Research on Back Pain

Irish Times image

Interesting research from University of Limerick (UL) on back pain, from an article published in the Irish Times on the 19 January 2021.
Some key points of interest as follows:

1. “Sitting up very straight is no longer advised as treatment for or prevention of back pain, according to a new international study involving researchers at the University of Limerick (UL).”

2. “For those who do suffer from back pain however, Dr O’Sullivan said that it’s reasonable to see if changing your posture helps your pain. “Don’t assume that the solution is always sitting up straight. Some people benefit from sitting up straight but slightly more people benefit from slouching.”

3. “According to Dr O’Sullivan, psychological factors such as worries and mood and lifestyle factors such as sleep and fitness are bigger influencers of back pain than posture.

4. “The study builds on other recent research at UL which found that physiotherapists and members of the public have an unnecessarily negative view of “slouched” sitting posture and also that physiotherapists and manual handling instructors often promote very stiff straight ways of bending and lifting, even though they are not shown to prevent or ease back pain.

5. “The best advice on back pain is to move and relax, get fit and strong and not worry about the angle of your back when sitting,” said Dr O’Sullivan.”

It is not possible to give examples of illnesses or ailments that can be improved…..

The following are reflections on some questions commonly asked with regard to Yoga  and what has become labelled as ‘Yoga Therapy’ – complete extract below published by Yoga Studies.

“I was asked in 2011 to provide ‘expert quotes’ in response to three questions for a media article by a freelance journalist on a Yoga related topic. These were my reflections that I am reposting unedited, especially given the surge in these past 7 years in what has become labelled as ‘Yoga Therapy’:

Q1. What are some examples of illnesses or ailments that can improve or be cured with the use of Yoga?

“It is not possible to give examples of illnesses or ailments that can be improved as it all depends on the matrix of the person who may also have certain combinations of problems. A student with cancer may improve or a student with a history of colds may experience little change.

The viewpoint of Yoga is to look at people as individuals and work from there rather than the more usual view of making lists of problems with flash card like answers to a specific problem. e.g. Sciatica, High Blood Pressure, Insomnia, Osteo-arthrosis, Chrohn’s Disease, etc.

“We cannot say that this Āsana or this Prāṇāyāma
can be given for this disease.”
– T Krishnamacharya 1984

According to Yoga we are all individuals who also have from time to time chronic or acute illnesses or ailments. In this view one hallmark is that the practice must be adapted to the individual and their current situation and immediate potential rather than expecting the individual to adapt to the practice.

This means that two individuals with the same symptoms may need very different approaches to practice and lifestyle choices because of their history, mindset and opportunity and intentions for implementing change.

“It appears that Modern Therapeutic Yoga is increasingly angled
at looking at the problems in front of the person
in terms of Yoga for What,
rather than looking at the person behind the problems
in terms of Yoga for Who.”

Yoga also tells us that nothing is destroyed so nothing is ‘cured’. We can perhaps reduce the symptoms to the point where they are dormant. Given the right sun, soil and moisture they can ‘sprout’ again. So cure is not a term that can be applied.

Yoga Psychology says being symptom free also implies that we still have to take care as the seeds can be re-activated given the right stimuli.”

Q2. Is there a certain type of Yoga which is more beneficial, when it comes to health, than other types?

“Any approach to Yoga which facilitates meeting with a student, developing an understanding of their unique background, looking at the opportunities for change which exist for the student in the immediate and near future, being able to propose a personalised practice appropriate to their situation and meeting regularly to both review and progress the practice according to the experiences and feedback from the student is beneficial.

“Yoga Cikitsā is about
treating a person in a problem.
Rather than
treating a problem in a person.”

This is really only realisable through 121 lessons, though not of the type offered by many which are comparable to a group class for one. A more comparable example would be to consulting a homeopath, or acupuncturist, or medical herbalist, or counsellor, where there is time, attention and personalised support and treatment offered.”

Q3. Is there a certain type of Yoga that can prove especially beneficial to those with asthma, and if so, why is this type of Yoga particularly good?

“As the physical basis of asthma is experienced through its effects on the breath, any approach that sees the breath as the canvas on which the pictures of the poses are painted could be helpful. Along with an approach that has the integral and intimate use of the breath in practice as a first priority, the study and application of the principles of Yoga Psychology would be very relevant to working with issues that could well underpin the student’s history of symptoms and personal experiences.”

Published by Yoga Studies.

When less Āsana time than you would like…..

“When less Āsana time than you would like,
better to reduce the number of Āsana,
or the number of repetitions,
or the length of the stays,
rather than, reducing the length of the breath.
Or….. even considering lengthening the breath,
thus even fewer Āsana, all with a longer breath than usual.
Here the Bhāvana could be to observe the effect
of a more spacious than usual Āsana breathing
on a more cramped than usual daily mindset.”
Paul Harvey

Meditation and breathing exercises can sharpen your mind…..

“It has long been claimed by Yogis and Buddhists that meditation and ancient breath-focused practices, such as prānāyamā, strengthen our ability to focus on tasks. A new study by researchers at Trinity College Dublin explains for the first time the neurophysiological link between breathing and attention.

Breath-focused meditation and yogic breathing practices have numerous known cognitive benefits, including increased ability to focus, decreased mind wandering, improved arousal levels, more positive emotions, decreased emotional reactivity, along with many others. To date, however, no direct neurophysiological link between respiration and cognition has been suggested.

The research shows for the first time that breathing—a key element of meditation and mindfulness practices—directly affects the levels of a natural chemical messenger in the brain called noradrenaline. This chemical messenger is released when we are challenged, curious, exercised, focused or emotionally aroused, and, if produced at the right levels, helps the brain grow new connections, like a brain fertiliser. The way we breathe, in other words, directly affects the chemistry of our brains in a way that can enhance our attention and improve our brain health.

The study, carried out by researchers at Trinity College Institute of Neuroscience and the Global Brain Health Institute at Trinity, found that participants who focused well while undertaking a task that demanded a lot of attention had greater synchronisation between their breathing patterns and their attention, than those who had poor focus. The authors believe that it may be possible to use breath-control practices to stabilise attention and boost brain health.

Michael Melnychuk, Ph.D. candidate at the Trinity College Institute of Neuroscience, Trinity, and lead author of the study, explained: “Practitioners of yoga have claimed for some 2,500 years, that respiration influences the mind. In our study we looked for a neurophysiological link that could help explain these claims by measuring breathing, reaction time, and brain activity in a small area in the brainstem called the locus coeruleus, where noradrenaline is made. Noradrenaline is an all-purpose action system in the brain. When we are stressed we produce too much noradrenaline and we can’t focus. When we feel sluggish, we produce too little and again, we can’t focus. There is a sweet spot of noradrenaline in which our emotions, thinking and memory are much clearer.”

“This study has shown that as you breathe in locus coeruleus activity is increasing slightly, and as you breathe out it decreases. Put simply this means that our attention is influenced by our breath and that it rises and falls with the cycle of respiration. It is possible that by focusing on and regulating your breathing you can optimise your attention level and likewise, by focusing on your attention level, your breathing becomes more synchronised.”

The research provides deeper scientific understanding of the neurophysiological mechanisms which underlie ancient meditation practices. The findings were recently published in a paper entitled ‘Coupling of respiration and attention via the locus coeruleus: Effects of meditation and pranayama’ in the journal Psychophysiology. Further research could help with the development of non-pharmacological therapies for people with attention compromised conditions such as ADHD and traumatic brain injury and in supporting cognition in older people.

There are traditionally two types of breath-focused practices—those that emphasise focus on breathing (mindfulness), and those that require breathing to be controlled (deep breathing practices such as pranayama). In cases when a person’s attention is compromised, practices which emphasise concentration and focus, such as mindfulness, where the individual focuses on feeling the sensations of respiration but make no effort to control them, could possibly be most beneficial. In cases where a person’s level of arousal is the cause of poor attention, for example drowsiness while driving, a pounding heart during an exam, or during a panic attack, it should be possible to alter the level of arousal in the body by controlling breathing. Both of these techniques have been shown to be effective in both the short and the long term.

Ian Robertson, Co-Director of the Global Brain Health Institute at Trinity and Principal Investigator of the study added: “Yogis and Buddhist practitioners have long considered the breath an especially suitable object for meditation. It is believed that by observing the breath, and regulating it in precise ways—a practice known as pranayama—changes in arousal, attention, and emotional control that can be of great benefit to the meditator are realised. Our research finds that there is evidence to support the view that there is a strong connection between breath-centred practices and a steadiness of mind.”

“Our findings could have particular implications for research into brain ageing. Brains typically lose mass as they age, but less so in the brains of long term meditators. More ‘youthful’ brains have a reduced risk of dementia and mindfulness meditation techniques actually strengthen brain networks. Our research offers one possible reason for this—using our breath to control one of the brain’s natural chemical messengers, noradrenaline, which in the right ‘dose’ helps the brain grow new connections between cells. This study provides one more reason for everyone to boost the health of their brain using a whole range of activities ranging from aerobic exercise to mindfulness meditation.”

The full paper ‘Coupling of respiration and attention via the locus coeruleus: Effects of meditation and pranayama’ is available here: https://onlinelibrary.wiley.com/doi/10.1111/psyp.13091

Back Pain – 10 key points

Courtesy Irish Independent

Back pain is unique to each person. While it may be a structural issue, stress, mood or poor sleep may all be at the root of the problem. Becoming aware of the various different factors provides a better understanding of the pain and how to address most appropriately.  All of these factors form part of the 121 Yoga process and the appropriate application of Yoga for the individual and their particular needs.

Key related extracts from an article published in the Irish Independent:

Back Pain is common
While back pain can be very painful and worrying, it is very common and rarely dangerous. A total of 84pc of people worldwide will experience back pain during their lifetime. It is equally common across all age groups; from young to old and doesn’t get worse with age. Therefore, it should not be seen as a result of ageing or “wear and tear”. Mostly people recover reasonably quickly, and many recover without the need for treatment. Some people experience repeated episodes of back pain which can be distressing, but again these are rarely dangerous.

Scans for back pain are rarely needed and can be harmful
Most people believe that a scan (for example an X-ray, MRI) will identify the cause of their back pain. However, the scientific research shows that scans are only needed when a serious condition is suspected (cancer, fracture/broken bone, infection). Luckily, these serious conditions are rare and account for approximately 1pc of all back pain worldwide.

The back is NOT that vulnerable to damage
Most people think the spine is something that needs to be protected. This is incorrect and has led to the provision of information and treatments that promote fear, protective guarding, avoidance and disability. Common examples include: “Your joint/pelvis/disc is slipped/out of place.”
People often move differently when in pain, giving the impression that something has gone out of place. However, scientific research has clearly shown that these structures do not go ‘out of place’ or ‘slip’.

The back is designed for bending and lifting
Like other body parts (for example the knee), the back is designed to move and adapt to many activities. It is important to be conditioned to lift; and shown how to lift heavy things correctly and safely. The back is designed to move and adapt to many activities. In the same way that a person can get a sore knee after doing an unaccustomed activity, people can get back pain when they lift something awkwardly or something that they aren’t used to.

You can have back pain without back damage or injury
The traditional view is that pain is a sign of injury or damage. While some back pain may be related to a sudden, repeated or heavy-loading event, we now know that the volume switch for back pain can be turned up by many other factors also. These include physical (minding/guarding the back, avoiding movements), psychological (fear of damage/pain or not getting better, low mood/depression, stress), health (being tired and run down, low energy), lifestyle (sleep problems, low levels of physical activity, being overweight), and social (poor relationships at work or home, work satisfaction, stressful life events like a death or illness) factors.

This means that you may feel more pain when you move or try to do something, even though you are not damaging your back. Ever have a headache when you are stressed, sad, tired or run down? Back pain is no different. For many people, back pain can occur from just a minor mechanical trigger, like picking something up from the ground or rolling over. In this situation it is due to the spinal structures being sensitised due to other factors such as sleeping position or stress.

Don’t take back pain lying down and don’t rush for surgery
Since people often think they have done damage when they get back pain, it is common for people to go to bed and rest until all pain is gone. However, there is very strong evidence that keeping active and returning to all usual activities gradually, including work and hobbies, is important in aiding recovery. While you may feel relief from rest initially, prolonged rest is unhelpful, and is associated with higher levels of pain, greater disability, and longer absence from work.
Surgery is rarely an option for back pain. There are some uncommon back conditions where there is pressure on the nerves that supply the leg and the patient gets leg symptoms such as pain, pins and needles or numbness. For these conditions surgery can help the leg symptoms but it is important to understand that surgery is not always required.

Exercise is good for back pain but people are often afraid
Contrary to popular belief, exercise is helpful for back pain….
It is emerging that the amount of exercise you do is more important than the type of exercise. More than 30 minutes per day has the greatest health benefits but any amount you can manage will result in benefit. The benefits of exercise even include reducing the risk of developing back pain.

Strong meds do not have strong benefits for back pain
Many people think strong pain needs a strong painkiller. This is not true. If you have a new episode of back pain, you should start with a simple over-the-counter painkiller and not rush for prescription medications. Scientific research has shown that strong painkillers such as those containing an opioid do not provide greater pain relief over simpler options, and actually have greater potential for harm.

Buyer beware: internet, fads, fashions and bandwagons
Be wary of commercial sites that are selling a product. We hear daily claims about miracle cures and best treatments for back pain in the media and on the internet.

Back pain can be cured
The thinking around the spine is distorted and infused with panic. Of course you can injure the back – but be confident that it will get better. It is common for people to be told that they cannot change their pain and they have to live with it. The evidence doesn’t bear this out. The back can also recover.

Think of it like an ankle sprain. It is incredibly painful at the start but it gets better with graduated activation. Avoiding movement would not help an ankle sprain, and the same goes for a back injury or back pain. The pain experience is unique to you and can involve an interplay of many different factors. It therefore makes sense that all of these factors must be considered in addressing your back pain. This could explain why many different treatments for pain fail in the long term as they only look at one piece of the puzzle.

Link to full article published in the Irish Independent.

The mind is part of a team…..

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” The mind is part of a team,
along with the body, the breath and the senses.
Everything that we do is a product of that team,
but the mind is generally the boss……..
We know that the state of the mind affects the breath and,
luckily for us, the opposite is also true”
What are we Seeking – TKV Desikachar

Yoga for You


Yoga Journey

Yoga, practiced regularly, offers tools for
– maintaining stability
– supporting development
– coping with change.
Yoga is a practice that you can learn ‘for you’,
a practice that can be personalised for where you are now
and adapted for creatively meeting what is to come.

Patients & Complementary Therapy – Irish Study

A summary of the details of a new Irish study has shown that a significant number of patients use alternative and complementary medicines without informing their GP, despite the fact that these may negatively interact with conventional medicines. The article is published by Irish Health.

“We found that a significant number of patients were using alternative and complementary medicines, with the majority not disclosing this to their GP and a significant proportion having chronic medical conditions for which they were also taking conventional medicines,” the researchers explained.

I think if research was conducted on the disclosure by clients to their complementary therapist in relation to their use of conventional medicine the findings would be similar. My experience in the area of Yoga teaching and Yoga therapy, in Dublin, is that students/clients quite regularly do not disclose relevant information in relation to specific physical conditions and the taking of prescribed medication.

While clients complete a confidential health questionnaire, additional information is frequently revealed though dialogue and verbal questioning. Clients often do not appreciate the importance of full disclosure in relation to their medical situation. It is as if there is a perception that medical treatment and complementary treatment are separate and that what is prescribed by one may not relevant to the other.

The point is that they are mutually supportive.