The Multifidus in Action*

and in Yoga
by Doug Keller

The multifidus muscles come into play when you are: standing still, bending forward, twisting to either side, picking things up or lifting heavier objects, walking.

They are not active when you are: bending directly to one side or the other (no twisting of the spine involved), bending backwards when there is no resistance (such as when bending backwards while standing), lying down.

These muscles are at work through a specific range of movement, and also need to know when to let go. In a forward bend the multifidus muscles contract as you bend over until you are about 40°-70° –and then the back muscles normally relax as the ligaments take over.

Fist Steps
From our description of the kind of actions in which the multifidus muscles are active, it’s fairly easy to see that the majority of the basic hatha yoga āsanas will help strengthen them. The multifidus muscles are given a workout most when you are practicing forward bends and twists, as well as basic standing postures. They’re also strengthened when you do simple back-bending actions which involve resistance from gravity, such as in prone positions like Locust Pose (Śalabhāsana) in which you lift and extend your legs behind you.

If you do suffer from low back pain, you of course have reason to be careful before attempting such poses. Thus we should start with a couple of simple suggestions that are safest for relatively inexperienced students, and then look more deeply at the basic actions of the bandhas that can be incorporated into a more seasoned yogi’s practice.

The first step is a fairly familiar warmup that can be part of any practice:
1. Start on your hands and knees, placing a folded blanket under your knees if necessary. Keep your head in line with your spine and begin with a natural, neutral inward curve in your lower back.
2. As you exhale, extend your leg back, bringing it in line with your spine, the leg parallel to the floor and big toe pointing straight down. Keep your hips level and steady, and your abdomen firm to keep your lower back from moving.
3. Hold for a second, and then lower your knee to the floor as you inhale.
4. Alternate between the two legs, doing a few repetitions on each side, until you can work up to doing either a total of two minutes work, or twenty repetitions with each leg. Once a day for two or three days a week is plenty when you’re just starting out.

If you can manage this amount, then you add more weight and resistance to the exercise by including arm extensions:
–As you extend your right leg back, raise and extend your left arm forward at the same time, palm facing downward. Don’t lift the arm so much that it causes pinching in your shoulder or increased arching in your lower back.
–Lower your arm and leg down at the same time, and follow the same program of repetitions. As this becomes easier, light ankle weights can be added (starting with 1 lb. each); the weight is appropriate if you can manage 30 seconds of doing the exercise or 10 repetitions.
–Balance is of course more tricky in this version, and it has the added advantage of toning your lower abdominals and obliques as you work to steady your balance!

The next logical step is to take the same action into Downward Facing Dog Pose: step one foot a bit closer to the midline and lift the other leg until it is in line with your upper body. Keep your big toe pointing straight downward to keep your hips level. In this case there is no need to twist: your focus is on working the muscles at the back of the spine symmetrically. Firm your lower belly, gently pressing the muscles below your navel toward the spine, drawing them upward slightly as your tailbone lengthens back.

This last action in Downward Facing Dog Pose introduces us to the actions of the bandhas in conjunction with the multifidus muscles. This is where the deeper yoga begins.
*Yoga As Therapy, Volume Two: Applications

What is a Multifidus?*

by Doug Keller

The name comes from a combination of the Latin words multus, meaning ‘many’, and findo, meaning ‘to cleave’. The name really refers to a group of many tiny individual muscles that ‘cleave’ the facet joints of the spine, interwoven from the top of the sacrum all the way up the base of the head. There are lots of multifidus muscles, each one crossing just two to five vertebrae each. As a whole, the multifidus muscles work together to provide stability to the spine, keeping the vertebrae in a safe position regardless of what the spine is being asked to do. And each multifidus has an individual job to do, controlling its own single segment of the spine.

And that can be the problem. In many cases of back pain, it’s just a single multifidus muscle – rather than the group – that is not working properly, and there is plenty of evidence linking failure of a single muscle to the specific area of back pain. And each multifidus is particularly vulnerable to a breakdown. Most muscles in the body are controlled by several nerves, which means that they have a backup to keep them running if one nerve fails. But the multifidus is rather unique, in that each of them is run by a single nerve from the spinal cord. If something happens to the nerve, the muscle stops functioning properly, like a single light going out on the Christmas tree. Since it lacks a backup, the multifidus is more prone to failure.

Why would this cause back pain? Because of the specific job entrusted to it. Each multifidus attaches directly to the joint capsule or tissue that surrounds the small facet joints at the back of the spine. When the multifidus contracts, it pulls backwards on this capsule, pulling the capsule or tissue that surrounds the small facet joints at the back of the spine. When the multifidus contracts, it pulls backward s on this capsule, pulling the capsule away from the bones of the joint so that it doesn’t get nipped or pinched by the vertebrae as you bend forward or twist. Since the capsule contains nerve endings, any pinching of the capsule will result in an attack of back pain, even if you’re doing simple everyday movements that never caused pain before.

But back pain from the multifidus does not arise only from pinching of the joint capsule. Often it is the muscle itself that is crying out in pain. Paradoxically, back pain often arises when the multifidus muscles don’t relax and release they’re supposed to! In the case of pregnant women – where the increasing weight of the child steadily increases the load on the spine – studies have found that the increased activity in the multifidus goes hand in hand with the increasing intensity of back pain that comes with pregnancy. In fact, measurements of increased activity in the multifidus provide a good predictor of which pregnant women will suffer from back pain.

In cases of disk herniation, we’re finding that the effect upon the mutifidus is also involved. Though the casual relationship is not fully understood, it’s been found that a herniated disk causes the multifidus to be overactive and contract more than it should. Moreover, the multifidus muscles in the area of the herniation have been shown to be much smaller (hence weaker) than normal. By the same token, studies have shown the exercises for the lower back muscles in cases of disk herniation have had high success rates in overcoming back pain.

An overworked multifidus muscle is weak and stressed, and even smaller or shrunken. A strong muscle, it seems, is also one that is able to relax and release when it ought to.
*Yoga As Therapy, Volume Two: Applications


Multifidus Muscle Atrophy and Association with Low Back Pain

Dysfunction in the lumbar multifidus muscles is strongly associated with low back pain. The dysfunction can be caused by inhibition of pain by the spine. This dysfunction frequently persists even after the pain has disappeared. Such persistence may help explain the high recurrence rates of low back pain. Persistent lumbar multifidus dysfunction is diagnosed by atrophic replacement of the multifidus with fat, as visualized by magnetic resonance imaging or ultrasound. One way to help recruit and strengthen the lumbar multifidus muscles is by tensing the pelvic floor muscles for a few seconds “as if stopping urination midstream”.
More at Wikipedia

Low Back Pain*

Part 1: Looking for a Common Cause
by Doug Keller

In recent years an intense search has been underway to find a single common denominator that might provide a key to the problem of low back pain. The results have been rather surprising, and the solutions they suggest point to one of the most fundamental actions taught by the original hatha yogis – called the Uḍḍīyāna Bandha – as central to a simple program for overcoming recurring low back pain.

Of course there are indeed quite a few things that can go wrong in the spine that we think of as causing back pain – such as a herniated or degenerated disk, nerve compression in the spine, or imbalances arising from scoliosis, a tilted pelvis, or one leg being shorter than the other. And indeed, one or more of these problems may present in your own spine… But the surprising thing is that although you may have these problems, they are not necessarily the cause of your back pain! In fact, you may have these conditions and not even suffer from back pain at all!

This was the finding of a range of studies chronicled by Jim Johnson in his book, The Multifidus Back Pain Solution. Studies using MRIs in the mid 80s and 90s took the novel approach of doing extensive imaging of people with no complaints of back pain – in addition to those who do suffer from it – and found that a surprising 24% of people with no back pain had spinal nerve compression, and a whopping 64% of people with no pain had abnormal disks. Additional studies show that things such as having one leg longer than the other or one hip higher than the other, a stiff and inflexible back, an increased curve in your lower back, scoliosis (except when the curve is 80° or more) or even a herniated disk is not necessarily the cause of back pain, simply because such conditions can be found in people with pain-free backs.

Perhaps there is something that all sore backs have in common despite their different stories – something that explains why or how one person with a ‘bad disk’ suffers from back pain, while another does not. Then we would be much closer to preventing recurrences of back pain by treating the true cause.

Researchers were actually quite successful in coming up with just such a common denominator: a particular set of muscles called the multifidus muscles (pronounced ‘məl-ˈtif-ə-dəs’). People who suffer acute back pain have been found to have noticeable abnormalities in these muscles, while people who are pain-free had no such abnormalities in their multifidus – even though they did have disk and other problems. This was the finding of a researcher named Haig, published in the journal Spine in 1995.

This led to experiments in which exercises aimed specifically at strengthening the multifidus muscles were given to one group, while (in keeping with good scientific method) a second ‘control’ group was given no such exercises or treatment. At the end of a year only 30% of the ‘exercise’ group had a recurrence of low back pain, while the ‘non-exercise’ group suffered an 84% recurrence rate. After three years, the numbers shifted only slightly: a 35% recurrence rate for the exercise group, and 75% recurrence rate for the control group. It seems the researchers were on to something.
*Yoga As Therapy, Volume Two: Applications

Let’s Twist Again

by Julie Gudmestad

Twisting poses will help restore your spine’s natural range of motion, cleanse your organs, and stimulate circulation.
TRY ASKING SOME non yogis what they think happens in a yoga class, and at least one will answer that people get “all twisted up like a pretzel.” In fact, we yogis do twist a lot in a well-rounded yoga practice: We twist while sitting, standing, and standing on our heads. Because there is such an intriguing variety of twists, you might guess that twists provide an abundance of benefits. And they do. There are physiological benefits to the circulatory system and internal organs, structural benefits to the musculoskeletal system, and focusing benefits to your consciousness.

India yoga master B.K.S. Iyengar describes twists as a “squeeze-and-soak” action. The organs are compressed during a twist, flushing out blood filled with metabolic by-products and toxins. When we release the twist, fresh blood flows in, carrying oxygen and the building blocks for tissue healing. So from the physiological standpoint, twists stimulate circulation and have a cleansing and refreshing effect on the torso organs and associated glands.

While these physiological benefits are undeniably valuable, this column will focus primarily on the functions of and benefits to muscles and joints used in twists. Yoga twists involve the spine, as well as several major joints, including the hips and shoulders. In fact, full range of motion in spinal rotation is essential to many yoga poses. Unfortunately, many people lose full spinal rotation in the course of living a sedentary lifestyle. Some losses can occur if joints fuse due to trauma, surgery, or arthritis, but most range of motion loss comes from the shortening of soft tissues. If you don’t lengthen the muscles, tendons, ligaments, and fascia (connective tissues) to their full length at least a few times a week, they will gradually shorten and limit the nearby joint’s mobility. In the case of twisting, the limitation is usually in soft tissues around the spine, abdomen, rib cage, and hips. If you regularly practice yoga twists, there are some clear benefits to these same joints and soft tissues. Not only do you maintain the normal length and resilience of the soft tissues, but you also help to maintain the health of the discs and facet joints (the small pair of joints on the back of the spine where each two vertebrae overlap).

A Twist a Day
TO MAINTAIN OR RESTORE the normal spinal rotation, I recommend that you practice a simple spinal twist once or twice a day. (Note: If you have a spinal disc injury, consult your health-care provider before practicing twists of any kind.) A variation of the twist Bharadvāṇjāsana (Pose Dedicated to the Sage Bharadvaja) done sitting on a chair is an excellent option because it is so easy to integrate into everyday life.

Even in such a basic twist, however, there are a few anatomical points to keep in mind. Most important is to elongate the spine; a slumped-over posture significantly limits spinal rotation. So begin by sitting sideways on a stable, armless chair, and take a moment to ground your sitting bones and draw your spine straight up toward the crown of your head. Also, make sure that your spine is perpendicular to the chair seat, neither listing to the side nor to the front or back. The second important point to remember is that each section of the spine has a different rotational mobility. The cervical (neck) vertebrae, for example, are the most mobile in twisting. Because the 12 thoracic (midback) vertebrae have ribs attached, they can’t twist as freely as the neck vertebrae. And because of the orientation of the lumbar (lower spine) facet joints, the rotation of these five vertebrae is the most limited. So to ensure that you don’t over twist in the more mobile parts of your spine, begin your seated twist by bringing your awareness into your lower back and beginning the twist from there. Let the twist gradually unfold up your spine, as though you were walking up a spiral staircase, so that each vertebra participates in the twist. If instead you twist quickly and without awareness, your neck will likely do most of the twisting, and whole sections of your spine can remain “stuck” and unmoving.

Once you’ve begun to rotate toward the back of the chair, you can use your hands on the corners of the chair back to deepen the twist in your spine and rib cage. Pull gently with the hand on the near corner and push with the hand on the far corner. Continue to sit tall, and don’t work so hard with the pulling hand that you draw that shoulder forward. As the twist unfolds all the way up into your neck, your head will turn, but be sure to keep your eyes and gaze soft. Hold the twist on each side for a minute or so, and use your breathing to help deepen the twist: On one exhalation, draw yourself taller; on the next exhalation, twist a bit more. With regular practice of this and other simple twists, your spine will regain its full potential for twisting.

Criss-Cross Action
NOW THAT YOU know the basics about restoring your spine’s rotational range of motion, let’s take a look at muscle activity in twists. Many, many muscle groups are involved in twists, contracting and shortening or stretching and lengthening. There are several groups of back muscles of varying length – the rotators, semi-spinalis, and multifidus—that contribute to spinal rotation. Some of the muscles that actively rotate the torso are quite small, like the intercostals, the layers of muscles between each two ribs. And several sets of muscles contribute to your ability to turn your head; the easiest to see is the sternocleidomastoids. The two SCMs sit on the front of your neck, forming a “V” starting at the top of the breastbone and running to the base of the skull just behind teach ear. Look in a mirror: If you turn your head to the right, you’ll see your left SCM contract, and vice versa.

Probably the most important muscle group in active twisting is the abdominal obliques. The obliques form two layers of muscle on either side of the better-known rectus abdominus, the “six-pack” muscle that runs vertically up the center of the abdomen from the public bone to the rib cage. The two internal obliques, left and right, originate primarily from the pelvis and travel diagonally up across the abdomen, while the two external obliques originate primarily from the lower rib cage and travel diagonally down across the abdomen. All of the obliques have strong attachments to the substantial fascia of the lower back and to the abdomen.

Take together, the four obliques form a diagonal cross that girdles the abdomen, and they have important functions in supporting the lower back, pelvis, and internal organs. The diagonal lines of the muscles also give them strong leverage in rotating the torso. When you turn to the right in Bharadvajasana, for example, the left external oblique will team with the right internal oblique to rotate your torso. At the same time, the opposite pair of obliques will have to lengthen. And so your twisting range of motion can be reduced by the inability of one pair (one external oblique and the other opposite internal oblique) to lengthen, while weakness in the opposite pair could limit your ability to actively draw yourself into the twist.

The obliques have a big part to play in yoga poses, and sometimes that role can be extremely demanding. Twisting arm balances such as Aṣṭāvakrāsana (Eight-angle Pose), and Pārśva Bakāsana (Side Crane Pose) require big work from he obliques. It you’re not quite ready for the difficulties of arm balances, you can still challenge your obliques in standing poses like Trikoṇāsana (Triangle Pose), Ardha Chandrāsana (Half Moon Pose), Pārśvakoṇāsana (Side Angle Pose), and Parivṛtta Trikoṇāsana (Revolved Triangle Pose). Each of these poses requires a strong rotation of the torso against the pull of gravity. For example, when you perform Trikonasana to the right, your muscles actively twist your trunk and neck to the left so that your heart looks straight ahead, not at the floor, and your eyes look up at your left hand. But when you do Parivṛtta Trikoṇāsana to the right, your torso and neck twist strongly to the right, requiring strong contractions of the obliques, the spinal rotators, the intercostals, and the left sternocleidomastoid.

In addition to the regular practice of standing poses, you can help keep your obliques strong by practicing the full or modified versions of Jāṭharaparivṛttāsana (Revolved Abdomen Poses). For the modified, milder version, lie on your back, with arms stretched out to the sides at shoulder height and knees pulled up toward your chest. Exhaling, smoothly drop both knees tone side, keeping your knees pulled up toward your arm. On your next exhalation, lift your legs back up toward your chest, flattening your back waist into the floor. For the full pose, lie on your back, arms outstretched again, and stretch your legs straight up toward the ceiling. Lower your straight legs toward the floor on one side (for the maximum challenge, don’t quite touch the floor). Keep stretching out through the soles of the feet; also, when you lift the legs back up to vertical, be sure to press the lower back flat. Since this can be quite a challenging pose, you may want to consult with your health-care provider before trying this if you have lower back or sacroiliac problems.

Now that you know how to reap the physiological and structural benefits of twists, you might also notice the centering benefits to your consciousness. As the layers of muscle and bone revolve deeply, your attention is drawn into the stable, unmoving center of the pose. And this ability to stay centered as the hubbub of the world swirls around you will pay obvious dividends in the yoga of daily living.

Published in Yoga Journal, January/February 2003

Iyengar and the Invention of Yoga

by Michelle Goldberg (The New Yorker, Aug. 23, 2014)

In contemporary yoga classes, teachers often speak of Patanjali’s “Yoga Sutras,” a philosophical text compiled around two thousand years ago, as the wellspring of the practice. This requires an imaginative leap, because the yoga sutras say next to nothing about physical poses; their overriding concern is the workings of the mind. Yoga, the sutras say, “is the restriction of the fluctuations of consciousness.” The total of their guidance about posture is that it should be “steady and comfortable.”

Instructions for postures, or asanas, appeared much later, in medieval tantra-inflected texts, such as the “Hatha Yoga Pradipika.” Even in those works, however, you won’t find many of the positions taught today as yoga. Fifteen poses appear in the “Hatha Yoga Pradipika,” most of them seated or supine. There are no sun salutations, no downward-facing dogs or warriors. There are instructions for drawing discharged semen back into the penis, so as to overcome death, and for severing the tendon connecting the tongue to the bottom of the mouth, and lengthening it so that it can touch the forehead.

Until the twentieth century, educated Indians and Westerners alike tended to disdain the occult practices denoted by the term “hatha yoga.” “We have nothing to do with it here, because its practices are very difficult and cannot be learnt in a day, and, after all, do not lead to much spiritual growth,” wrote Swami Vivekananda, who did much to popularize yoga philosophy in the West with his 1896 book, “Raja Yoga.” Only in the modern era has hatha yoga been transformed into a wholesome, accessible regimen for health and well-being. A central figure in this transformation was B. K. S. Iyengar, the author of the 1966 yoga bible “Light on Yoga,” who died this week at the age of ninety-five.

I met Iyengar in 2010, at his institute in Pune, a city about a hundred miles south of Mumbai, where students from all over the world travelled to study with the revered yoga master. I’d gone there to interview him for my book about Indra Devi, an actress born in Russia, who’d studied with Iyengar’s brother-in-law, the guru Tirumalai Krishnamacharya. Iyengar sat at the head of a table in a windowless basement library surrounded by Western students bent over research and translation projects. With his mane of white hair and intense, laughing eyes topped by bushy caterpillar brows, he seemed, in his nineties, impossibly vital, as if he had actually discovered a yogic method for cheating death.

Iyengar was the eleventh of thirteen children born into a poor South Indian family; after his father’s death, when he was eight years old, they neared destitution. Before Iyengar found yoga, he said many times, he was a sickly boy, enervated by tropical diseases. “My sisters and sisters-in-law used to say that my head would hang down on a repulsive body in such a way that they never touched me on account of my appearance,” he wrote in the essay “My Yogic Journey.” He left secondary school after failing an exam and losing his scholarship, and never received further education.

When Iyengar was sixteen, in 1934, he was sent to live with his sister and her husband, Krishnamacharya, in Mysore, a green, temperate city not far from Bangalore. He arrived at a time of enormous ferment in the development of modern yoga. Indian nationalists were particularly taken with the global vogue for “physical culture,” in part because British domination was often justified in terms of physical superiority. As the nationalist movement gained steam and Indians turned away from foreign imports— replacing Western clothing with homespun khadi cloth, for example—nationalists found in the old hatha yoga the basis for a physical culture that was distinctly Indian. Krishnamacharya, a brilliant scholar who had sacrificed respectability to pursue the outré path of hatha yoga, was at the forefront of this renaissance. At the invitation of the progressive Maharaja of Mysore, a patron of traditional Indian arts and an avid sportsman, he ran a yoga shala at the palace, where he taught yogic physical culture to royal boys.

The system that Krishnamacharya created there drew on hatha yoga, as well as traditional Indian wrestling and gymnastics, British Army calisthenics and, according to the scholar Mark Singleton, the Danish educator Niels Bukh’s “primitive gymnastics.” It included sun salutations and standing postures, such as the triangle pose, that don’t appear in any ancient yogic text. In his 2010 book, “Yoga Body: The Origins of Modern Posture Practice,” Singleton concludes that Krishnamacharya’s method was “a synthesis of several extant methods of physical training that (prior to this period) would have fallen well outside any definition of yoga.”

Krishnamacharya could be fierce and demanding. “Guruji had a frightful personality,” Iyengar wrote. “He would hit us hard on our backs as if with iron rods. We were unable to forget the severity of his actions for a long time. My sister also was not spared from such blows.” Soon after Iyengar arrived, Krishnamacharya’s top pupil ran away, just days before a Y.M.C.A. conference at the palace that was to include an asana recital. Needing someone to demonstrate, Krishnamacharya recruited his young relative, demanding that he learn a series of difficult poses. Though weak and stiff, Iyengar did his best to comply, injuring himself badly but impressing the audience. After that, he often demonstrated for his brother-in-law.

Krishnamacharya, eager to proselytize, eventually sent Iyengar to teach in colleges and gymnasiums in Pune. Iyengar worked hard as an instructor, afraid that, if he failed, he’d have to return to his brother-in-law. He knew from experience the dangers of forcing oneself into poses prematurely, and he set about developing a slower, more anatomically precise type of yoga, using props like blocks and blankets to help students find correct alignment. At once challenging and therapeutic, his yoga would become hugely popular in the West, thanks in large part to the assistance of the violinist Yehudi Menuhin.

Menuhin, who’d developed an interest in yoga after finding a book about it in an osteopath’s waiting room, met Iyengar while on tour in India in 1952. Iyengar’s teachings had a profound effect on him; in a 1953 Life magazine story called “Yehudi’s Yoga,” he said that yoga had led to a breakthrough in his art, and was even more important to him than violin practice. Menuhin introduced Iyengar to the Standard Oil heiress Rebekah Harkness, who brought him to Rhode Island for six weeks in 1956. Life photographed Iyengar instructing her family in seated forward bends and shoulder stands, and showed him performing a difficult forearm balance while perched on a low wall overlooking the sea. The article was headlined “A New Twist for Society.”

Iyengar doesn’t get all the credit for making yoga safe for society ladies; two of Krishnamacharya’s other students helped to disseminate yoga as we know it. Devi, the actress, who taught Hollywood stars like Greta Garbo and Gloria Swanson, was for a time known as the First Lady of Yoga. K. Pattabhi Jois, who began studying with Krishnamacharya as a boy and remained devoted to him all his life, created the vigorous ashtanga system, the prototype for “power yoga.”

No other yoga teacher, however, was as influential as Iyengar. His “Light on Yoga,” with a foreword by Menuhin, remains unparallelled as a guide to asana practice. As a Yoga Journaltribute put it, when “teachers refer to the correct way to do a posture, they’re usually alluding to the alignment Mr. Iyengar instructs and expertly models in his book.” In “Light on Yoga,” Iyengar describes yoga as a “timeless pragmatic science evolved over thousands of years dealing with the physical, moral, mental and spiritual well-being of man as a whole,” and calls Patanjali’s “Yoga Sutras” the “first book to systematize this practice.” The desire to imbue his methods with ancient authority is understandable, but Iyengar was too modest. It was he, not any ancient sage, who figured out how to show people the world over the safest way to stand on their heads.

Study Finds Yogā(sana) Can Help Back Pain

Study Finds Yogā(sana) Can Help Back Pain, but Keep It Gentle, with These Poses by Allison Aubrey

New research finds that a yogā(sana) class designed specifically for back pain can be as effective as physical therapy in relieving pain. The protocol includes gentle poses and avoids more difficult ones. Comstock Images/Getty Images

If you’re tired of popping pain medicine for your lower back pain, yogā(sana) may be a good alternative.

New research finds that a yogā(sana) class designed specifically for back pain can be as safe and effective as physical therapy in easing pain.

The protocol was developed by researchers at Boston Medical Center with input from yogā(sana) teachers, doctors and physical therapists.

During the class, trained instructors guide participants through gentle poses, including cat-cow, triangle pose and child’s pose. Simple relaxation techniques are part of the class as well. More difficult poses, such as inversions, are avoided. A guidebook that details the poses taught during the class is freely available, as is a teacher training manual.

The findings, published Monday in the Annals of Internal Medicine, are in line with new guidelines for treating back pain from the American College of Physicians. The group recommends that people with back pain should avoid pain medicines if possible, and instead opt for alternatives such as tai chi, yogā(sana) and massage. As we’ve reported, those guidelines are aimed at people with run-of-the-mill back pain, rather than pain due to an injury or other diagnosed problem.

Who was in the study? Researchers recruited 320 racially diverse, predominantly low-income participants in the Boston area, all of whom had chronic low back pain. The study lasted one year.

What did participants in the study do? Participants were divided into three groups. One group was assigned to a weekly yogā(sana) class for 12 weeks. Another group was assigned 15 physical therapy (PT) visits. The third group received an educational book and newsletters. For the remainder of the year — roughly 40 weeks — participants in the yogā(sana) group were assigned to either drop-in classes or home practice. The PT group was assigned to either “PT booster sessions” or home practice.

The skinny: Researchers assessed changes in pain and function using a 23-point questionnaire. The participants in the yogā(sana) and physical therapy groups had about the same amount of improvement in pain and functioning over time.

When the study began, about 70 percent of the patients were taking some form of pain medication. At the end of three months, when the yogā(sana) classes were wrapping up, the percentage of yoga and PT participants still taking pain medication had dropped to about 50 percent. By comparison, the use of pain medication did not decline among participants in the education group.

“It’s a significant reduction,” says study author Rob Saper, director of integrative medicine at Boston Medical Center.

“I’m not recommending that people just go to any yogā(sana) class,” Saper told us. He pointed out that their research has helped nail down poses and relaxation techniques that are helpful and safe.

Saper says he chose to compare the effects of yogā(sana) with physical therapy because “PT is the most common referral that physicians make for patients with back pain. It’s accepted, it’s reimbursed, and it’s offered in most hospitals.”

Saper says if research shows that yogā(sana) can be as effective, “maybe yogā(sana) should be considered as a potential therapy that can be more widely disseminated and covered [by insurance].”

An editorial published alongside the study points out that treating low back pain is complicated and improvements documented in the study were modest.

“Any single treatment approach is unlikely to prove helpful to all or even most patients,” writes Stefan Kertesz of the University of Alabama at Birmingham School of Medicine and his co-author, Douglas Chang of University of California, San Diego. Nonetheless, as this new study has shown, “yogā(sana) offers some persons tangible benefit without much risk,” they conclude.