Every day I am asked to recommend the best exercise plan for improving low back pain. My first response is that any exercise done on a consistent basis helps reduce pain in the majority of low back pain sufferers. A commitment to exercising on a consistent basis is the first hurdle most must overcome to get lasting benefit from exercise. Incorporating an exercise program into your life is as important as taking daily medications, getting adequate sleep, controlling your weight, and stopping smoking. For those who suffer daily with low back pain, its time to realize that you don't have time NOT to exercise. Through appropriate exercise, you can reclaim your back health!

YOGA AND SPINE HEALTH

The second hurdle to obtaining lasting benefits from exercise is to choose a program that you are able to follow for LIFE. There are no quick fixes for nonsurgical low back pain. An exercise program that increases flexibility and range of motion of the spine, increases core strength to support the low back, relieves muscle spasms that result from dysfunctional movement patterns must be continued to sustain its benefits. Often physical therapy can help one to recover from a bout with back pain but when the exercises are not continued at home, back pain is apt to return. To continue the benefit, one must continue the exercises that made the improvement.

Lifelong exercises such as biking, swimming, and water aerobics can be started at any age or fitness level, although my most recommended exercise is yoga. Yoga is an excellent choice for enhancing spine health that cannot be duplicated by any other fitness program.

There is a wise saying in yoga, "Everything that gets worse with age, gets better with yoga". From professional and personal experience, I wholeheartedly agree. Yoga IS a lifestyle. It incorporates not only breathing, meditation, and physical postures, but also a commitment to living with a light heart, less stress and consumerism, more compassion and love. While embracing yoga as a lifestyle may not be for everyone, learning to breathe, reduce stress, focus the mind more effectively, and regain lost body flexibility is important for everyone. Letting go of the incorrect notions that yoga is incense burning, chanting hippies that sit around cross legged and mediate all day and that it is simply easy stretching is crucial to success in yoga. Yoga can be one of the most physically, mentally, and emotionally challenging practices available. The good news is that yoga meets you where you are physically and your success in yoga depends on your commitment level. Yoga is referred to as an "inside out" practice meaning that the goal of yoga is to go to the core of your limitations and slowly unfold one layer at a time until there is renewal of life. With regular practice, yoga can realign your spine, lessen muscle spasms, and lengthen shortened muscles to let emerge a freer, healthier, mobile body.

PHYSICAL AND MENTAL BENEFITS

Additional benefits gained from a regular yoga practice far outweigh the physical achievements of touching your toes again. Yoga focuses attention to deep breathe and fully exhale all stale air. Deep breathing through yoga helps calm your mind, focus your attention and lower your cortisol level. Cortisol is a hormone in your body that is released in response to stress that causes increased blood pressure, weight gain, anxiousness, high blood sugar, depression and insomnia. It also reduces our immune system and increases our response to pain. Reducing the body's circulating cortisol lessens all of the major health risks and at the same time makes us stronger and healthier.

Currently an estimated 14.9 million people practice yoga in the United States. The main type of yoga that is practiced in the U.S. is Hatha, the physical practice of yoga. Although Hatha yoga can be practiced in a heated or non-heated environment, heated yoga practice is not recommended for anyone who has chronic medical problems or as yoga therapy for patients with chronic back pain. Iyengar yoga, a specialized study that incorporates typical Hatha yoga postures with specific focus on alignment of the joints and spine, was developed by yoga master B.K.S. Iyengar. For over 70 years, he has applied therapeutic variations of classic poses to most health conditions including low back pain. Iyengar yoga has been the most studied style of yoga by medical doctors for treatment of medical disorders. The American Cancer Society has incorporated yoga therapy as an adjunct to chemotherapy protocols in women with breast cancer. Their studies reveal that women who practiced yoga during their cancer treatments had fewer side effects from the treatments, less anxiety and depression, and a more hopeful outlook on their survival.

In 2009, a prestigious spine journal published an outcome based study evaluating the value of weekly Iyengar yoga sessions in patients with chronic low back pain. The study divided 90 patients, average age of 48, into two groups with half of the patients beginning a yoga program, participating in yoga twice weekly for 6 months. The researchers documented significant improvements in the yoga-treated group. The yoga patients reported a 50% decrease in pain with significant improvement in their disability index scores compared to traditional treatments. Additionally, the yoga group had a major reduction in pain medications usage. The most encouraging finding was that 67.9% of the yoga-treated group continued practicing yoga more than 3 days a week for longer than six months after the study ended. Differing from other exercise treatments, yoga appears to be successful in alleviating chronic low back pain and disability and worthy of making a long commitment.

GETTING STARTED

So how do you get started with yoga? Some helpful tips include—

• Ask for a referral to a good instructor or studio. Before your first class, speak with your instructor so he/she is aware of your needs and limitations. This will help the instructor provide you modifications for your condition to insure your safety and comfort. Try various classes or instructors that are at your level since instructors can be different and finding right one for you is important for long term success.

• Keep an open mind and realize that yoga is a journey. Your first classes may seem awkward. Pick a comfortable spot on the side and enjoy the calmness, practice the breathing and postures. Do give yourself at least a month to decide.

• Be humble and modest allowing yourself not to be competitive or judgmental. Yoga is an extremely individual practice that is, oddly, often done in groups where you can watch and compare yourself to others. Try to keep your eyes on your own mat and the focus on your own goals. You are there to heal your back, lessen your stress and cortisol level, and heal yourself from the INSIDE out. The outside isn't important if you are focusing on inside yourself. The best yoga practitioners are those who have found peace and freedom.

• Remember, the more you are overweight, deconditioned, inflexible, or hurried and on a strict time table, the more you need to get into a yoga class ASAP!

In summary, yoga is likely the best overall exercise regimen for back pain sufferers. Yoga concentrates on strengthening the abdominal core, increasing the flexibility of the spine, and lengthening hip, leg and shoulder muscles that are essential for back rehabilitation. The additional heath benefits from yoga practice are simply a bonus!