Back pain and yoga and physiological benefits

how yoga is helpful in managing back pain

1. YOGIC MANAGEMENT OF
MUSCULO-SKELETAL DISORDERS
(Upper, Mid & Low Back Pain)
S. LAKSHMI KANDHAN,
Assistant Professor (Yoga Therapy)
MorarjiDesai National Institute of Yoga (MDNIY),
Ministry of AYUSH, New Delhi -110001.
Email: [email protected]
Mobilelno. 08506007251

2. YOGIC MANAGEMENT OF UPPER AND MIDDLE
BACK PAIN
•Upperbackpain-originatefrommuscular
irritation,intervertebraldiscs,spinalfacet
joints,ribsorsofttissue(e.g.
ligament/fascia)problems.
•Commonlyintra-scapularpainisreferred
fromthelowercervicalspine.Contributing
factorstoinjuryinclude;lackofstrength,
poorposture,overuseinjuries(suchas
repetitivemotion),oratrauma(suchasa
caraccidentorsportsinjury).
•Upperandmiddlebackpainmaybe
causedby:Overuse,musclestrain,or
injurytothemuscles,ligaments,anddiscs
thatsupportyourspine.Poorposture.
Pressureonthespinalnervesfromcertain
problems,suchasaherniateddisc.
Photo courtesy: https://urlzs.com/US8Q
https://urlzs.com/rm6q
Intra-Scapular Pain
Middle Back Pain

3. Yogic Practices for Upper & Middle Back Pain
SukshmaVyayama:Shoulder movements, Katichakrasana.
ASANAS:
1.Tadasana
2.Ardhakatichakrasana
3.Ardhachakrasana
4.VirabhadrasanaI & II
5.Marjariasana
6.Gomukhasana
7.Uttanmandukasan
8.ArdhaUstrasana
9.Shashankasana
10.Bhujangasana, while leaving, rest the chin on palms,
arms folded, elbows resting on the floor.
11.Relaxation:Makarasana,Shavasana
Visualizingneckmusclesrelaxing,‘letgo’tension,flushing
theareawithfreshblood.Pranicenergyvisualizedtoflowin
theaffectedarea.

4. Mechanism of Yoga in the management
Upper and Middle Back Pain
RegularpracticeofAsana,Pranayama,Meditation,
MudraandYogicDiethelps,
•tostrengthentheupperandmiddletrunk
musclesandligaments
•Reducethedegenerativechangesinintervertebral
jointanddiscinthoracicregion.
•Torealignthethoracicvertebralcolumn
•Toacceleratethehealingprocessinthoracic
region
•Reducethestiffnessinthoracicregion
•Reducethetendernessandtriggerpointsin
thoracicregion.
•Improvespinemobility

5. Research Evidences
•OmkarSN,VishwasS.Yogatechniquesasa
meansofcorestabilitytraining.Journalof
bodyworkandmovementtherapies.2009Jan
1;13(1):98-103.
•LeeM,HuntoonEA,SinakiM.Softtissueand
bonyinjuriesattributedtothepracticeofyoga:
abiomechanicalanalysisandimplicationsfor
management.InMayoClinicProceedings2019
Mar1(Vol.94,No.3,pp.424-431).Elsevier.

6. LOWBACKPAIN

7. Vertebralcolumn
➢Thespinehasfournatural
curves.Twoarelordotic
andtwoarekyphotic.
➢Thecervicalandlumbar
➢curvesarelordotic.
➢Thethoracicandsacral
curvesarekyphotic.
➢The curves helpto
distribute mechanical
stressasthebodymoves.

9. Thelumbarvertebrae
➢Lumbarspine.Mostpeople
havefivelumbarvertebrae
althoughitisnotunusualto
havesix.
➢Thelumbarvertebraeare
largerthanthecervicalor
thoracicasthisspinalregion
carriesmostofthebody's
weight.
➢Canbedistinguishedby
othervertebraebytheir
greatersizeandtheabsence
ofcostalfacetsonthesides
oftheirbodies.

10. TheLumbarVertebræ

12. Ligaments
1.Theanteriorlongitudinal
ligament(ALL)
2.Theposterior
longitudinalligament
(PLL)
3.Theligamentumflavum
(LF)
4.Theintertransverse
ligaments(ITL)
5.interspinousligaments
(ISL)
6.Thesupraspinous
ligament(SSL)
7.Thecapsularligaments
(CL)

14. FACET JOINT

16. •Thesacroiliacjointisthe
jointbetweenthesacrum,
atthebaseofthespine,
andtheiliumofthepelvis,
which arejoinedby
ligaments.
•Itisastrong,weight
bearingsynovialjointwith
irregularelevationsand
depressionsthatproduce
interlockingofthebones.
sacroiliacjoint
•Inflammationofthisjointmaybecausedbysacroiliitis,
onecauseofdisablinglowbackpain.Withsacroiliitis,
theindividualmayexperiencepaininthelowback,
buttocksandthighs.

17. ➢Flat,round"cushionsactasshockabsorbers
➢Eachdischasastrongouterringoffiberscalledthe
annulus,andasoft,jelly-likecentercalledthenucleus
pulposus
IntervertebralDisc

18. PHISIOLOGICALCURVES:
CERVICAL & LUMBER LORDOSIS
DORSAL& SACRALKYPHOSIS.
Allcurves aredependentuponthelumbosacralangleto
retainitsbalancetothecenterofgravity
Lumbosacralangle

19. FSU–FunctionalSpinalUnitorspinalmotionsegmentis
thesmallestsegmentthatrepresentsthecharacteristicsofthe
entirespinalcolumn.

20. Lowbackpain
•Lowbackpaindefinedaspainanddiscomfort,
localizedbelowthecostalmarginandabovethe
inferiorglutealfolds,withorwithoutreferredleg
painwhilechroniclowbackpainisdefinedas
lowbackpainpersistingforatleast12weeks.

21. Riskfactors
1.Themostfrequentlyreportedareheavyphysical
work,frequentbending,twisting,lifting,pulling
andpushing,repetitivework,staticpostures
andvibrations.
2.Psychosocialriskfactorsincludestress,
distress,anxiety,depressionandmentalstress.
3.Otherriskfactorsmaybeassociatedwithlow
backpainasheavylifting,drivingmotor
vehicles,jogging,weakertrunkstrength,
obesity,pregnancy,psychosocialfactors,and
cigarettesmoking.

22. Causesoflowbackpain
➢May beeithermechanical (apophyseal
osteoarthritis,degenerativediscspinaldisc
herniation,spinalstenosis,spondylolisthesis
andothercongenitalabnormalities,fracture,
ligamentousstrainsorsprains),
➢Inflammatory(Rheumatoidarthritis,Ankylosing
spondylitis),neoplastic,metabolic(osteoprotic
fractureosteomalacia,paget`sdisease)
➢Infectious(osteomyelitis,epiduralabcess,septic
discitis
➢Psychosomaticdisorders,referredpain(ovarian
cyst,chronicprostatitis,colonicneoplasm)

23. Causesoflowbackpain
Mechanical(affecting
spineonly)
•Musclestrain
•Osteoarthritis
•Spinalstenosis
•Spondylolisthesis
•Vertebralfracture
•congenital
Nonmechanical(systemicdiseases)
•Ankylosingspondylitis
•Neoplasms
•Infections (TB,Herpes,
osteomyelitis)
•Atherosclerosis
•Visceralpain
Biomechanicalcauses
•Poorposture
•Sedentarylifestyle
•Poorfurnitre
Pyschologicalcauses
•Depression
•stress

24. RiskFactors
•Occupational
•Age
•AlcoholandDrugAbuse
•FamilyHistory
•Gender
•LevelofActivity(PhysicalFitness)
•Obesity
•PoorPostureandAlignment
•PreviousBackInjury
•Psychological,SocialandSpiritualFactors
•Smoking-Studieshaveshownthatsmokershavea1.5to2.5
timesgreaterriskofdevelopinglowbackpainthannonsmokers.It
isthoughtthismaybeduetoreducedoxygensupplytodisksand
decreasedbloodoxygenfromtheeffectsofnicotineon
constrictionofthearteries.
•Sports
•Otherfactors

25. Lumbar spondylosis
➢ThewordspondylosiscomesfromtheGreekwordforvertebrae.
➢Spondylosisreferstodegenerativechangesinthespinesuch
asbonespursanddegeneratingintervertebraldiscsbetweenthe
vertebrae.
➢Spondylosischangesinthespinearefrequentlyreferredto
asosteoarthritis.Forexample,thephrase"spondylosisofthe
lumbarspine"meansdegenerativechangessuch
asosteoarthritisofthevertebraljointsanddegenerating
intervertebraldiscs(degenerativediscdisease)inthelowback.
➢Spondylosiscanoccurinthecervicalspine(neck),thoracicspine
(upperandmidback),orlumbarspine(lowback).Lumbar
spondylosisandcervicalspondylosisarethemostcommon.
•Thoracicspondylosisfrequentlydoesnotcausesymptoms.
•Lumbosacralspondylosisisspondylosisthataffectsboththelumbarspine
andthesacralspine.
➢Multilevelspondylosismeansthatthesechangesaffectmultiple
vertebraeinthespine.

26. Lumbarspondylosiscanbedescribedasalldegenerative
conditionsaffectingthediscs,vertebralbodies,andassociated
jointsofthelumbarvertebrae....Theseosteophytesarebony
overgrowthsthatoccurduetothestrippingoftheperiosteum
fromthevertebralbody.

27. CausesofLumbarspondylosis
Lumbar spondylosisappearstobea
nonspecificagingphenomenon.
-Weaklowbackmuscles
-Occupation
-poorposture
-obesity
-stress
Symptoms of Lumbar spondylosis:
➢Backpainandstiffnessarethemainones.Theyare
usuallyworseinthemorningandgetbetterthroughout
theday.
➢Ifbonygrowths(osteopytes)arepushingagainstanerve
rootorthespinalcord,leadstonumbness,tingling,
weakness,oranaching,shootingpaininbuttockandleg.

29. ProlapsedlumbarIntervertebral Disc (PIVD)
•HerniationofpartofalumbarIVD
isacommoncauseofcombined
backpain&sciatica.
•Cause:aninjuryorspontaneous
age-degenerationofdisc
•L4-L5&L5-S1aremostlyaffected.
•Partofnucleuspulposusprotrudes
thro’aannulusfibrosusatits
weakestpart(i.epostero-lateralor
sometimestornannulusitself
protrudesbackwards

31. PIVD-clinicalfeatues
➢Historyoftrivialtraumaorliftingweight
➢Shootingpainwithspasm
➢Painradiatingdownthelegbelowtheknee
➢Aggravatedbycoughing/sneezing
➢Usuallysuddenonset
➢May beassociatedwithconcurrent
neurologicaldeficit;sensoryormotor,
paresthesias.

32. Caudaequinasyndrome
➢Cauda equina
syndrome (CES)isa
conditionthatoccurswhen
thebundleofnervesbelow
theendofthespinalcord
known asthecauda
equinaisdamaged.
➢Signsandsymptomsinclude
lowbackpain,painthat
radiatesdowntheleg,
numbnessaroundtheanus,
andlossofbowelorbladder
control.

33. PIVD-Examination

34. PIVD-Investigations
•Plainx-ray
•Ct-scan
•MRI(preferred)
•EMG

35. PIVD-Treatment
•Conservativemanagement: rest,drugs,physiotherapy
•Operativeintervention–failureofconservative
measures,caudaequinasyndrome
1.Fenestration
2.laminectomy
3.hemi-laminectomy
4.laminotmy
Fenestrationdisectomy

36. Spondylolisthesis
Bilateraldefectintheparsinterarticulariswhich
causesforwarddisplacementofvertebra
Spondylolisthesisisaslippingofvertebrathatoccurs,inmost
cases,atthebaseofthespine.Spondylolysis,whichisadefect
orfractureofoneorbothwing-shapedpartsofavertebra,can
resultinvertebraeslippingbackward,forward,oroverabone
below.

37. Spondylolisthesis

38. SPONDYLOLISTHESIS
RETROLISTHESIS
DISLOCATIONOF VERTEBRA

39. Spondylolisthesis-clinicalfeatures
Symptoms
➢Varyfrommildtosevere.Mayevenhaveno
symptoms.
➢Classicallya“STEP”maybepalpable.
➢Canproduceincreasedlordosis(alsocalled
swayback),butinlaterstagesmayresultinkyphosis
(roundback)astheupperspinefallsoffthelower
spine.
➢Lowerbackpain,tenderness
➢Muscletightness(tighthamstringmuscle)
➢Pain,numbness,ortinglinginthethighsand
buttocks
➢Weaknessinthelegs

41. Spondylolisthesis-Treatment
➢Conservativemethodsfor
grade2to3
spondylolisthesis,including
braceandanalgesics
➢Spineflexionexercises
➢Failureofconservativeand
severelisthesismayrequire
operativeintervention-
intertrasversefusionor
internalfixaton.

42. LumbarCanalStenosis
➢Duetothecommonoccurrenceof
spinaldegenerationthatoccurs
withaging.
➢sometimescausedbyspinaldisc
herniation,osteoporosisora
tumor.
➢Lumbarspinalstenosiscanputpressureonthespinal
cordandthenervesthattravelthroughthespine.Age-
relatedchangesarethemostcommoncause.
➢Symptomsincludepainorcrampinginthelegswhen
standingforlongperiodsorwhenwalking.The
discomfortusuallyeaseswhenbendingforwardor
sittingdown.

43. LumbarCanalStenosis

44. Ankylosing
spondylitis

45. Definition
Thisisachronicprogressiveinflammatorydiseaseofthe
sacroiliacjointsand the axialskeleton.
Causes
Causesareunknown.Itisfoundtobestrongly
associatedwithHLA-B27geneticmarkerisabout85
percent.Age/sexCommon inyoungmaleadults
(M: F = 10:1).
Pathology
Theinitialinflammationofthejointsisfollowedby
synovitis,arthritis,andcartilagedestruction,fibrous
andlaterbonyankylosis.Thejointscommonlyaffected
areSIjoints,spine,hip,andkneeandmanubrium
sterni.

46. Clinical Features
•Patient usually complains of early morning stiffness and
pain in the back. On examination patient has a stiff
spine. Tests for sacroiliac joint involvement are positive.

48. ➢Continuedinflammationof
theligaments,tendons,
jointcapsules(softtissues
surroundingthejoint)and
jointsofthespine

50. PIRIFORMIS SYNDROME
•Piriformissyndrome isaconditioninwhichthe
Piriformismuscle,locatedinthebuttockregion,spasms
andcausesbuttockpain.ThePiriformismusclecanalso
irritatethenearbysciaticnerveandcausepain,
numbnessandtinglingalongthebackofthelegandinto
thefoot(similartosciaticpain).

51. Fibromyalgia
Research Evidences:
1.CarsonJW,CarsonKM,JonesKD,BennettRM,WrightCL,MistSD.ApilotrandomizedcontrolledtrialoftheYogaof
Awarenessprograminthemanagementoffibromyalgia.PAIN®.2010Nov1;151(2):530-9.
2.SilvaGD,LageLV.Yogaandfibromyalgia.RevistaBrasileiradeReumatologia.2006Feb;46(1):37-9.
3.RudrudL.Gentlehathayogaandreductionoffibromyalgia-relatedsymptoms:Apreliminaryreport.International
journalofyogatherapy.2012Jan1;22(1):53-8.
4.FirestoneK,CarsonJ,MistS,CarsonK,JonesK.Interestinyogaamongfibromyalgiapatients:Aninternational
internetsurvey.Internationaljournalofyogatherapy.2014Jan1;24(1):117-24.
5.HennardJ.Aprotocolandpilotstudyformanagingfibromyalgiawithyogaandmeditation.Internationaljournalof
yogatherapy.2011Sep1;21(1):109-21.
6.Dalmau‐CarolàJ.Myofascialpainsyndromeaffectingthequadratusfemoris.PainPractice.2010May;10(3):257-60.
Fibromyalgia,also called
fibromyalgiasyndrome(FMS),isalong-
termconditionthatcausespainall
overthebody.Aswellaswidespread
pain,peoplewithfibromyalgiamay
alsohave:increasedsensitivitytopain,
extremetiredness(fatigue)muscle
stiffness.
https://urlzs.com/XRrN

52. Yogic Management of Low Back Pain
•Lowbackpainisacommonhealth
problem.Inmanypeople,lowbackpain
maylastforthreemonthsormore,at
whichpointtheconditionisconsidered
chronic.LowbackpainduetoMuscle
strain,Discbulgeor herniation,
Sacroiliacstrain,Lumbarspondylosis
(Discdegeneration),Sciaticacausedby
prolongpooralignmentofspine,
occupation,lackofphysicalactivity,
accident,liftingheavyobjects,obesity
etc,.
•Yogapracticehelpstotreatthelowback
painbyreducethedegenerativechanges
indiscandimprovelumbarmobility.
Reference:
➢Wieland LS, SkoetzN, Pilkington K, VempatiR, D'AdamoCR, Berman BM. Yoga treatment for chronic
non‐specific low back pain. Cochrane Database of Systematic Reviews. 2017(1).
➢Whitehead PB. Yoga Treatment for Chronic Nonspecific Low Back Pain. Clinical Nurse Specialist. 2018 Nov
1;32(6):294-5.
Photo Courtesy:
https://bit.ly/2UvN75R
Low Back Pain

53. Yogic Management of Low Back Pain
ASANAS:
1.Tadasana
2.Urdhwahastottanasana
3.Katichakrasana
4.Ardhachakrasana
5.Trikonasana
6.Uttanapadasana
7.Marjariasana
Relaxation:
Makarasana,Shavasana.
Reference:
➢AttanayakeAM,SomarathnaKI,VyasGH.Clinicalevaluationofselectedyogicproceduresinindividualswith
lowbackpain.
Visualisingtightbackmusclesrelaxing,‘letgo’tension,flushingthearea
withfreshblood.Pranicenergyvisualisedtoflowinthecongestedarea.
8.Ushtrasana
9.Vakrasana
10.Sasangasana
11.Sethubandasana
12.ArdhaShalabhasana
13.Bhujangasana

54. Yogic Management of Low Back Pain
VajrasanarecommendedforPranayama.
Breathawareness:movementofbreathinspinalpassage
fromMooladharatoAjnachakraatthetopofspinal
column-beneficialandeffectiveinallspinaldisorders
•Sectionalbreathing
•NadishodhanaPranayama
•SuryabhedhanaPranayama
•BhramariPranayama
(12to16breaths/minuteshouldbereducedgradually
withregularpractice,slowbreathewillinfluencespeed
ofthoughtsinmind.
Exhalation longer than inhalation –calms mind.)

55. Yogic Management of Low Back Pain
➢Dhyana:
•Nadanusandhana,
•Ommeditation
•Ajapajapa
➢Speedshealing,bringsdeepmentalandphysical
relaxation.
➢Inmildcases,Padmasanawithbacksupportedwitha
pillowagainstawallatlumbarregionforlongstraight
sitting.
➢Mindhastorelaxbyreducingthespeedofthoughts.-
Dharana,Dhyana,devotionalsessions–valuabletools
tobringemotionalstability,↓distractionsofmind
➢Therapistsinstructionsduringrelaxationpostures,
counselling-importantguidetopatient’spsyche.
➢Betterunderstandingoftheproblem,autosuggestions
tohealsmoothlyandspeedily.

56. Mechanism of Yoga in the management
Low Back Pain
RegularpracticeofAsana,Pranayama,Meditation,
MudraandYogicDiethelps,
•tostrengthenlowertrunkmusclesandligaments
•Reducethedegenerativechangesinintervertebral
jointanddiscinlumbarregion.
•Torealignthelumbarvertebralcolumn
•Toacceleratethehealingprocessinlumbarand
sacralregion
•Reducethestiffnessinlumbarregion
•Reducethetendernessandtriggerpointsinpara
spinal,gluteal(piriformissyndrome)region.
•Improvelumbarspinemobility

57. Mechanism of Yoga in the management Low Back Pain
Lengtheningthebackextensormuscles(latissimusdorsi,erector
spinae,multifidi,quadratuslumborum)evenlyonbothsidesofthe
trunkdecreasescompressioninthelowerback.Thisinvolves
creatinganinternaltractionbyelevatingthesternumand
lengtheningthelowerbackthroughmovingthebuttocksinferiorly
awayfromthewaist.
Pavanamuktâsana
Photo courtesy: https://bit.ly/2G0eJpE
Ref: Williams K, Steinberg L, PetronisJ. Therapeutic application of Iyengaryoga for healing chronic low back pain. International Journal of Yoga
Therapy. 2003 Jan 1;13(1):55-67.

58. Mechanism of Yoga in the management Low Back Pain
Broadeningthebackofthepelvisisachieved
byrotatingboththethighsinternallyanddrawing
theouterthighsupandintowardthehipsocket,
andbymovingthebuttocksdownandposterior
pelvictilt.
Thesemovementscreatedgappingor
distractingthesacroiliac(SI)jointandservesto
relievecompressionoftheSIjointsandthesciatic
nerve.
Co-contractionofthequadriceps,hamstrings,
tensorfascialatae,andgluteusmaximusis
performedtohelpstabilizethebroadpelvis
createdbytheaboveactions.
Ref: Williams K, Steinberg L, PetronisJ. Therapeutic application of Iyengaryoga for healing chronic low back pain. International Journal of Yoga
Therapy. 2003 Jan 1;13(1):55-67.
Photo courtesy : https://bit.ly/2DfXujR
Tadasana

59. Research evidence
Complement TherMed.2012 Jun;20(3):107-18.A
comprehensiveYogaprogramsimprovespain,anxietyanddepression
inchroniclowbackpainpatientsmorethanexercise:anRCT.Tekur
P,NagarathnaR,ChametchaS,HankeyA,NagendraHR.
➢Previously,outpatientYogaprogramsforpatientswithchronic
lowbackpain(CLBP)lastingseveralmonthshavebeenfoundto
reducepain,analgesicrequirementanddisability,andimprove
spinalmobility.Thisstudyevaluatedchangesinpain,anxiety,
depressionandspinalmobilityforCLBPpatientsonshort-term,
residentialYogaandphysicalexerciseprograms,including
comprehensiveyogalifestylemodifications.
➢Asevendayrandomizedcontrolsingleblindactivestudyinan
residentialHolisticHealthCentreinBangalore,India,assigned80
patients(37female,43male)withCLBPtoyogaandphysical
exercisegroups.TheYogaprogramconsistedofspecificasanasand
pranayamasforbackpain,meditation,yogiccounselling,and
lecturesonyogaphilosophy.Thecontrolgroupprogramincluded
physicaltherapyexercisesforbackpain,andmatchingcounselling
andeducationsessions.
➢SevendaysintensiveresidentialYogaprogramreducespain,
anxiety,anddepression,andimprovesspinalmobilityinpatients
withCLBPmoreeffectivelythanphysiotherapyexercises.

60. Research evidence
AnnInternMed.2011Nov1;155(9):569-78.Yogaforchroniclow
backpain:arandomizedtrial.TilbrookHE,CoxH,HewittCE,
Kang'ombeAR,ChuangLH,JayakodyS,AplinJD,SemlyenA,
TrewhelaA,WattI,TorgersonDJ.(UnitedKingdom)
➢Theaimofthisstudywastocomparetheeffectivenessofyoga
andusualcareforchronicorrecurrentlowbackpain.
➢313adultswithchronicorrecurrentlowbackpain
participatedinthisstudyconductedin13non-NationalHealth
ServicepremisesintheUnitedKingdom.
➢Yoga(n=156)orusualcare(n=157).Allparticipantsreceived
abackpaineducationbooklet.Theinterventiongroupwasoffereda
12-class,graduallyprogressingyogaprogramdeliveredby12
teachersover3months.
➢ScoresontheRoland-MorrisDisabilityQuestionnaire(RMDQ)at
3(primaryoutcome),6,and12(secondaryoutcomes)months;pain,
painself-efficacy,andgeneralhealthmeasuresat3,6,and12
months(secondaryoutcomes).
➢Offeringa12-weekyogaprogramtoadultswithchronicor
recurrentlowbackpainledtogreaterimprovements inback
functionthandidusualcare.

61. Research Evidences
1.WielandLS,SkoetzN,PilkingtonK,VempatiR,D'AdamoCR,
BermanBM.Yogatreatmentforchronicnon‐specificlowbackpain.
CochraneDatabaseofSystematicReviews.2017(1).
2.CramerH,LaucheR,HallerH,DobosG.Asystematicreviewand
meta-analysisofyogaforlowbackpain.TheClinicaljournalof
pain.2013May1;29(5):450-60.
3.TilbrookHE,CoxH,HewittCE,Kang'ombeAR,ChuangLH,
JayakodyS,AplinJD,SemlyenA,TrewhelaA,WattI,Torgerson
DJ.Yogaforchroniclowbackpain:arandomizedtrial.Annalsof
internalmedicine.2011Nov1;155(9):569-78.
4.TekurP,SingphowC,NagendraHR,RaghuramN.Effectofshort-
termintensiveyogaprogramonpain,functionaldisabilityand
spinalflexibilityinchroniclowbackpain:arandomizedcontrol
study.Thejournalofalternativeandcomplementarymedicine.
2008Jul1;14(6):637-44.
5.PosadzkiP,ErnstE.Yogaforlowbackpain:asystematicreviewof
randomizedclinicaltrials.ClinicalRheumatology.2011Sep
1;30(9):1257.
6.BehrndtG.OntheEffectivenessofYogaforNon-specific,Chronic
BackPain.
7.FishmanL,SaltonstallE.Yogainpainmanagement.InIntegrative
PainMedicine2008(pp.259-284).HumanaPress.