Introducing Yoga for Healthy Lower Backs to GPs / Public Health / Primary Care / NHS Professionals / Private Healthcare Professionals / Commissioners

‘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/persistent 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.

*Group YOGA (as mind-body exercise) is now recommended 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 a significant amount to the body of evidence influencing the national back pain guidelines recommending for group exercise (including mind-body – yoga) (*November 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) with its associated nationally-approved YHLB training course set up by the yoga researchers.

YHLB offers ‘VALUE’ and fits with NHS Right Care, GP Forward View, NHS 5 Year Forward View, ICS/ICO/STP integrated budget models where care pathways are being redesigned, Health Promotion, Social Prescribing.

• 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 multi-modal 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.)
• Standardized evidence-based course with patient individualization 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 Well-Being 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 specialized 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 training.  British Wheel of Yoga (yoga governing body for Sport England and Sports & Recreation Alliance) have approved YHLB as a ‘Recognized Centre for excellence in training and teaching standards’.  The 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 us 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 Yoga for Healthy Lower Backs 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 –
  -Average Private sector (2019) Total of £219 per person (more in London or group classes smaller than 10), payable in 3 instalments (pre-course, course-start, mid-course).  This includes Resources Pack available from our not-for-profit social enterprise).  Includes teaching fees, hall hire costs, pre-course phone-call, enquiries/registration/bookings, course information sheets, comprehensive educational resources (book, relaxations audio tracks, handouts, etc.), continuity of support, teacher travel time/costs, pre- and post-course outcome measure collation.  In 2018, this still compares favourably to other similar rehabilitation programme costs, i.e. not as costly as specialist nurse-led rehabilitation programmes.
  –NHS/Public Sector Example Costs (2019) – £1250 for 12 course participants on a 12-week course (includes room and specialist yoga teaching fees); Patients/course attendees pay for their own ‘Yoga for Healthy Lower Backs’ Resources Pack via this not-for-profit social enterprise for access onto the course and to ensure quality-assured resources contributing to patients’ lifelong healthy living toolkit. View Commissioning / Public Sector Page.
  -Original Research Trial costs – the Yoga for Healthy Lower Backs programme was valued at £292 pp in 2012 published Spine Journal research). This is currently provided at a lower cost than this in order to reach more people.
• 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.) 
• Cost-Effectiveness – Economic Evaluation paper (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 70% reduction in work absenteeism 3.83 days off work for the yoga group compared to approx. 12.29 days in the non-yoga control group over the 12-month period studied. 
  Link to this August 15th 2012 paper http://journals.lww.com/spinejournal/Abstract/2012/08150/A_Pragmatic_Multicentered_Randomized_Controlled.10.aspx
• Arthritis Research UK‘s report of the University of York‘s press statement August 16th 2012
  

  Yoga: a cost-effective treatment for back pain sufferers?

  See Arthritis Research UK published articles above.

‘Prescribing yoga on the NHS could slash annual £1.37 billion back pain bill,  say experts

http://www.dailymail.co.uk/health/article-2189761/Prescribing-yoga-NHS-slash-annual-1-37billion-pain-say-experts.html#ixzz24CKpXBuy

Many thanks for your interest.

For help with:
accessing and educating about this evidence-based, safe, effective and cost-effective programme with its biopsychosocial approach to helping people to help themselves,
or if you wish to receive, share and file documents such as ‘Information for GPs/Health Professionals’,

receive Trifold Info Leaflets for patients if you have a YHLB Yoga teacher in your location.
– Contact us at [email protected]