Yoga Matters: How It Can Support a Healthy You
By Jasper Sidhu, BSc, DC
"Can I continue to do yoga while undergoing chiropractic care?" "Is it OK to go back to yoga while I'm getting my back treated?" "It is safe to start my yoga classes again after my neck pain improves?" These are some of the questions yoga enthusiasts have been asking me over the years.
Yoga, in addition to various other exercises, is increasing in popularity. The Yoga in America study (2012) reported yoga was practiced by 15.8 million Americans. Because so many people are participating in yoga, it's important to understand the literature when it comes to its effectiveness and safety. Let's examine some of this research so you can appreciate the health benefits of this increasingly popular activity.
Yoga 101: Origins, Utilization, Etc
Yoga is a form of exercise and deep breathing with origins in India. There are a wide variety of different styles of yoga, each focusing on specific goals and programs. Programs can focus on structure (Iyengar yoga) with the use of blocks and straps, to meditation and breathing (kundalini yoga). Although addressing each style of yoga is beyond the scope of this article, we'll reference them if the information relates to a specific style.
Participation in yoga is increasing. Holden, et al. (2015), found one-third of all women used complementary and alternative medicine during pregnancy and childbearing years, but only half disclosed CAM to their health care providers. Thirteen percent of pregnant women and 16 percent of nonpregnant women used yoga.
A recent National Health Statistics Report revealed yoga use increased across three time points from 2002 to 2007 to 2012 (5.1 percent, 6.1 percent and 9.5 percent, respectively). The highest prevalence of use across all three time points was by adults between the ages of 18 and 44.
In a study of women 60 to 65 years of age, Murthy V, et al. (2014), found that 75.2 percent of women self-prescribed one or more CAM therapies for back pain. Yoga and meditation accounted for 14.3 percent of use.
Injuries related to yoga are infrequent, although the number of reported injuries is increasing due to increased use. A recent study by Russell K, et al. (2015), found the most common type of injury was a sprain (34 percent) and the most likely area was the lower extremity (42 percent). Severe injury is also quite rare. Holton MK, et al. (2014), found less than 1 percent of individuals who practiced yoga reported an injury that led to discontinued use. A recent systematic review and meta-analysis of randomized, controlled trials came to the same conclusion. Cramer H, et al. (2015), concluded yoga appears to be as safe as usual care and exercise.
Yoga for Musculoskeletal Health
Research suggests yoga may be effective for a wide variety of conditions, such as arthritis, chronic low back pain, fibromyalgia and balance in the elderly. Let's take a look at some of the most recent findings.
Low Back Pain: A systematic review by Crow, et al. (2015), found there was strong evidence for the short-term effectiveness for yoga. However, there was little evidence for long-term effectiveness for chronic spine pain. The type of yoga reviewed in this study was the Iyengar yoga method.
Iyengar yoga also was examined in a randomized, controlled study by Nambi GS, et al. (2014). They compared yoga therapy to conventional exercise therapy on pain intensity and health-related quality of life in subjects with nonspecific, chronic low back pain. Results showed Iyengar yoga provides better improvements in pain reduction and improvement in health-related quality-of-life measurements.
Muscle Activation: A recent study by Ni M, et. al. (2014), sheds some light on muscle function during various poses. "High plank," "low plank" and "downward facing dog" were effective for strengthening the external oblique abdominis. "Chair" and "warrior 1" poses were useful for the gluteus maximus, and chair and "halfway lift" poses were effective for strengthening the longissimus thoracis. The "upward facing dog" pose can be used to strengthen all three muscles.
Elderly Balance: Although a Cochrane Review (2012) didn't find any evidence of improvements in balance, newer studies seem to show some benefits. In a study by Nick N, et al. (2015), an intervention group performed yoga two times per week for eight weeks. Compared to controls, the yoga group had significant improvements in the Modified Falls Efficacy Scale and the Berg Balance Scale.
Saravanakumar P, et. al. (2014), looked at the impact of tai chi and yoga on balance and falls in residential care settings. Yoga participation was associated with a slight decrease in fall incidence and average pain scores, although results were not statistically significant.
Arthritis: Although the average yoga user is younger than older, yoga may be beneficial for those with arthritis. A recent study by Moonaz SH, et al. (2015), assessed integral-based hatha yoga in sedentary people with arthritis. Preliminary evidence suggested yoga can be practiced safely and improves physical and psychological health, including health-related quality of life. Ghasemi GA, et al. (2013), also found yoga significantly reduced pain and symptoms in a group of women with osteoarthritis.
Which yoga exercises provide the best muscle activation for knee strengthening in patients with osteoarthritis? Longpre HS, et al. (2015), assessed various yoga postures, finding quadriceps activation was highest during the squat and lunge postures, producing more co-contraction indices than other postures. The wide-legged squat ("goddess") and lunge with trunk upright ("warrior") poses produced the lowest knee adduction moments, which may benefit those with knee osteoarthritis.
Flexibility: For flexibility training, yoga was shown to be more effective than calisthenics. Farinatti PT, et al. (2014), used hatha yoga for the study, which features slow, passive movements.
Spinal flexibility is also shown to improve with yoga use. Grabara M, et al. (2015), assessed the effects of hatha yoga for women older than age 50. Results demonstrated not only increased hamstring flexibility, but also overall spinal flexibility.
Interested in yoga, but don't know where to start? The International Association of Yoga Therapists (IAYT) and the Yoga Alliance both offer online search tools to provide a qualified yoga practitioner in your community. Although not all-inclusive, this is a good list to begin with.
A final note: As more chiropractors look to provide services to their patients beyond spinal manipulation, they may be considering adding yoga as a practice service. Talk to your chiropractor about your interest in yoga and to learn more.
Jasper Sidhu, DC, graduated from Canadian Memorial Chiropractic College in 1994 and opened the Downtown Injury Rehab Centre in Windsor, Ontario, incorporating vibration training into the rehabilitation part of his practice. He is vice president of clinical services for WAVE Manufacturing (www.wavexercise.com).