Introducing Yoga for Healthy Lower Backs to GPs / Public Health / Primary Care / NHS Professionals / Private Healthcare Professionals / Commissioners
“It is affordable, empowers patients and offers long-term benefits to society.”
NHS / Public Sector Enquiries – Email [email protected] (Our Project Manager for YHLB in Public Sector, Barbara, will be able to help you co-ordinate finding teacher(s) and setting up course(s).)
‘YOGA for Healthy Lower Backs’ (YHLB Yoga)
12-week Evidence-based Course
Empowering people to help themselves to improved long-term comfort, health and well-being.
Mind-body approach, gentle, enjoyable, effective, educational, beginner-friendly, taught by highly-qualified teachers. Attendees learn to help themselves to improved comfort, health and well-being. Already proven to be safe, effective, cost-effective.
Unique, well-structured, specialised yoga course with life-long toolkit (EBM Resources Pack)
Group exercise, with physical/psychological long-term self-management approach, now recommended for low back pain (NICE, Public Health England, Lancet) – YHLB Yoga offers this.
Health-promotional programme teaches self-care skills (healthy ageing/living). Social Prescribing.
Randomised control trial; University of York / Arthritis Research UK (Annals Int. Med., Spine, Physiotherapy Journals).
Original Yoga for Healthy Lower Backs Research findings
– Significant reduction in work absenteeism (70% over 12 months), equating to average workplace savings of £800 pp pa (after paying for cost of self-management course). Shows potential for long-term self-management of this prevalent condition.
– More effective than other rigorously-tested treatment options; 30% significant improvement in daily function; significant improvements in Pain and Self-efficacy (Annals of Internal Medicine). Long-term.
– Cost-effective for NHS provision and from societal perspective (Spine Journal)
Group Case Studies of Yoga for Healthy Lower Backs show:
– 63% Reduction in pain affecting work
– Reduction in pain meds.; 75% improvement in function in NHS Primary Care Trust staff.
– Mental health improvements; Multiple health condition improvements
– 63% improvement in being able to control / cope with their back pain by themselves – Turning back pain patients into non-back-pain patients can save £500 pp pa (according to study).
YHLB Yoga Course Attendee Quotes
“A life-changing experience, after years of frustration.”
“My back pain no longer controls me.”
“No more visits to A&E.”
“My blood pressure and shoulder have improved. I feel more positive.”
“This course has been so beneficial to my back, but also for me mentally.”
“I know what to do at work to help myself now.”
National Support and Strategic Fit:
– Public Heath England, ARMA, Arthritis Research UK/ Versus Arthritis, Healthy London support YHLB Yoga’s approach. PHE MSK ROI tool/report lists this specific programme as offering a good return on investment £10:1. Social Prescribing / Workplace Health / Return to Work / Personal Health Budgets / Community / Mental Health / Physical Activity / Self-Care / Long-Term Conditions.
As Featured on National TV:
ITV’s Tonight programme (national TV Feb. 2019) – ‘Back Pain – Britain’s Unseen Crisis‘ featured this specific Yoga for Healthy Lower Backs programme. YHLB enabling people to get back to being more active.
https://youtu.be/dBiir8yJomk Feb2019 (ITV Tonight 3½ mins Julia Moore teacher)
Two ‘Outstanding Contribution/Achievement’ national awards for programme designer (CAM; yoga); national yoga governing body of Sport England (British Wheel of Yoga) recognition of excellence in training and standards; Lifestyle Medicine (poster)
Excellent Outcomes for NHS Schemes Providing Yoga for Healthy Lower Backs 12-week courses
– Many successful NHS schemes for patients, staff /workplaces (See Case Studies page)
– Specialised group exercise offering an evidence-based ‘Tier 3’ programme (as in PHE/NHSE/DoH/ARUK’s ‘Physical Activity Implementations for those with Musculoskeletal Conditions’
– Healthy London Partnership scheme offering fully-funded ‘Yoga for Healthy Lower Backs‘ courses (NHS Improvement project – long-term self-management of mental health and MSK conditions)
– Council part-funding (e.g. course attendees pay for their own Resources Pack and Council pays for teaching and/or provides the room).
Signposting and Referring (more on other pages)
GPs, pain/physio/spinal consultants and other health professionals are increasingly signposting strongly to this specific gentle ‘Yoga for Healthy Lower Backs’ programme.
Thank you for ensuring that it is appropriate, safe and effective, quality-assured ‘specialised evidence-based yoga’ like this ‘Yoga for Healthy Lower Backs’ 12-week course that is signposted or referred to.
Helpful for Mental Health Patients with Persistent Pain – We are involved in mental/physical health projects (e.g. Health Foundation and MIND charity). Our case studies show good outcomes for mental health.
Direct people to this website’s FIND A TEACHER page and/or contact us.
Yoga for Healthy Lower Backs is a multi-modal/combined mind-body educational programme for persistent 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.
Integration of skills and techniques into daily life.
Preventative – it lessens the intensity/duration/frequency of low back pain.
Combined physical/psych. self-care approach for persistent MSK conditions and multimorbities.
Healthy ageing, increasing physical activity, community-based self-management.
12-class course plus Resources Pack gives life-long tool-kit.
Links to Document Downloads….
4 2019 YHLB Introductory Sheet for GPs and other health professionals AND Yoga for Healthy Lower Backs Trifold Info Leaflet vSept2018
Arthritis Research UK published articles – Press, website, magazine
NHS Spinal Study Day YHLB Arthritis Research UK Website Article November 2011
‘2017 Powerpoint’ – Go to Case Studies Page
ARMA (Arthritis & Musculoskeletal Alliance) Newsletter ‘Guest Blog’ Alison Trewhela on YHLB – March 2018 http://arma.uk.net/?wysija-page=1&controller=email&action=view&email_id=177
Royal College of GPs (RCGP Tamar Faculty) – Alison Trewhela 2016 Yoga for Healthy Lower Backs Presentation – Go to our Case Study Page
PLUS Dr. Anna Huette’s 2016 NHS England Health Education, SW Deanery Leadership Scholarship GP Training ‘Quality Improvement Project’ (QIP) Powerpoint – Go to our Case Study Page
Found Elsewhere on this Website
Outcome Evaluations, Individual Case Studies, Powerpoint Presentations, Details of the 5 Published YHLB Research Papers, Referral Examples, Yoga Research, Commissioners Info (including link to 60-second video – ‘YHLB Can Reduce Burden on NHS‘, Public Health Info, Workplace Info, Programme Overview/Research/Testimonial Videos +++
“Now it has been shown that this once-off self-management 12-week course would save NHS / health and social care costs – what are we waiting for?”
“This evidence-based yoga programme could (or should!) be the way forward for back pain treatment.”
NICE Guidelines for ‘Low Back Pain with or without sciatica’ (Nov 2016) included the Yoga for Healthy Lower Backs research in their review process, as the University of York / Arthritis Research UK / YHLB clinical trials research papers (H. Tilbrook, H. Cox, L-H. Chuang (cost-effective for NHS, society and workplaces)) contributed significantly to the body of evidence for this and other back pain reviews. NICE mentioned ‘yoga’ in its Press Statement on 16th November 2016 https://www.nice.org.uk/news/article/nice-publishes-updated-advice-on-treating-low-back-pain.
The BMJ in its 6th January 2017 published Summary of these revised national guidelines for low back pain with or without sciatica also mentions ‘yoga’. Practice Guidelines Low back pain and sciatica: summary of NICE guidance Link here… http://www.bmj.com/content/356/bmj.i6748
Longer Introduction to YHLB for Practice Managers / GPs / Health Professionals /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/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