My dad suffers from chronic low back pain. So do a lot of my yoga therapy clients – even when it’s not the main reason they come to see me. I’ve heard cashiers at Target and Home Depot complain about their lower backs. The other day, I even spoke to a yoga teacher who told me she’s taking time off to address her low back pain.

Low back pain is the number one cause of disability globally.  The cost in the U.S. has been estimated at $100 billion a year (yeah, that’s a “b”). In fact, it’s one of the main reasons people seek medical care.

And yet docs have a hard time treating it. Heaps of research have shown that pharmacological interventions come up short. While opioids may be helpful after an injury, they are a lousy (not to mention addictive) way to treat chronic pain. One pain doc told me that if opioids came on the market today, they would not likely get FDA approval – because there is little evidence that they actually work for chronic pain. And in some cases, they can even make chronic pain worse. 

Yesterday the American College of Physicians published groundbreaking clinical guidelines for the treatment of chronic pain. The paper, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians, formally put out of its misery the idea that medications are best practice in the treatment of low back pain.

Based on research, the authors offered three recommendations:

1.      For acute low back pain, use heat, massage, acupuncture or spinal manipulation.

2.      For chronic low back pain (12 weeks+), use exercise, rehab, acupuncture, MBSR, tai chi, yoga, motor control exercise, progressive relaxation, biofeedback, low-level laser therapy, operate therapy, CBT, and/or spinal manipulation.

3.      With chronic back pain, if patients don’t respond to non-drug treatments, then use NSAIDs first. And if these don’t work try SSRIs and opioids and discuss the risks with your patients.

It’s exciting that yoga got a  mention. But the yoga research is still weak, many more trials need to be conducted and also the yoga therapy community needs to step up its PR game. A lot of yoga out there can make back pain worse. If we don’t explain to docs how to refer to safe classes and well trained yoga therapists and teachers, people can easily end up in more pain (you’ve heard the stories I’m sure!).

You’d like to think that at least you could get a good diagnosis and etiology for low back pain. But studies show that there’s little link between MRIs or Xrays and the level of your pain. In fact, some studies show that these diagnostic tools can actually worsen the condition!  Many people have no apparent damage in their spine, but tons of pain. Others have no pain, but tons of damage.

Head scratching, isn’t it.

So what do we do? Do we just throw up our hands in confusion? lie on a heating pad? do some yoga or exercise? Hope it works?

The problem of chronic low back pain is actually a useful one through which to examine and redefine our assumptions about health and how we heal. Chronic low back pain runs deeper than the mechanics or condition of the spine. Research shows that people make the greatest improvements when they are cared for mind, body, spirit and in terms of their support system and relationships, and by addressing the social determinants of health. Chronic pain is a whole person problem – to address it, the whole person has to be treated. 

It’s so messy isn’t it? Being a human being and having a mind, a heart, a community, a support system or lack thereof? It would be SO much easier to just take a pill and get over it. But the splendid life work of looking deeply into our minds, into our bodies, into our higher power, into our relationships, into our communities, into our culture, are essential. There is no easy answer – especially when you look at this problem with a limited perspective.

If you are blindfolded, and you only feel a tail, you may mistake an elephant for a rope.  We have to take off our blindfolds to understand the larger reality in front of us. Western medicine encounters this conundrum when it tries to treat chronic pain. As Abraham Maslow famously said, “I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.” In the west, we use pills like hammers. And we try to pound everything with them. But the answers can only be found when we look at the entire person.

I have worked with many clients with low back pain who’ve done very well with yoga postures. But again, if we treat postures like pills, we won’t solve this systems problem. Yoga in its entirety – postures, breathing, meditation and relationship skills can be very helpful. They can help us shift our worldview and understand our challenges as responses to dysfunctional behavior patterns, and the result of dysfunctions in the culture.

That being said, you probably want something tangible at the end of this article.

So here are two key poses I give almost everyone I work with who has low back pain. They are helpful, but only the tip of the iceberg as far as yoga therapy goes. A biopsychosocial spiritual model and assessment is key.

1. Apanasana – from lying on your back, draw your knees into your chest. Place one hand on each knee with the fingers pointing toward the ankles. Take a deep breath. As you exhale, bring your knees into your chest. Repeat for 3-5 breaths. You can also do this one leg at a time.
2. Dvipada pitham – from lying on your back, bring your feet up flat. As you inhale, lift you hips and reach your arms up toward the ceiling, and then to the floor behind you.As you exhale, lower your hips and your arms back down. Repeat for 3-5 breaths. Until the pain subsides and you start to get stronger, avoiding twists is probably a good idea as well.