat manipulative/soft tissue treatments) will ‘empower patients to help themselves to improved health’ forever, whilst addressing the physical and emotional/mental aspects of back pain
– Explain that it offers a very gentle and kind approach to beginning to exercise, with the added benefit of also teaching relaxation skills. YHLB could additionally help other co-existing stress-related MSK and stress-related conditions.
– Explain that patients may have to wait a while for a course start-date, as they did in our trial, and also that is best not to begin the course when they are experiencing a particularly acute back pain phase.
– Mention that employers/workplaces will often offer time off work to attend the course (and sometimes pay for or subsidize the course cost) due to its proven work absenteeism 70% reduction.
– Know that men like the ‘learning to be in control of my back condition’ and ‘just 12 weeks’ aspects of YHLB.
– Those who want to help themselves for the present and also the future and those who want to feel in control of preventing or lessening their back pain (rather than relying on others to help them), will do especially well on this educative course. Also those who have tried multiple approaches are likely to find this helps them to ‘turn a corner’.
– Begin the conversation easily by introducing the free single track ‘Simply Relax’ App, which offers up the YHLB Relaxations CD Track 1 (also includes an Urdu language version commissioned by Sheffield CCG), speaking about how back pain which ‘unhelpfully hangs around’ may be influenced by stress factors (exciting/challenging/unwelcome life/work/family events/situations) and saying how the YHLB course might help considerably. Please ASK for information about accessing this free App if you are an NHS GP – firstname.lastname@example.org.
Thank you for understanding the importance of signposting to these specific, high-quality, appropriate and specialised evidence-based ‘Yoga for Healthy Lower Backs’ 12-week courses. Just recommending ‘yoga’ is not helpful enough, because many yoga classes:-
might be too strenuous/sedentary/advanced for those with back pain;
will be unlikely to be taught by sufficiently and/or specifically back-care trained specialised yoga teachers;
would be unlikely to have a well-structured patient-enabling course taught according to 12 class plans over 12 weeks for long-term self-management and positive behavioural changes;
will be unlikely to identify how to modify and personalize the yoga for individual back condition needs;
will not provide an evidence-based toolkit to enable long-term self-help, i.e. the book, relaxations CD, home practice sheets, pain-relieving ‘menu’ sheet, hand-outs, home practice timetable, etc.).
A ‘Mission Statement’ is available showing how YHLB could help within integrated Adult Health and Social Care. This includes research references and Testimonials from health professionals and YHLB course attendee Case Studies. For a copy – Ask Alison at email@example.com.
Alison Trewhela, Yoga Researcher, Yoga Teacher and Director of Yoga for Healthy Lower Backs Institute
YOGA for Healthy Lower Backs Institute (nationally-accredited by UK governing body British Wheel of Yoga as a Recognized Centre for excellence in training and standards), Director and Principle Tutor, yogaforbacks.co.uk
Social enterprise: Yogaforbacks.co.uk (University of York / Arthritis Research UK knowledge transfer project)
Specialist Tutor for Yoga and Research for University of Exeter Medical School
Yoga Teacher and Researcher – www.yogatrewhela.co.uk
CNHC, IYUK, ICNM, S-BRCP, BWY, BCYT, BackCareUK Associate Professional Member
* NICE Press Statement of 24 March 2016
‘Exercise not acupuncture for people with low back pain says NICE in draft guidance
NICE is updating its 2009 guidance on the early management of low back pain and has today published draft recommendations for public consultation.
The draft guideline recommends exercise, in all its forms (for example, stretching, strengthening, aerobic or yoga), as the first step in managing low back pain.
Massage and manipulation by a therapist should only be used alongside exercise because there is not enough evidence to show they are of benefit when used alone……..’*
** Arthritis Research UK reporting on research into the NHS financial burden of patients with back pain http://www.arthritisresearchuk.org/news/general-news/2013/january/uk-study-shows-high-cost-of-treating-back-pain.aspx
‘UK study shows high cost of treating back pain Published on 04 January 2013
…..In total, they looked at data on 64,167 patients with chronic low back pain and a further 52,986 patients who were pain-free between 2007 and 2009.
…. total health care costs for patients with back pain were double those for patients without back pain.
On average, the financial burden of caring for a patient with low back pain in the 12 months following their diagnosis was £1,074, compared with just £516 for a typical person without back pain.
Almost three-fifths (58.8 per cent) of this cost difference was due to additional GP consultations, with another fifth (22.3 per cent) due to referrals to secondary care and the remainder accounted for by the cost of pain medications.
… the findings do not take into account the indirect costs associated with low back pain, nor the expense of over-the-counter medications or lack of adherence to treatment.
… in Spine journal, the study authors concluded: “Our findings confirm the substantial economic burden of chronic low back pain, even with direct costs only.”
A spokesman for Arthritis Research UK…commented: “Chronic back pain is the scourge of modern western society and is a huge burden to the NHS.
“There are a number of treatments, including painkillers and exercise, and our research has also established that yoga (http://www.arthritisresearchuk.org/news/press-releases/2011/november/yoga-aids-chronic-back-pain-sufferers.aspx) can help people whose back pain becomes chronic (long-term).”
Objectives and Potential of ‘Yoga for Healthy Lower Backs’ Programme:-
- Improve the health of those with chronic and recurring low back pain. The charity, Arthritis Research UK (funders of the original high-profile yoga for back pain randomized controlled trial) and The University of York support this research ‘translational’ project (Annals Intern Med3).
- Show best practice partnership-working during implementation of integrated services – perhaps with 3-way (NHS, Council and patient) sharing of costs in commissioning of evidence-based YHLB courses. Save NHS, Councils, Government, societal and economic costs by offering a high value, self-management, educative treatment option with the potential to offer wide-ranging, long-term, positive outcomes. It showed an average 70% reduction in work absenteeism over 12 months, showing how the YHLB course motivates and teaches good self-management skills (Spine2).
- Help prevent ‘NHS patients’ with chronic/ episodic/ recurring low back pain in Primary Care settings ‘falling into’ costly Secondary Care. Our research showed YHLB would be likely to be cost-effective if offered within the NHS compared to current care pathway treatments2.
- Give a ‘hand up out of’ NHS Secondary Care, with YHLB’s gently-progressing, multi-modal (biopsychosocial) approach, to patients with non-specific, but nevertheless disabling, low back pain3.
- Build patient ‘resilience’ to improve quality of life, and to help people to become more active whilst living longer, happier and healthier lives. YHLB proactively addresses ‘secondary preventative care’, i.e. improvement and prevention of co-existing conditions along with back pain, e.g. diabetes, obesity, depression, high blood pressure, and stress-related and musculoskeletal conditions.
Download list of research papers here. Research Evidence for Yoga for Chronic lbp Oct2014
The specialized gentle Yoga for Healthy Lower Backs 12-week fully-resourced course offers:-
1. Long-term improvements for those with a history of low back pain, plus benefits for the whole person (body and mind);
2. Health and Wellbeing / Health Promotion (this gentle, beginners’ appropriate yoga helps people to have the confidence to get back to being physically active and encourages positive mental health);
3. Self-management and resilience (with yoga home practice sheets, Relaxations CD and manual) – the majority in our research were still practising yoga at home the recommended amount (30 minutes twice a week) at the 12-month follow-up;
4. Fully-resourced (educational resources available from Arthritis Research UK charity-funded research; trained teachers available);
5. Safe and enjoyable group activity in the community (patient choice);
6. Specifically trained, experienced yoga teachers adhering to the programme (with understanding of back dysfunction, individual patient needs, medical terminology, Inclusion Criteria, Red Flags and more);
7. Cost-effectiveness / cost savings for the NHS, society and individuals – potential shown in ‘Cost Evaluation’ published paper – University of York (Spine). Savings likely to be even more impressive as patients only need one 12-week course to continue to self-manage for longer than the 12 months studied in our research;
8. One of the most effective, similarly rigorously-tested treatment options currently available (shown in Forest Plot graph Annals of Internal Medicine);
9. Education of patient – posture, lower back function, breathing, mental perspective, pain perception – with advice on how to use this information throughout daily life;
10. QIPP and other Department of Health health provision improvement initiatives can be addressed;
11. Evidence of long-term self-management – those offered the 12-week yoga course had an average of only 3.83 days off work over the 12 months studied compared to 12.29 in the non-yoga group;
12. Benefits to NHS staff, e.g. courses offered to hospital staff to reduce absenteeism by potential of 70%.
On this website find out more about our research as follows:-
- The University of York, Department of Health Sciences, York Trials Unit’s rigorous RCT research led by Prof. David Torgerson adds more evidence to show that yoga decreases non-specific chronic / episodic / recurring low back pain. This research was generously funded by the charity Arthritis Research UK and they are supportive of our endeavours to make this research have the impact it deserves for the benefit of others.
- Link from our Home Page to our Nov 1st 2011 main RCT results paper published in ‘Annals of Internal Medicine’, showing appropriate, specialized group yoga classes (our fully-resourced ‘Yoga for Healthy Lower Backs’ programme) to be a ‘safe and effective treatment option that clinicians should consider recommending for patients with a history of chronic or recurrent low back pain’.
- Newly published Economic Evaluation paper (Abstract March 16th 2012; Full paper August 15th 2012) in ‘Spine’ Journal, shows ‘Yoga for Healthy Lower Backs’ would be likely to be cost-effective within the UK NHS and of great value to society and the economy, e.g. an average of 3.83 days off work for the yoga group compared to approx. 12.29 days in the non-yoga control group over a 12-month period. Follow the link to the Abstract here:- http://www.ncbi.nlm.nih.gov/pubmed/22433499. For link to full published paper (N.B. subscription or purchase only; not open access) click here http://journals.lww.com/spinejournal/Abstract/2012/08150/A_Pragmatic_Multicentered_Randomized_Controlled.10.aspx . For a link to Arthritis Research UK’s report of the University of York’s press statement August 16th 2012 – click here http://www.arthritisresearchuk.org/news/press-releases/2012/august/yoga-a-cost-effective-treatment-for-back-pain-sufferers.aspx .
- Short video film giving an overview of the ‘Yoga for Healthy Lower Backs’ classes. ‘Annals of Internal Medicine’ requested that we make this film for use as a supplement to the online published paper and this links from their site. Link top right or top bar Video Page (Video 1).
- Our published Trial Protocol paper ‘A pragmatic multi-centred randomized controlled trial of yoga for chronic low back pain: trial protocol’ Helen Cox, Helen Tilbrook, John Aplin, Ling-Hsiang Chuang, Catherine Hewitt, Shalmini Jayakody, Anna Semlyen, Marta O Soares, David Torgerson, Alison Trewhela, Ian Watt, Gill Worthy, is found at ‘Complementary Therapies in Clinical Practice’ (2010).
- Other research into low back pain as background to, plus support for, our Research Findings. View our Research Page.
- Tri-fold Information Leaflet, Powerpoint Presentation (health professional version ready soon), links to press coverage and more on our Promotional Resources Page.
- Details of these cost-effective group ‘Yoga for Healthy Lower Backs’ courses that have the potential to provide long-term as well as short-term improvements – enabling patients to self-manage with potential added health benefits, e.g. less depression, improved joint alignment and muscular balance, less headaches, lower blood pressure.
- All ‘Yoga for Healthy Lower Backs’ yoga teachers listed on our website are already qualified yoga teachers from various yoga schools and methods with considerable teaching experience. Whilst training, they attend four training days (2 + 2), study and practise the yoga programme extensively at home over approx. a 6-month period, and are mentored and supported throughout the time that they teach their first course (Approx. 135 hours total training time). (Courses are 6 weeks, mid-course break, plus 6 weeks.) Ofqual course accreditation is being worked on. CPD is in place.
- The published pilot trial paper ‘A randomised controlled trial of yoga for the treatment of chronic low back pain: Results of a pilot study’ Helen Cox, Helen Tilbrook, John Aplin, Anna Semlyen, David Torgerson, Alison Trewhela, Ian Watt can be found at Complementary Therapies in Clinical Practice, 16 (2010) 187-193.
- Sales of the Relaxations CD help fund this Website and the yoga programme development work of our social enterprise Yogaforbacks.
- Contact firstname.lastname@example.org for discussions about potential in your region, especially with regard to Public Health, NHS/CCG and Health and Wellbeing Board and Adult Social Care partnership working.
- New ‘Physiotherapy’ Journal paper published 14th Feb 2014, shows those compliant had even greater improvements than our original ‘intention to treat’ efficacy results. Each dose (class) of yoga gave additional benefit for long-term outcomes.
- Arthritis Research UK have featured us twice in their ‘Arthritis Today’ magazine and also in their ‘Synovium’ Newsletter which goes out to Health Professionals.
- HUMAN RESOURCES / OCCUPATIONAL HEALTH personnel can visit our Healthy Workplace Page to find out how the Relaxations CD would be a potentially useful educational resource for employees. Also for information about how our one-off, group basis, 12-week course would be likely to decrease work absenteeism by approx. 70%, as well as offering long-term benefits contributing to health and wellbeing in the workplace.
Contact us, via our contact page, for help with provision of this evidence-based biopsychosocial, safe, effective and cost-effective treatment with the aim of arranging to provide a team of trained yoga teachers in your locality. We are aiming to have teams of teachers working as part of multidisciplinary teams teaching this 12-week ‘Yoga for Healthy Lower Backs’ courses within Primary Care NHS settings.
Many thanks for your interest.
The ‘Mail on Sunday’ picked up the Press Release Statement sent out by The University of York and reported on our recently published cost-effectiveness paper in Spine journal like this – follow the link below.
‘Prescribing yoga on the NHS could slash annual £1.37billion back pain bill, say experts
- Bad back sufferers taking part in the yoga programme had far fewer days off work than those in the control group By Claire Bates
PUBLISHED:12:33 GMT, 17 August 2012| UPDATED:12:33 GMT, 17 August 2012′
Arthritis Research UK reported it like this – read below or follow link http://www.arthritisresearchuk.org/news/press-releases/2012/august/yoga-a-cost-effective-treatment-for-back-pain-sufferers.aspx.
Yoga: a cost-effective treatment for back pain sufferers?
Specialised group yoga classes could provide a cost-effective way of treating patients with chronic or recurrent low back pain, according to the UK’s largest ever study of the benefits of yoga.
Funded by Arthritis Research UK and led by the University of York, the study provides an evaluation of a specially-developed 12-week group yoga intervention programme compared to conventional general practitioner (GP) care alone.
The results published in Spine, show that the yoga intervention programme – ‘Yoga for Healthy Lower Backs’ – is likely to be cost effective for both the UK National Health Service (NHS) and wider society.
The cost assumed for yoga intervention is important in determining whether this is an efficient use of NHS resources. As yoga classes are not currently available through the NHS, the researchers examined a range of possible costs. They conclude that if the NHS was to offer specialist yoga and managed to maintain the cost below £300 per patient (for a cycle of 12 classes), there is a high probability (around 70 per cent) of the yoga intervention being cost effective. Researchers also found that those taking part in the yoga programme had far fewer days off work than those in the control group.
On average, a control group participant reported 12 days off due to back pain, whereas those in the yoga group had four days off. The cost associated with taking time off was £1,202 for a control group member, compared with £374 for a yoga group member. The study was carried out by researchers from the University of York’s Department of Health Sciences and the Centre for Health Economics, and the Hull York Medical School.
Chief Investigator Professor David Torgerson, Director of York Trials Unit, in the University of York’s Department of Health Sciences, said: “Back pain represents a significant burden to the NHS in the UK and to society as a whole. As well as the associated health care costs, it is also a major cause of work absenteeism which leads to a productivity loss to society. “While yoga has been shown as an effective intervention for treating chronic and low back pain, until now there has been little evidence on its cost effectiveness. In our study we evaluated a specially-designed yoga class package by using individual-level data from a multi-centred randomized controlled trial. On the basis of the 12-month trial, we conclude that 12 weekly group classes of specialised yoga are likely to provide a cost-effective intervention for the treatment of patients with chronic or recurrent low back pain.”
Back pain is estimated to cost the NHS £1.37 billion and the health care sector £2.10 billion a year. It is also one of the most common conditions treated in primary care in the UK with about 2.6 million people seeking advice from their GP about back pain each year.
Professor Alan Silman, medical director of Arthritis Research UK, said: “We welcome the fact that not only has yoga been found to help people manage their back pain, but that it is also cost effective, and results in fewer sick days. It is another option for people who are struggling to manage their condition, and one that encourages the move to self-management. Yoga is an intervention that has been proven to make their everyday lives easier and their pain more manageable. “We’d hope that on the back of this, more people with back pain are encouraged to take up the yoga programme.” The trial involved two groups of people who were identified as having chronic or recurrent back pain. A group of 156 people were offered group yoga classes specially designed to improve back function, while a second control group of 157 people received GP care alone. Both groups received usual GP care, which could have involved, for example, referral to pain clinics and physiotherapists or prescription of painkillers.
The 12-week yoga programme was delivered by 12 experienced yoga teachers. It was designed by Alison Trewhela, an Iyengar Yoga teacher and senior practitioner in yoga on the British Register of Complementary Practitioners, in collaboration with yoga teacher Anna Semlyen, a back care advisor to the British Wheel of Yoga.
Alison Trewhela said: “GPs and commissioners are showing great interest in this yoga programme. Many consider it could be the primary treatment option because it offers long-term positive outcomes, as well as a multi-disciplinary combination of taught skills that suits the bio-psycho-social nature of the condition of chronic low back pain. “Within its confidence-boosting, gradually-progressing environment, the gentle ‘Yoga for Healthy Lower Backs’ course addresses joint mobility, muscle-strengthening, emphasis on the breath, mental attitude to pain and perspective on life lessons, postural awareness and low back education, relaxation techniques, and advice about other potentially health-giving techniques and benefits.”
More information on the York Trials Unit’s randomized controlled trial is available at www.yogatrial.co.uk. Lower back pain sufferers, yoga teachers and health professionals can also learn more about the ‘Yoga for Healthy Lower Backs’ programme at www.yogaforbacks.co.uk, a website created by the yoga teachers involved.