The new treatment guidelines for low back pain, and how yoga therapy fits in

The current medical treatments of low back pain do not offer the right care and are a waste of resources. You may have heard this in the news, shortly after The Lancet reported it in a comprehensive review of low back pain studies on 21 March 2018. This leading medical journal announced that low back pain has increased worldwide and that the medical approaches used in high-income countries, most notably surgery, medication, injections and imaging, are not effective. The studies suggest that exercise and education, as well as psychological therapies, are most appropriate for the majority of low back pain cases. From my experience, I know how yoga therapy can help manage and even heal back pain. This blog takes a closer look at the new treatment guidelines for low back pain, and at how yoga therapy can offer what is prescribed: exercise, education and a form of emotional support.


The three articles written by the Low Back Pain Series Working group in The Lancet (published 21/03/18) reveal that non-specific low back pain has increased over the past 25 years, to such an extent that it is now considered “the leading cause of disability worldwide”. The increase has been most notable in low- and middle-income countries. Symptoms of back pain occur among young and old alike; it may come as a surprise that 40% of 9 to 18 year olds have to cope with back pain. In high-income countries, research is proving that the medical approaches to low back pain are ineffective, despite being high-tech and expensive. also anti-inflammatory drugs have little impact.


Treating low back pain effectively is important because it comes at a high cost to the health care system and to the individual. For the latter, there may be loss of productivity and extra costs, as well as psychological consequences that are hard to deal with.


Research suggests that low back pain is most effectively prevented through exercise and education. When it comes to treatment, the studies advocate self-management, with only a very conservative use of medication, imaging and surgery. Self-management is specified as physical and psychological therapies. The physical therapies that are mentioned are massage, exercise, acupuncture, spinal manipulation, Tai Chi and yoga. The psychological therapies that can help are cognitive behavioural therapy, progressive relation and mindfulness-based stress reduction.


For those who do not respond to the conservative programme, some epidural injections can be beneficial, at least in the short term. For continuing and disabling low back pain, surgery is still sometimes the best option, but the long-term benefits are not always superior when compared to careful management. The authors report that “patients tend to improve with or without surgery so non-surgical management is an appropriate option for those who wish to defer or avoid surgery.”


In my own words, the new guidelines for medical practitioners are:

-At first, give education and advice.

-Tell patients to stay active and stay at work.

-Limit imaging and only use it when you suspect a cause that is different from non-specific low back pain.

-Do not prescribe medication as a first choice.

-Using electrical physical interventions (such as short-wave diathermy or traction) is not advisable.

-The use of opioid analgesic medication is discouraged.

-Limit surgery.

-Recommend exercise for chronic low back pain.

-Seek “biopsychosocial” help.


In my opinion, a self-management programme for low back pain that comprises this variety of possible treatments, could best be offered in specialised back pain clinics. A general practitioner whose time is limited to 10 minutes per patient, is unlikely to provide the appropriate time, care, advice and follow-up. Setting up back pain clinics would give patients the opportunity to fill in an initial questionnaire and to talk to a specialist, so that they can then be referred to the appropriate treatment plan.



How Yoga Therapy can help


You can imagine that these new guidelines sound fabulous to a complementary practitioner like me, who approaches low back pain with exercise, education and relaxation techniques.


Yoga therapy for back pain tailors yoga movements, breathing and relaxation to the needs of the individual. The treatment differs according to the particular cause of back pain, fitness levels, and other health concerns of the patient. It also involves talking about the implications of the pain and which lifestyle changes can help. Similar to the “self-management” approaches, it requires the active involvement of the patient and is therefore empowering. The result is greater body awareness, less stress, less or no pain, and knowledge about what to do in case of a relapse. I have seen how yoga therapy, sometimes by itself and sometimes in combination with physiotherapy or other back treatments, can reduce and remove low back pain. I have observed how it empowers people and gives them new hope. The knowledge, active engagement and hope are very important at a time when persistent pain can give rise to frustration, fear and despair.


Education in my field of work also means discussing the movements that are exacerbate the condition. Often, though not always, patients automatically avoid movements that hurt, but equally often they keep hurting their back by putting shoes on a certain way, by bending down awkwardly, etc. Knowing how to change the habitual movement patterns that aggravate the pain is important. If you would like to receive some tips about this, subscribing to these blogs will give you the free “Keep Your Back Safe at Home Guide”.

By combining physical exercise with breathing and relaxation techniques, body awareness, and concentration, yoga therapy also addresses the underlying mental and emotional stress that can contribute to back pain. Yoga therapy may not take away the need to have psychotherapy or to learn more about mindfulness, but it is a good start.


My advice in a nutshell:

  1. Firstly, if your back pain keeps you up all night and cannot be alleviated by any position, please seek medical help as soon as possible. You want to rule out a cancer growth, an infection or fracture. Also loss of bladder/bowel control is an emergency.


  1. Back pain is a symptom; reflect on what the cause could be: is it a repetitive activity, or lack of activity? Note the things you do every day, such as bending down, sitting all day long, going on long car journeys, running on hard surfaces, horse riding, playing golf, … Can you change these activities, for example: take frequent breaks from your desk or sofa, change sports for a period? This blog gives tips on how to make a long car journey more back friendly. Also improving your posture is an important starting point. Alternatively (or in addition), can there be an emotional reason for your back pain? Is it stress or unhappiness that you have to address?


  1. Avoiding activities that hurt also means choosing the form of exercise that does not cause pain, or at least does not increase pain. It is true that we need to stay active, but the exercise has to be appropriate for the condition. Pain is a warning sign.


  1. Choose the exercise that you find enjoyable but know that extreme sports are generally not conducive to healing. More favourable are walking, swimming, targeted exercises, pilates, and gentle, appropriate yoga.

  1. If you would like to try yoga for back pain, ensure it is right for your back condition. While some yoga poses will help, others may exacerbate the pain. When you have back pain it is better to choose specialised yoga therapy and avoid large classes with a dynamic yoga style.


The links below are meant to give you a taste of what yoga therapy for low back pain can be like:


If you have non-specific low back pain that does not involve nerve pain, learn how to release low back tightness with this blog.


How to strengthen the back once pain has subsided,  is addressed in this blog.


Of course strengthening abdominal muscles is important too, and instructions on how to do this with back pain can be found in my video series here.



For low back pain that does include nerve pain (such as shooting pain down the leg), see here for more information.


  1. Use yoga, mindfulness techniques or meditation to calm your mind, to enhance concentration, and deal with mental or emotional stress. Some techniques are discussed in my blog “stressed out of your mind”.


  1. Find a yoga therapist to create a programme that is tailored to your particular back condition and health needs. My basic yoga therapy for back pain programme contains 5 sessions that teach you which movements to avoid and which to include in a daily practice, how to use the breath for greater calm and focus, and how to improve your posture.


  1. Finally, prevention is easier than cure, so prevent back pain by keeping your spine supple, and by taking time to relax and restore your energy and mental clarity.


Best of luck!





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