LIRA Week 4: Yoga

Michael Chiauzzi, Marissa Leoni, Christian Navarro, & Michael Scholz

Objectives

● Learn about current research regarding yoga and musculoskeletal

disorders

● Learn different yoga poses to promote strength, balance, flexibility, &

relaxation

● Learn about different meditation techniques and apps

● Review diaphragmatic breathing

● Yoga Resources

Current Research

Primary care physicians’ attitude and reported prescribing behavior for chronic low back pain: An exploratory cross-sectional study

● Background:○ Chronic LBP: Global prevalence ~20%, 33% recurrence within 1st year of exacerbation.

○ 533 Physicians in the French speaking portion of Switzerland were given the questionnaire.

● Methods: Questionnaire○ 79 Items

■ 4 parts: Socio-demographic data, PCP’s perceived usefulness of various conventional treatments for

chronic or recurrent LBP, PCP’s perceived usefulness of CM in general and of specific CM treatments,

PCP’s attitude towards and personal use of CM.

Primary care physicians’ attitude and reported prescribing behavior for chronic low back pain: An exploratory cross-sectional study

● Participants

Primary care physicians’ attitude and reported prescribing behavior for chronic low back pain: An exploratory cross-sectional study

● Results:○ Top 3 conventional treatments most often considered useful

■ PT (94.8%) NSAIDs (87.9%) Manual Therapy (822.5%)

○ Most prescribed conventional treatments

■ PT (99.2%) NSAIDs( 97.4%) Acetaminophen (94.4%) Osteopathic treatment (78.4%) yoga (69.3%)

therapeutic massage (63.9%)

○ Most recommended complementary medicine:

■ Osteopathic treatment (87.3%) acupuncture (69.3%) therapeutic massage (58.7%)

Yoga as a treatment for chronic low back pain: A systematic review of the literature

● Background: ○ Performed by US Dept of VA

○ Increasing prevalence of CLBP and increased report on the reduction in function being seen.

● Review of the literature until beginning of 2015 using PubMed as a database. ○ Included were randomized control trials using yoga as a treatment for CLBP

■ 27 articles of initial 128 that were found were used

● Discussion: ○ Common risk factors associated with CLBP

■ Previous back injury, high physical demands on job, low job satisfaction, age, back weakness, smoking.

○ Benefits to yoga:

■ Cost-effectiveness

■ Reducing functional disability

■ MAY have an effect on depression and other psychological disabilities. BDNF Levels

● Further research needed

Integrative effect of yoga practice in patients with knee arthritis. Wang et. al., 2018

● Background

○ Meta Analysis to quantify the efficiency of yoga exercise for patients

pain reduction, functional recovery and well-being.

● Methods

○ 13 studies included containing 1557 subjects

■ Subjects with OA, RA or suspected OA

○ 3 types of yoga

Visual analog scale (VAS)

Western Ontario and McMaster Universities Arthritis Index (WOMAC)

Health Assessment Questionnaire (HAQ)

Short Form 36 Health Survey (SF-36)

Integrative effect of yoga practice in patients with knee arthritis. Wang et. al., 2018

● Conclusion

○ Clinically significant pain alleviation and functional improvements

○ Stress reducing effects may be the effective mechanism for reducing

pain

○ Systemic effects such as lowered HR

○ Similar effects on low back pain and carpal tunnel

Effects of Yogasanas on osteoporosis in postmenopausal women. Motorwala et. al., 2016

● Background

○ Very common, increased risk of fracture

○ Can be measured with a DEXA scan

● Methods

○ 30 females ages 45-62 with t-score of ≤2.5

○ 6 month yoga program

○ Pre and post test analysis

Integrative effect of yoga practice in patients with knee arthritis. Wang et. al., 2018

● Results

Effects of yoga on cardiovascular disease risk factors: A systematic review and meta-analysis. Cramer et al., 2014

● Background

○ Assess the effects of yoga on modifiable cardiovascular risk factors in the general

population and high-risk disease groups

● Methods

○ 44 studies with a total of 3,168 participants

○ Yoga vs usual care or no treatment

● Limitations

○ Some studies contained a high-risk for bias

Effects of yoga on cardiovascular disease risk factors: A systematic review and meta-analysis. Cramer et al., 2014

● Results○ Systolic Blood Pressure -5.85 mmHg○ Diastolic Blood Pressure -4.12 mmHg○ Heart Rate -6.59 bpm○ Respiratory Rate -0.93 breaths per minute ○ Waist circumference -1.95 cm ○ Waist to hip ratio -0.02 ○ Total cholesterol -13.09 mg/dl○ HDL +2.94 mg/dl○ LDL -6.52 mg/dl○ VLDL -5.70 mg/dl○ Triglycerides -20.97 mg/dl○ Fasting blood glucose -14.11 mg/dl○ HbA1c -0.45%○ Insulin resistance -0.19

Conclusions● ~12 weeks is the sweet spot

for these effects● Should be used as an ancillary

treatment

Lower Extremity Strengthening Poses

Warrior I

● Strengthens: Glutes and Quads of front leg, Stretches opposite adductor

and hip flexor as well as chest and abdominals

● Step-by-step Guide:

○ https://www.yogajournal.com/poses/warrior-i-pose

Bridge Pose

● Strengthens:Hip Extensors, also hamstrings minimally

● Step-by-step Guide:

○ https://www.yogajournal.com/poses/bridge-pose

Chair Pose

● Strengthens: Glutes, Quads, Ankle stability. Also stretches chest, posterior

shoulders

● Step-by-step Guide:

○ https://www.yogajournal.com/poses/chair-pose

Upper Extremity Strengthening Poses

Downward Facing Dog

● Strengthens: Shoulder girdle, Lats

● Stretches: Triceps, Forearms, Hamstrings, Calves, arches

● Step-by-step Guide:

○ https://www.yogajournal.com/poses/downward-facing-dog

Also See...

● Plank and Side Plank

● Strengthens: Shoulder Girdle, Triceps, Core

Core Poses

Boat Pose

● Strengthens: abdominals and deep hip flexors and requires

good sitting balance

● Step-by-step guide:

○ https://www.yogajournal.com/poses/full-boat-pose

Plank Pose

● Strengthens: core and upper extremities

● Step-by-step guide:

○ https://www.yogajournal.com/poses/plank-pose

Cat-Cows

● Spinal mobility

● Step-by-step guide cat pose:

○ https://www.yogajournal.com/poses/cat-pose

● Step-by-step guide cow pose:

○ https://www.yogajournal.com/poses/cow-pose

Balance Poses

Tree Pose

● Single Leg Balance, Hip Stability esp. Abductors

● Step-by-step guide:

○ https://www.yogajournal.com/poses/tree-pose

Side Plank Pose

● Arm balance, strengthens arms and wrists

● Step-by-step guide:

○ https://www.yogajournal.com/poses/side-plank-pose

Warrior III Pose

● Step-by-step guide:

○ https://www.yogajournal.com/poses/warrior-iii-pose

● 23 Minute Video For Improving Balance:

○ https://www.yogajournal.com/videos/balancing-poses

Flexibility Poses

Legs-Up-The-Wall Pose

● Stretches: Back of Legs- Hip Extensors (Glutes), Knee Flexors (Hamstrings)

● Step-by-step Guide:

○ https://www.yogajournal.com/poses/legs-up-the-wall-pose

High Lunge Pose

● Stretches: Hip Extensors (Glutes), Opposite Hip Flexors

● Step-by-step Guide:

○ https://www.yogajournal.com/poses/high-lunge

Big Toe Pose

● Stretches: Hip Extensors (Glutes), Knee Flexors (Hamstrings), Low Back

● Step-by-step Guide:

○ https://www.yogajournal.com/poses/big-toe-pose

Extended Triangle Pose

● Stretches: Adductors (inner thighs), Opposite Abductors (Gluteus

Medius/Minimus), Lateral Trunk

● Step-by-step Guide:

○ https://www.yogajournal.com/poses/extended-triangle-pose

Relaxation & Meditation

Restorative Poses● Corpse Pose

○ Step-by-step guide:

https://www.yogajournal.com/poses/corpse-pose

● Child’s Pose

○ Step-by-step guide:

https://www.yogajournal.com/poses/child-s-pose

● Reclining Bound Angle Pose

○ Step-by-step guide:

https://www.yogajournal.com/poses/reclining-bound-angle-pose

Meditation and Mental Imagery ● https://www.youtube.com/watch?v=e1qHRZGd82k

Meditation Apps

● The Mindfulness App

● Calm

● Headspace

● Mindbody

Yoga Resources

● Yoga with Adriene

○ https://www.youtube.com/user/yogawithadriene

○ Meditation, Weight Loss, Flexibility, Beginners

● Yoga Journal

● Different styles of yoga

○ https://www.mindbodygreen.com/articles/the-11-major-types-of-yo

ga-explained-simply

○

References ● Chang DG, Holt JA, Sklar M, Groessl EJ. Yoga as a treatment for chronic low back pain: A systematic review of

the literature. Journal of orthopedics & rheumatology. 2016;3(1):1-8.

● Cramer, H., Lauche, R., Haller, H., Steckhan, N., Michalsen, A., & Dobos, G. (2014). Effects of yoga on

cardiovascular disease risk factors: A systematic review and meta-analysis. International Journal of Cardiology,

173(2), 170-183. doi:10.1016/j.ijcard.2014.02.017

● https://www.healthline.com/health/mental-health/top-meditation-iphone-android-apps

● https://www.yogajournal.com

● Rodondi, P., Dubois, J., Bill, A., Koutaïssoff, D., Ros, J., Aveni, E., . . . Burnand, B. (2018). Primary care physicians’

attitude and reported prescribing behavior for chronic low back pain: An exploratory cross-sectional study.

Plos One, 13(9). doi:10.1371/journal.pone.0204613

● Wang Y, Lu S, Wang R, et al. Integrative effect of yoga practice in patients with knee arthritis: A

PRISMA-compliant meta-analysis. Tusconi. M, ed. Medicine. 2018;97(31):e11742.

doi:10.1097/MD.0000000000011742.