GPs / Health Professionals Info on YHLB (includes Programme Content)
Evidence-based, Long-Term Self-Management, Mind/Body Back-Care Programme
YOGA for Healthy Lower Backs (YHLB) 12-Week Course
INFORMATION FOR GPs and Health Professionals – UK
- 12-Class structured (EBM) course, taught in groups (12 maximum)
- 12 x 1¼ hr classes taught once a week (with breaks for practising self-management)
- Teaches:- pain-relieving poses (to pre-empt, or help with, acute phases); gradual strengthening and stretching movements designed to improve mobility, body posture , breathing and relaxation techniques for long-term self-care
- Initial teacher telephone consultation; Registration process; Class 1 Assessment
- Teacher available before and after class to give individual advice
- Fully-resourced: EBM student manual , 4-track Relaxation CD, home practice sheets
- Constitutes a comprehensive package of self-care:-
-15+ hrs of taught group classes (person-centred + pre-, post-, inter-class support)
– 52+ hrs of supported self-management (home practice – 30 minutes daily, then 2 x weekly as preventative once pain subsides)
– 3-4 months course duration, offers continuity of care (same teacher)
– 12+ months additional support during attendance at missed classes
– Lifetime of self-management with simple and effective yoga tool-kit
– Motivation to incorporate simple relaxation/ breathing/ mindfulness/ postural techniques into daily life; back-care education
– Encouragement to return to increased physical activity levels, e.g. getting back to the gym / sports / hobbies / return to workplace
- Once only (time-limited) course (course attendees guaranteed 12 classes, i.e. catch-up opportunities for missed classes, but would NOT need repeat ‘treatment doses’)
How to refer to YHLB? – (social enterprise with self-employed teachers) – check whether social prescribing / workplace / Council schemes exist in your locality
- Give patients YHLB Trifold leaflet
- Tell them ‘Find a Teacher’ on this website or email [email protected]
- Perhaps speak about YHLB’s Simply Relax App (free via NHS GPs, CCG-commissioned) for reducing stress/ tension/ pain – Please ask for exclusive Link via [email protected]
- Ask CCG, Public Health, Council whether the course can be subsidized for some / all
- Lancet Journal recommends exercise (with psychological support) in its 2018 Back Pain Series. NICE recommends group exercise, including yoga, as a ‘first step to managing low back pain’ as well as self-management advice and support (November 2016).
- GPs and patients have confidence in its evidence-base
- ‘De-medicalizes’ back pain treatments within Primary Care for improved outcomes
- Back pain patients cost the NHS double the cost of non-back-pain patients!
- Free up your time by helping these ‘heart-sink’ patients (75% of those attending GP surgery with low back pain will re-present within 12 months)
- This model of providing care offers extremely good value, i.e. 15 hrs of fully-supervised exercise (YHLB) versus NHS physiotherapy / chiropractor package, where average = 4 x 20 minute sessions = Total 1hr 20mins? (AQP)
- Once-off ‘early intervention’ (video), preventative, holistic course – compared to patients often requiring repeated referrals to physiotherapy/ chiropractors, etc.
- Public Health England features this specific yoga programme on its ROI Toolkit for MSK interventions (online tool)
- NHS England / Dept of Health / Public Health England / Arthritis Research UK’s report ‘Providing physical activity interventions for those with musculoskeletal conditions’ shows how this yoga represents a unique Tier 3 option (where Tier 1 is self-directed exercise and the highest Tier 4 is 1-1 physio)
- Encourages long-term positive lifestyle and behavioural changes
- Addresses other ‘biopsychosocial’ aspects that may be perpetuating, or linked to, back problems e.g. anxiety, stress, MSK issues, tension headaches.
- Educational, interactive, active course (not a passive treatment); ‘patients’ become ‘students’; empower patients to improve physical and mental health
- Gap in care pathway provision (worsening:- financial constraints; new NICE GLs = reduction in meds., treatments, Secondary Care investigations/ procedures)
- Case study average attendance of 9/12 classes = enjoyment, commitment
- Very gentle, mindful movements and poses – likely to do lots of good
- Prior investment – see below
Research Findings (University of York / Arthritis Research UK / Cornwall Study):
- Offered a YHLB course, over 12 months, participants had average of 3.8 days off sick compared to control group’s 12.3 days = 70% reduction
- Significant 30% improvement in general daily functioning (doubled in recent study)
- Participants report 63% improvement in their ability to “control and cope with back pain on their own”
- Cost-effective within NHS and dominant treatment for society and workplaces
Where? In the Community alongside GP Care. TEAMS. Case Study Examples (please ask):
- Trained, regulated, nationally-accredited teachers, delivering original randomised control trial intervention, throughout UK (Registered by Yoga for Healthy Lower Backs, approved by British Wheel of Yoga, Sport England’s yoga governing body, all trained by Alison Trewhela, yoga researcher, University of Exeter Med. School specialist tutor, 35+ yrs yoga for back pain specialist, project lead and designer of YHLB for Uni. of York).
- GP Surgery Patients NHS Pilots (2016-17) – Dr Anna Huette, GP Registrar as part of SW Deanery Leadership Scholarship NHS England Health Ed. programme and QIP (Penryn)
- ‘Social prescribing’ project (St. Austell)
- NHS Staff Scheme for Cornwall Primary Care Trust – Subsidized courses (case study)
- NHS courses for patients from 6+ GP practices in Cornwall. (case studies) Commissioner promise of inclusion in back pain care pathway redesign and MSK contract provision.
- NHS Staff Scheme in South Yorkshire for Trust, CCG, Mental Health Teams, Council.
- Norfolk and Kent – Councils (Sport England grants?); Kent – GP Surgery
- AHSN NENC and SWAHSN support
Who is it suitable for?
- People of all shapes and sizes, provided they…can get up and down off the floor (perhaps with help of chair and wall)
- Patients with history of back pain, prepared to commit to programme
- Holistic approach, i.e. also beneficial for those with emotional, mental factors contributing to their back pain (STartBack tool predictor)
- People appreciate learning methods of “getting back in control of their back condition” (men especially, who like this empowering short course)
- Those with injuries/ illnesses preventing more strenuous forms of exercise/ activity
- Ideally patients will not attend Class 1 in an acute phase (usually appropriate later)
- Designed for beginners to yoga (who may be very unfit and inflexible), but also suitable for those with prior yoga experience
- Those who: want to help themselves for the present and also the future; who have tried multiple approaches without success
YHLB Course Costs:
- Current costs = £300 pp (includes £70 YHLB Resources Pack, teaching & room fees)
- Private sector = £224-300 pp = bargain rates to get the programme to more people, includes £70 Resources Pack obtained separately from social enterprise).
- Course valued at £292 per person (Spine Journal 2012, NICE)
- ?- Patient Contribution of £70-£154 = 12 x ‘mind/body programme prescription’ charges / ‘commitment contract’? Studies show payment = acceptable to patients/ GPs.
- Some subsidies in some localities (including NHS GP Pilots, social prescribing)
Comparative Average Costs and Benefits:
- One private back pain manipulation consultation could cost £40 with some patients having weekly/months sessions for months or years = £1000s
- A cappucino @ £2.50 per day for 16 weeks = £280
- Council gym membership for 12 weeks = £100
- Cost of similar rehabilitation programme (COPD; cardiac BHF) = £307-£477 pp
- Cost of a referral to Outpatient consultant or attendance at A&E (gov.uk) = £114-£132
- Cost of 1700 patients with complex LTCs in one CCG = £36 million p.a. (Right Care) – YHLB
could help reduce, e.g. chronic back pain, fibromyalgia, depression/anxiety with MSK
Back Pain Patients are twice as costly to the NHS as non-back pain patients. Annual NHS Cost for ‘back pain patients’ = £1076 compared to ‘non-back-pain patients’ = £516 pa (London School of Economics & Political Sciences studied 100,000+ NHS patients 2013)…….
…Turning patients into non-back-pain patients could save current and ongoing costs = good investment and happy patients. (Also see PHE MSK ROI Toolkit Oct 2017.)
Prior background investment.
YHLB represents:- 11+ yrs design, evaluation, post-research development; effort, work and passion of 1000s people (researchers, charity, publisher, GPs, national bodies, teachers); £438,500++ investment (includes £285,000 charity funding).
Case Studies and Health Professional Testimonials (more available)
“This course is unique…this is absolutely what I would do, if I had back pain…and it helped my frozen shoulder” Back Pain Specialist Physiotherapist, Pain Clinic
“No more A&E visits and meds for me – I have learnt how to prevent my muscle spasms.”
“Very pleased to have avoided surgery and enjoying being happily back at work.”
“Life-changing, after years of frustration.”
With Its Specificity and Quality-Assured Evidence-Base, YHLB is Not the Same As…..
- Going to the gym (limited supervision; not always appropriate)
- Going to exercise classes (REPS low back pain training = only 4hrs, ours is 300-hour course. Classes could be too strenuous)
- Going to general yoga class (may not be appropriate)
- Going to a yoga therapy 1-1 (evidence shows improved outcomes in groups)
- Going to a physiotherapist (mainly addresses acute phase; unlikely to empower long-term)
- Going to private backcare professional (mainly passive; physical; acute phase; short-term; repeat costs)
- Going for CBT (does not address the physical, e.g. strengthening muscles, improving posture)
RCGP (Nov 2016) Presentation plus NHS Spinal Study Day Powerpoint (2018) plus ARMA Guest Blog (March 2018) Downloads/Links found at:-
More information – Trifold Leaflets, Mission Statement (Research Refs.), Case Studies www.yogaforbacks.co.uk, [email protected]
Compiled by Yoga for Healthy Lower Backs and YHLB Cornwall Steering Group with support from SWAHSN.
YOGA for Healthy Lower Backs
Programme Course Content
Patients become Students, i.e. they are educated, they study, they learn (140-page book)
Pain-relieving positions to pre-empt (deal with) acute phases (Pain-relieving pose ‘Menu’ sheet)
Pain perception – reality checks (and notice when body feels ‘good’)
Relaxation (YHLB 4-track relaxations CD; Simply Relax app)
Antidote to stress and tension – yoga techniques
Culturing positive mental attitude
Confidence in back’s health (less fear; return to more normal ‘biopsychosocial’ function)
Self-reliance and self-care (with support of yoga programme)
Postural awareness and postural re-education
Yoga practice sequences for home practice (x 5)
Healthy movement patterns (during yoga and daily life)
How to stand, sit, walk and lie comfortably
A&P education re MSK back function
12 classes reinforce and consolidate learning over time for positive behavioural changes
“YES – You can do something to help yourself!”
12 Class Themes
Each of the 12 lesson plans thread a clear positive philosophical theme throughout the class for contemplation. Course attendees’ mental, emotional, social, psychological wellbeing is positively affected, thus allowing them to reduce their experience of pain.
- Introduction to Yoga – Relaxation (sukha) – Soften and Pacify – “Let Go and Relax”
- Steadiness of Body, Breath, Mind – (sthita/dharana) – “Steady and Still- Quiet Mind”
- Posture + Symmetry (asana) – Comfortable, Confident and Efficient within Body – “How to Stand, Sit and Lie Comfortably”
- Awareness – (svadhyaya/sarira prajna) self-observation – “You have a Body all the time, NOT just when it aches”
- Mobility – movement (karmayoga) – health to the joints – “Get out the oil-can!”
- Height, Space, Lift – Defy Gravity (rajas/akash) – “Lift Off and Grow Tall”
- ‘Intelligence’ and Life – (prana prajna) Body wants to be Healthy and Comfortable – Potential for Health – The Soul wants to allow happiness to shine out – “Your Cells are Full of Life”
- Stretch – Space for Joints – Healthy Muscles – Increased Circulation – Antidote to Stress (moksa)– “Don’t Turn into Tanned Leather – Stretch and Release”
- Strengthen – Body, Mind and Belief in Yoga (sthira)– “Stronger in Body and Mind”
- Added Benefits – (saucha/sarva) e.g. less anxious, enhanced immune function, fewer headaches, lower blood pressure – not Just Health for Low Back, but also organs and systems, e.g. endocrine, nervous, digestive, respiratory, excretory, cardio-vascular, senses – “Feeling ‘Wholistically’ Healthy”
- Positivity – Notice Improvements, Acknowledge Path to Comfort and Health – (ananda) Joy – “Power of Intention”
- Long-term – Reinforce Reasons Why we Continue to do Yoga (tapas/sadhana), e.g. facets joints need movement, muscles need to be used, tissues need to know they are needed, circulation is aided by movement and muscle use, discs need movement and horizontal rest for health, when the mind is at ease so is the body, possible to slip gracefully and effortlessly into mature age without disability – yogis are the example e.g. B.K.S.Iyengar – Opportunities for Further Yoga Classes or How to Continue to Practice at Home – “Keep Up Your Yoga”