Development of the ‘Yoga for Healthy Lower Backs’ Programme
for the University of York / Arthritis Research UK clinical research trials
– Accompanied by the ‘Yoga for Healthy Lower Backs’ educational resources (manuals, practice sheets, Relaxations CD), the 12-class course for newcomers to yoga with chronic and recurrent low back pain was devised and successfully taught as a yoga intervention for The University of York led, Arthritis Research UK funded, trial (2007-10).
– Alison Trewhela designed the yoga programme along with 4 home practice sequences after much research and consultation with many senior teachers and teacher trainers, including trial team members, Anna Semlyen and John Aplin.
– Yoga needed to be safely and effectively taught by Iyengar Yoga Association (UK) (IYA(UK)) and The British Wheel of Yoga (BWY) teachers, whilst taking advantage of their knowledge base and skills, and without compromising any teacher’s teaching quality or methodological beliefs.
– 20 teachers (10 from IYA(UK) and 10 from BWY) with between 4 and 30 years’ experience were trained in the programme by Alison Trewhela over two intensive weekends at Sarva Centre in High Wycombe in early July and late September 2008. Support was given by Anna Semlyen, Prof. John Aplin and Prof. Jennifer Klaber-Moffett.
– Trial participants were followed up for a year. The aspiration was to encourage them to practise yoga at least twice a week for the rest of their lives for the long-term maintenance of back health.
– A Students’ Manual, a Teachers’ Manual, Home Practice Sheets and a Yoga Relaxations CD were produced and constitute a necessary part of the successful delivery of this yoga programme.
‘YOGA for Healthy Lower Backs’ – Book.
A Manual for course attendees used in high profile research – Published by Lotus Publishing). Course attendees need to use and refer to this 144-page Students’ Manual (developed and written for the trial by Alison Trewhela and Anna Semlyen) in order to help themselves for the long-term. It includes details of all 50+ yoga poses (How to perform them, Observations whilst in the poses, Variations and Benefits). There are also chapters entitled ‘Yoga for your daily activities’ (a reminder of those elements of postural awareness and mindfulness learnt within the yoga course) and ‘What to do if you get a sign of a painful back episode’ (reminding of specific pain-relieving poses taught within the class). This Students’ Manual is available to the public as an edited and published book. Teachers also need to study and refer to this manual.
‘YOGA for Healthy Lower Backs’ Teachers’ Manual.
This approx. 90-page manual compiled by Alison Trewhela, with help from Anna Semlyen, was specially designed for the trial. Trial-related material has been taken out and an edited version is used in the training of teachers. It contains the 12 differing Class Teaching Plans, lists of prevalent student symptoms and poses that may alleviate them, and a table of diagnostic terms for low back conditions with accompanying possible yoga solutions. It is only available for those teachers who decide to do the full four-day training course.
‘YOGA for Healthy Lower Backs – Relaxations Album / CD
This crucial tool within the yoga programme comprises of four tracks, where the experienced yoga teacher voices of Anna Semlyen and Alison Trewhela talk students through how to calm and pacify their body and mind whilst in a modified Savasana. Students use one track at a time, usually after their yoga pose (asana) practice, and is used to aid beginners who may be in pain to more readily learn to relax the body and the mind. This 58-minute CD was recorded and produced at The University of York and is available for general public use. Sales of the CD help fund this Website.
Home Practice Sheets
CORE PRACTICE A, CORE PRACTICE B, COMPLETE CORE PRACTICE, PROGRESSIVE PRACTICE A, PROGRESSIVE PRACTICE B, WHAT TO DO IF YOU GET A SIGN OF AN EPISODE OF BACK PAIN, HOME PRACTICE DIARY +++
The above single sheets are used by students for practising yoga at home and are also contained in a changed format within the book. When attending a ‘Yoga for Healthy Lower Backs’ course, participants will be given these sheets by their teacher at intervals throughout their 12-week course.
Overview of the ‘YOGA for Healthy Lower Backs’ Programme
VIDEO – As well as the link from our Video Page, you can view a short video showing an overview of this yoga programme by following this link http://annals.org/article.aspx?articleid=1033130 and underneath the published paper title and authors list, Click on Audio/Video. It was filmed in Cornwall with Alison Trewhela teaching, directing and narrating.
– This yoga programme is an ideal introductory foundation course for beginners with a focus on low back health
– Designed for use with students who are not showing signs of serious low back pathology and who do not have any other contraindicating medical conditions, i.e. it is designed for the common-or-garden back pain that the majority of people suffer with from time to time.
– Yoga aims to give students a good grounding in the subtle and accurate beginnings of most aspects of yoga, including Tadasana; Savasana; backbends; forward bends; twists; foot, leg, hip, hand, arm and shoulder work; seated and standing poses; simple breathing; awareness and mental focus; and yogic philosophical ideas.
– Enables and encourages newcomers to yoga who suffer from low back pain to learn to practise appropriately in class and at home for the long-term health of their back.
– Students are taught once a week in a 12-class course where classes comprise of 75-minute group classes with a mid-course break of one or more weeks.
– Yoga poses (asanas) and variations were chosen to be simply understood and user-friendly so that students can practise at home from Day 1.
– For ease of understanding and accuracy within home practice, advice on using simple yoga props for some of the poses is taught. These props are: a blanket or pillow, a belt, a block or book, a chair, a firm table, the wall and the floor.
– Poses are taught without physical hands-on adjustments, but with accurate and attentive verbal instructions in order that the students quickly learn to align themselves correctly within the poses.
– English posture names are used for ease of learning, but Sanskrit names are shown in the Students’ Manual and are sometimes used in class.
– All 12 classes differ and each has a separate yoga philosophical theme, such as ‘Steadiness’. These themes are reflected within the teaching according to the Teachers’ Manual 12 class plans.
– Within the 12 differing classes, the postures are introduced in a gradually progressing way that builds on previous well-learnt knowledge for effectiveness, understanding, safety, and in order to keep the students’ interest.
– The timings for each yoga asana are more usually short (e.g. 10-15 seconds) and poses are sometimes repeated. Savasana usually lasts 5-20 minutes.
– Learning to relax the body and the mind is an integral part of the yoga programme and use of the ‘Yoga for Healthy Lower Backs – Relaxations CD’ is encouraged from Day 1 of the course.
– The four Practice Sequences are followed by students for home practice and sometimes referred to in class. The two CORE sequences CORE PRACTICE A and CORE PRACTICE B fit together within the sequence COMPLETE CORE PRACTICE and the first six classes are structured around this. The two PROGRESSIVE sequences PROGRESSIVE PRACTICE A and PROGRESSIVE PRACTICE B, introduced at a later date, include and build on the CORE poses. PROGRESSIVE PRACTICES A and B fit together within the sequence COMPLETE PROGRESSIVE PRACTICE, around which the latter six taught classes are based. COMPLETE CORE PRACTICE and COMPLETE PROGRESSIVE PRACTICE are the basis of how the asanas are sequenced within the classes in order to teach and appropriately introduce the home practice sequences, but each of the 12 classes has its own unique teaching plan. A few additional poses other than those in the sequences are included once only within classes towards the end of the course for interest and progression.
– Within the Students’ Manual (given to students at Week 1 to those who took part in our trial) and now the book, there is a Recommended Home Practice Timetable showing which of the four yoga practice sequences to practise on what day. Yoga Home Practice Sheets are usually handed out by course yoga teachers throughout the 12-class course. Students therefore practice in class, but may also fill out a Home Practice Diary to encourage regular home practice.
This YHLB Specialised Yoga Programmes Works as Shown in our Research Papers and Subsequent Case Studies and Evaluations.
– Our research showed that the yoga in our programme improved back function (disability) self-eficacy, and decreased back pain and depression immediately after the yoga course had finished, but that these beneficial effects were maintained both at 6 months and also at 12 months. So, yoga does not just work when one is being taught in class, but the effects last.
– Although our ‘intention-to-treat’ statistics (where we had to include those yoga group participants who did not have any contact at all with a yoga teacher (n=-21)) were shown to be significantly in favour of the yoga group, our compliant statistics are even more impressive (where we estimated that those who had attended 3 of the first 6 ‘Yoga for Healthy Lower Backs’ classes and at least any 3 other classes would have learnt enough yoga to gain some benefit).
– Yoga intervention participants seemed to function better at work and at home
– There was some evidence in our trial that if participants expressed a preference for yoga that there was a more beneficial effect. This might suggest that those who decide they actually want to do yoga to help themselves will find it more beneficial.
– In our trial, we had good compliance (60% of our participants attended 3 or more of the first 6 and at least 3 other classes, i.e. 6 in total), which shows that yoga is a form of treatment that will be readily accepted by people. Drop-out rates are more usually at least 50% for exercise classes. When students self-referred to yoga in another trial (K. Williams et al), then compliance was 80-95%, i.e. when someone decides they want to attend yoga, they are more likely to attend more classes.
– One would expect people to be more motivated to attend classes and to practice the yoga now that there is considerable evidence that yoga works to improve the health of the lower back. This will mean that people will gain more benefit than within the trial.
-Our ‘Yoga for Healthy Lower Backs’ specialised yoga classes taught by 12 teachers (all with at least 10 years experience of teaching) who were trained in how to deliver the yoga programme, were proven to be effective against low back pain
– British Wheel of Yoga (various schools and methods of yoga) and Iyengar Yoga teachers were all able to successfully deliver the yoga programme in our trial. There were no significant clustering effects – meaning that variables such as class and location or teacher did not influence the results. Yoga teachers from other schools and other methods of yoga with at least 4 and preferably 10 years of teaching experience are likely to also be able to deliver this yoga programme successfully.
– The above applied to all the 16 ‘Yoga for Healthy Lower Backs courses’ taught for the trial in different areas of the country including cities (e.g. London, Manchester) and rural areas (e.g. Cornish villages such as Mylor near Falmouth and Grampound Road near Truro
– If yoga students give up practising yoga after 3 months, then we would expect the benefits gained to gradually diminish – rather like a bank credit/debit system, but the more they have practised, generally the longer the effects are likely to last, before needing to repeat the ‘prescription/maintenance programme’.
– The best-case scenario is for students to practise 2-3 times a week forever to maintain and improve the health of their back for their lifetime.
– The yoga teachers would have liked to have given refresher classes to students at 6 months and again at 12 months, but for the trial we could not do this because it could have introduced bias just before participants filled out their follow-up forms. However, in pragmatic terms, refresher classes would be a useful addition to the support already given in the form of home practice sheets, the relaxation CD and the Students’ Manual in order that low back pain sufferers are enabled to help themselves more and for longer
– We would aspire to help people with chronic low back pain for the very long term
– The yoga research programme is generalizable, i.e. it worked for the research and is being shared and is still working now.