Spine Savers

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Physician Loren Fishman still recalls clearly the day 30 years ago when he found his calling. Not yet a doctor, he knew that he wanted somehow to help people in pain. He was contemplating going to medical school but had chosen first to spend a year studying yoga with B.K.S. Iyengar in Pune, India. "One day," Fishman says, "Mr. Iyengar suddenly asked me, 'You want to go teach my yoga?' It caught me off guard, but I thought, 'If he says I can teach it, I guess I can teach it!'"

Today Fishman is a noted specialist in back pain with a rehabilitation clinic in New York City. But he still teaches at least one yoga class a week for his patients. And he recommends yoga to many patients with back pain, through both his practice and his books, one of which is Relief Is in the Stretch: End Back Pain Through Yoga.

Most importantly, after many years of feeling isolated from his fellow doctors by his focus on yoga, Fishman now finds himself sought out by them. "Using yoga to treat back pain is increasingly respected by mainstream experts," Fishman says. "I hear from more and more of my colleagues that they are adding yoga to the therapies they recommend."

For a long time, doctors were reluctant to endorse yoga because they felt there wasn't solid science showing it worked. Some studies have been done over the years, but most were carried out in India or Europe and didn't turn up in major American medical journals. That changed last December with the publication in the respected Annals of Internal Medicine of a randomized, controlled clinical trial—the most definitive form of scientific evidence—that showed quite clearly that yoga helps those with low back pain: Not only did yoga work, but it worked so well that it surpassed even traditional physical therapy exercises.

Researcher Karen Sherman and her colleagues at the Group Health Cooperative in Seattle took 101 adults suffering from chronic low back pain and randomly assigned them into three groups. One group attended weekly yoga classes for 12 weeks, following a therapeutic routine developed specifically for lower back pain by Viniyoga experts Gary Kraftsow and Robin Rothenberg. The participants were also expected to practice the poses at home every day.

The second group attended a program of stretching and strengthening exercises developed by a physical therapist, also once a week with daily home practice. The third group received a self-care book that included some stretches and relaxation exercises.

It turned out that the yoga participants had less pain and were better able to go about their daily activities than people in either of the comparison groups. Follow-up revealed that after three months, the yoga practitioners continued to have less pain and better function, and they needed fewer pain medications.

This certainly echoes my own experience. Chronic back pain that was keeping me from working more than a few hours a day sent me to my first yoga class, aching for relief. And I discovered that certain poses—Marjaryasana (Cat Pose) at the beginning of the day, Supta Baddha Konasana (Reclining Bound Angle Pose) at the end—make a huge difference.

Yoga's effectiveness stems in part from the body awareness it promotes. "You learn to pay attention to what your spine is doing," says Sherman.

And then there is yoga's, well, flexibility. "There are multiple kinds of back pain," says Kraftsow, who's based in Santa Monica, California, and is the author of Yoga for Transformation. "What's ideal about yoga is that you can offer different remedies for different conditions."

Adds Mary Pullig Schatz, a physician and Iyengar Yoga practitioner in Nashville, Tennessee, and the author of Back Care Basics, "Practicing yoga gives you a more acute sense of body awareness, which gives your body a chance to move and respond in new ways." Indeed, many of the study participants—most of whom had had little or no previous yoga experience—chose to continue practicing after the study ended.

Of course, none of this would surprise yoga teachers and therapists, who see yoga benefiting people with back pain every day. "Yoga is about seeing the patterns in the body and how to bring them into balance and stability," says Janice Gates, a yoga therapist and the founding director of Yoga Garden Studio in San Anselmo, California. "You figure out where things are tight and where things are loose and how to even them out."

What's tricky, though, is that what provides heaven-sent relief to one person might do little—or even make things worse—for another. That's because the different types of back pain often have very different causes.

"No matter what type of back pain you have, there are poses appropriate for that type of pain," says Fishman. "But not all back pain is the same, and yoga can work in different ways depending on what's going on with your body." (See Better Your Back for specific postures to try.)

Take me, for instance. I have a wacky spine, flattened and fused in one area, overly mobile in another, which means that when I do certain poses, the mobile part is all that bends, and the pain in the rest of my back never goes away. My teachers have taught me how to modify poses to keep my lower spine rigid and focus the flexing and extension in my upper spine, where I need it.

If you don't do this kind of fine-tuning, says Gates, "you can end up deepening the grooves rather than making new movement patterns." So don't be afraid to tailor your practice to what works for you.

And who knows? You might love what you're doing so much that it becomes a brand-new calling.