Continuing education

Yoga to Treat Nonspecific Low Back Pain

by Catherine Carter, RN, MSN, NP, COHN-S, Carol Stratton, RN, MNEd, COHN-S, and
Debra Mallory, RN, PhD, NP-BC

abstract
Low back pain is common and poses a challenge for clinicians to find effective treatment to prevent it from becoming
chronic. Chronic low back pain can have a significant impact on an employees ability to remain an active and productive
member of the work force due to increased absenteeism, duty restrictions, or physical limitations from pain. Low back
pain is the most common cause of work-related disability among employees younger than 46 years. Advancing technol-
ogy and less invasive surgical procedures have not improved outcomes for employees who suffer from low back pain.
Most continue to experience some pain and dysfunction after conventional treatments such as injections and surgery. An
alternative treatment that could reduce nonspecific chronic low back pain would benefit both employees and employers.
Exercising and remaining active are part of most guidelines routine care recommendations but are not well defined.

L
ow back pain, one of the five most common symp-
tom-related reasons to seek health care in the Unit-
ed States, will affect 25% of adults during their
lifetimes. More than 85% of those who seek primary care
for low back pain are diagnosed with nonspecific low back
pain, for which no precise pathoanatomical cause of pain
has been determined. Other terms, such as strain, sprain,
or degenerative processes, are sometimes used to label this
type of low back pain (Deyo & Weinstein, 2001). Those
ABOUT THE AUTHORS
Ms. Carter is Supervisory Occupational Health Nurse, U.S. Army Health
Clinic, Dugway, UT. Ms. Stratton is Occupational Health Nurse, Yuma
Health Clinic, Yuma, AZ. Dr. Mallory is Professor, Department of Ad-
vanced Practice Nursing Program, Indiana State University, Terra Haute,
IN.
The authors disclose that they have no significant financial interests in any
product or class of products discussed directly or indirectly in this activity,
including research support.
Address correspondence to Catherine Carter, RN, MSN, NP, COHN-S, Su-
pervisory Occupational Health Nurse, U.S. Army Health Clinic, 5116 Kister
Avenue, Dugway, UT 84022. E-mail: catherine.carter@us.army.mil.
Received: January 13, 2011; Accepted: June 4, 2011; Posted: July 25,
2011.
individuals who seek treatment are usually between the
ages of 30 and 50 years and of both genders (Chou et al.,
2007; Deyo & Weinstein, 2001). As clinicians develop the
diagnosis and plan of care, they must determine whether
the condition is acute or chronic, because the treatment
modalities differ. The American College of Physicians
(ACP) and American Pain Society (APS) (2007) treat-
ment guidelines define chronic low back pain as low back
pain present for more than 3 months, with the major-
ity of the pain being nonspecific. According to the 1999-
2002 National Health and Nutrition Examination Survey
(NHANES), 10.1% of the U.S. population was estimated
to have chronic back pain (Hardt, Jacobsen, Goldberg,
Nickel, & Buchwald, 2008).
Chronic back pain carries a significant financial bur-
den for employees, employers, and insurance companies.
Lost wages and health care, disability, and retraining costs
associated with back pain range from $20 to $50 billion
each year (Whitehouse, 2006). Back pain can negatively
impact quality of life, functional ability, and measures of
general health and is frequently associated with depres-
sion or anxiety (Chou, 2010).

AAOHN Journal Vol. 59, No. 8, 2011 355

Downloaded from whs.sagepub.com at CORNELL UNIV on September 5, 2016

Recommendations on Activity by Organization Guidelines
Organizations Published Guideline
American College of Physicians and American Pain
Society (2007)Diagnosis and Treatment of Low Back
Pain
American College of Occupational and Environmental
Medicine (2008)Occupational Medicine Practice
Guidelines: Evaluation and Management of Common
Health Problems and Functional Recovery of Workers
National Institute for Health and Clinical Excellence
(2009)Low Back Pain: Early Management of Persis-
tent Non-specific Low Back Pain
Institute for Clinical Systems Improvement (2008)
Health Care Guideline: Adult Low Back Pain
Guideline for the Evidence-Informed Primary Care Man-
agement of Low Back Pain (2009)
In 2003, 13% of the U.S. work force had a 2-week
loss of productivity (absenteeism or job reassignment due
to work limitations) due to common back pain (Chou,
2010).
Most individuals will experience improvement in
acute symptoms within a few weeks with little or no in-
tervention. The likelihood of symptom improvement is
reduced when back pain persists past 12 weeks (Chou,
2010). Selecting long-term pharmacologic treatment
is a challenge for clinicians because each drug carries
its own list of benefits and potential side effects (Chou,
2010). Long-term opioid use is controversial and not
guaranteed to relieve pain or improve quality of life.
Clinicians should be aware that alternative methods may
empower clients to manage the pain and improve quality
of life.
Most published treatment guidelines for nonspecific
chronic low back pain recommend exercising or staying
active (Table). However, the recommendations are not
specific and do not clearly define the type of activity or
exercise that is best to alleviate low back pain.
One alternative is yoga; a 2008 survey indicated
that more providers were recommending yoga as therapy
(Hayes & Chase, 2010). Yoga may be beneficial for some
clients, but what evidence supports its use and how ef-
fective is it in reducing chronic pain? The ACP and APS
(2007) joint clinical practice guideline on diagnosing and
treating nonspecific low back pain recommends that the
addition of nonpharmacologic therapy be considered for
clients whose conditions do not improve with education,
self-care options, or pharmacologic interventions after
3 months of treatment (Chou et al., 2007). On the 2007
National Health Interview Survey (NHIS), the most com-
mon condition reported as a reason for using an alterna-
tive type of treatment was back pain (Barnes, Bloom, &
Nahin, 2008). Growing evidence suggests that comple-
mentary and alternative therapies (e.g., yoga, acupunc-
356
Downloaded from whs.sagepub.com at CORNELL UNIV on September 5, 2016
Table
Recommendation on Activity (Brief)
Remain active
Aerobic exercise, strengthening exercises, or yoga for
select, highly motivated workers
Physical activity and exercise
Resumption of light-duty activities and early return to
work or activities
Gradual resumption of normal activities (including work
and physical exercise) as tolerated
ture, and massage therapy) may produce therapeutic ef-
fects. Additionally, yoga can be taught in a group setting,
reducing costs (Groessl, Weingart, Aschbacher, Pada, &
Baxi, 2008).
Yoga
The National Center for Complementary and Alter-
native Medicine (NCCAM, 2010) describes yoga, with its
origins in ancient (around 200 B.C.) Indian philosophy,
as a form of exercise in which physical postures, breath-
ing techniques, and meditation are used to balance mind,
spirit, and body. Barnes et al. (2008) reported yoga as be-
ing one of the top 10 alternative modalities used by adults
in the United States. In the 2007 NHIS, 13 million adults
older than 18 years reported they had used yoga in the
previous year. The 2007 survey also showed an increase
in yoga among young adults, compared to the 2002 sur-
vey, of about 3 million. Individuals practice yoga for a
variety of health conditions, including anxiety disorders,
stress, hypertension, and depression, as well as for overall
health. Yoga is generally considered a safe form of exer-
cise (NCCAM, 2008).
Clinicians should be aware of differences in yoga
styles prior to recommending use of yoga. Viniyoga is
considered therapeutic and gentle. The poses are adapted
to individual abilities (Hayes & Chase, 2010). Another
style that has shown positive effects is Iyengar, which
uses props (i.e., blocks, belts, and blankets) to support
the body during poses (Williams et al., 2009). The ex-
perience of the yoga instructor is central to workers
meeting their goals and avoiding injury. However, in-
structors do not hold standard licensure or certification,
although several organizations are trying to standardize
instructor credentials. The International Association of
Yoga Therapists (2011) supports research and educa-
tion with a mission to establish yoga as a recognized
therapy.
Copyright American Association of Occupational Health Nurses, Inc.
 Summary of Systematic Reviews

Quinn, Hughes, and Baxter (2006)

Works reviewed: 9 articles; 2 on yoga and 7 on other treatmentsmeditation, willow bark, capsicum, breathing
therapy, massage, relaxation and hypnosis, and yoga.
Purpose of review: Complementary and alternative medicine (CAM) for the treatment of low back-specific pain, func-
tion, work disability, generic health status, and client satisfaction.
Conclusion: Favorable regarding the use of CAM. However, only one or two random controlled trials (RCTs) were
found for each CAM, so impossible to draw definitive conclusions regarding the effectiveness of any one therapy.
Limitations: Limited trials; authors rated trials as only moderate methodological quality.
________________________________________________________________________________________
Slade and Keating (2007)
Works reviewed: 6 random controlled trials.
Purpose of review: Compare unloaded exercise to no exercise or alternative therapy for nonspecific chronic low back
pain.
Conclusion: Results reported as standard mean deviation (SMD). Meta-analysis indicated significant and large ef-
fects from yoga, for medium-term pain (pooled SMD: 0.92 [0.47-1.37]) and function (pooled SMD: 0.95 [0.50-1.40]),
in favor of yoga. Unloaded exercise as effective as vigorous exercise with resistance.
Limitations: Authors noted that incomplete intervention descriptions would make replication difficult. Results are
pooled for varied interventions.
________________________________________________________________________________________
Tan et al. (2007)
Works reviewed: 25 articles, 2 systematic reviews, and 3 yoga trials (Level 3: Probably Efficacious).
Purpose of review: To summarize the evidence for selected CAM modalities for the management of chronic pain
complaints, provide general guidelines, and identify areas for future study.
Conclusion: CAM therapies have a mixed track record for efficacy. Studies suggest benefits from yoga therapy; it is
probably efficacious for some cases, but not enough evidence exists to routinely recommend this intervention.
Limitations: Authors identified that sample demographics may not match the usual chronic pain population. Limited
statistical data provided.
_________________________________________________________________________________________
Lewis, Morris, and Walsh (2008)
Works reviewed: 15 articles, 2 on yoga.
Purpose of review: The primary aim was to explore which exercises were effective in reducing pain for clients suffer-
ing with chronic low back pain. Physiotherapy exercises compared to yoga, hydrotherapy, surgical stabilization, back
care booklets, and placebo.
Conclusion: Physiotherapy exercises are effective for the treatment of chronic low back pain, although no treatment
modality was found to optimize therapy outcomes to a much greater extent than others. Yoga exercise had superior,
but not clinically or statistically significant, outcomes in one trial.
Limitations: Limited number of yoga studies, small sample size, interventions were not well described, and few statis-
tical results provided.
__________________________________________________________________________________________
Chou and Huffman (2007)
Works reviewed: 40 systematic reviews, 19 trials, and 3 yoga trials.
Purpose of review: To assess benefits and harms of various treatment modalities, including yoga, for acute or chronic
low back pain (with or without leg pain).
Conclusion: Regarding treatment with yoga, one trial found yoga was substantially superior to the self-care book
(p = .001) and resulted in decreased medication use (21% of clients), one trial demonstrated small effects on pain,
and the other trial found no significant differences between yoga and standard exercise.
Limitations: Limited yoga studies; authors noted language and publication bias may exist.

AAOHN Journal Vol. 59, No. 8, 2011 357

Downloaded from whs.sagepub.com at CORNELL UNIV on September 5, 2016
 Random Controlled Trials of Yoga for Back Pain

Tekur, Singphow, Nagendra, and Raghuram (2008)

Number in study: 80
Intervention: 1-week daily residential intensive yoga-based lifestyle program
Control: 1-week daily residential physical exercise and lifestyle program
Effect: A 49% reduction in disability (p = .01) and a significant improvement in flexibility (p = .008) among those par-
ticipants who used yoga.
_______________________________________________________________________________________
Saper et al. (2009)
Number in study: 30
Intervention: 12-week weekly intervention of yoga
Control: usual care (educational book on self-care strategies for low back pain)
Effect: A significantly greater reduction in pain (67% vs. 13%, p = .008) and pain medication use (67% vs. 13%, p =
.003) with yoga than with usual care (73% vs. 27%, p = .03).
________________________________________________________________________________________
Galantino et al. (2004)
Number in study: 22
Intervention: 6 weeks, twice a week, 1-hour yoga sessions
Control: no treatment
Effect: Study not powered to reach statistical significance; however, at 3-month follow-up, 54% reported improved
low back pain since completing the study.
__________________________________________________________________________________________
Sherman, Cherkin, Erro, Miglioretti, and Deyo (2005)
Number in study: 101
Intervention: 12-week weekly sessions of yoga
Control: 12-week weekly sessions of exercise classes or a self-care book
Effect: At 12 weeks, the yoga group showed greater improved function than the book group (p < .001) or exercise
group (p = .034). At 26 weeks, the yoga group still showed improvement over the book group (p < .001), but not sig-
nificantly greater than the exercise group (p = .018).

Literature review reviews using yoga as monotherapy for the treatment of

Does yoga improve pain management for workers
with nonspecific chronic low back pain? Literature from
the past decade generated by a search of peer-reviewed
articles from CINAHL, PubMed, Cochrane, EBSCO, and
MEDLINE databases using key terms yoga and back
pain and treatments and low back pain was reviewed.
Several educational articles and systematic reviews were
found. Eliminating the articles written for educational
or informational purposes resulted in only four random
controlled trials and one other study with a total of 269
participants. Five systematic reviews and two guidelines
were also found. A Google search of the Internet added
three current guidelines for the treatment of back pain.
Systematic reviews and meta-analyses are consid-
ered the strongest level of evidence on which to base
clinical judgment. In the literature review, no systematic
low back pain were identified. However, five systematic
reviews about treatments for chronic low back pain were
found. The results of these reviews are summarized in
the Sidebar. In their systematic review of complementary
and alternative medicine (CAM) for the treatment of low
back pain, Quinn, Hughes, and Baxter (2006) reported
favorable conclusions regarding the use of CAM to treat
low back pain (p. 108). They could not, however, recom-
mend one therapy over another.
A systematic review by Slade and Keating (2007)
evaluated the effects of unloaded exercise, defined as
moving the body without additional load, on low back
pain and function. Yoga was one of the unloaded exercises
evaluated. They concluded that, compared to no exercise,
unloaded exercise showed strong evidence of improving
outcomes for pain and function.

358 Copyright American Association of Occupational Health Nurses, Inc.

Downloaded from whs.sagepub.com at CORNELL UNIV on September 5, 2016
 Tan et al. (2007) evaluated CAM interventions for
chronic pain and found that yoga positively benefited
low back pain. They also concluded that spinal ma-
nipulation therapy, meditation, and yoga appear to be
promising treatments (p. 208), but recommended ad-
ditional research.
Lewis, Morris, and Walsh (2008) presented a sys-
tematic review of the literature on the effectiveness of
physiotherapy exercises compared to other therapies,
including yoga. They concluded that physiotherapy ex-
ercises were effective for the treatment of chronic low
back pain, but not superior to other exercise interven-
tions.
In a systematic review of ACP and APS practice
guidelines, Chou and Huffman (2007) assessed evi-
dence from other systematic reviews and random con-
trolled trials of 17 nonpharmacologic therapies for
low back pain. They reported that Viniyoga resulted in
greater improvement of functional status and use of an-
algesic medication compared to traditional exercise (p =
.034) (weekly sessions for both) and a self-care educa-
tion book (p < .001) after a 12-week trial. At 26 weeks,
the yoga group and the exercise group were not signifi-
cantly different, but the yoga group remained superior
to the self-care group (p < .001) and the yoga group re-
ported less medication use (21%) compared to both the
exercise group (50%) and the self-care education book
group (59%). Sherman, Cherkin, Erro, Miglioretti, and
Deyo (2005) compared yoga to conventional therapeutic
exercise and a self-care book. After 12 weekly sessions,
the yoga group showed greater improved function than
the other groups. At 26 weeks, the yoga group continued
to show improvement over the book group, but not sig-
nificantly greater improvement than the exercise group.
Two other random controlled trials comparing yoga to
exercise were reviewed. These trials were smaller and
had inconclusive results.
Four random controlled trials of yoga and back pain
were reviewed (Sidebar). One compared yoga to physical
exercise in a 1-week residential program of daily inten-
sive yoga or physical exercise. The yoga group and the
control group spent the same amount of time performing
their assigned exercises. A reduction in disability and a
significant improvement in flexibility were found among
those participants who practiced yoga (Tekur, Singphow,
Nagendra, & Raghuram, 2008).
In a random controlled trial pilot study with a sample
(n = 30) from minority populations, a 12-week interven-
tion of yoga was compared to usual care (i.e., continued
routine medical care and medications for chronic low
back pain). The yoga participants reported a clinically
significant reduction in pain (p = .008) and use of pain
medication (p = .003) compared to those receiving usual
care (Saper et al., 2009).
Another random controlled trial pilot study compared
yoga to no treatment. The yoga group had improved bal-
ance and flexibility and reported decreased disability and
depression. On a 3-month post-intervention survey, the
yoga group continued to report improved low back pain
(Galantino et al., 2004).
AAOHN Journal Vol. 59, No. 8, 2011
Downloaded from whs.sagepub.com at CORNELL UNIV on September 5, 2016
A non-random controlled study included 33 clients
who participated in at least eight yoga sessions and also
exercised at home. After 10 weeks, participants indicated
on a questionnaire a statistically significant improve-
ment of pain, depression, and energy/fatigue (p < .001)
(Groessl et al., 2008).
The literature reviewed showed that research on
yoga was limited and that most of the studies had small
samples. The time in the intervention varied between
studies, making comparisons difficult. However, the re-
viewed studies reported a positive outcome, or at least
no increase in symptoms, when yoga was used to treat
low back pain. These findings support the general guide-
line for exercise and activity, but do not define the fre-
quency or duration of exercise necessary to improve low
back pain. This review clarified that additional studies
are needed to provide more definitive guidance to cli-
ents. Although supporting evidence was weak, none of
the systematic reviews or studies evaluated reported a
harmful effect when yoga is practiced to treat low back
pain.
Implications for occupational health
nurses
Most acute nonspecific low back pain will resolve
within a month or two with minimal or no intervention.
If the pain becomes chronic, exploring alternative inter-
ventions such as yoga may be beneficial. Providing cli-
ents with educational materials listing both conventional
and alternative treatments may further assist them in in-
formed decision making regarding their health and well-
being. Godges, Anger, Zimmerman, and Delitto (2008)
studied the effects of education and counseling for pain
management, physical activity, and exercise on return-to-
work status. They found that those employees with acute
low back pain who received education and counseling on
low back pain returned to work sooner on average (100%
within 45 days of the back injury) than the comparison
group who received neither education nor counseling
(68% within 45 days of the back injury). Mannion et al.
(2009) found it beneficial to provide clients with evi-
dence-based educational materials addressing low back
pain. These materials focused on encouraging exercise
along with limiting rest, staying at work, and taking re-
sponsibility for treatment.
Fleming, Rabago, Mundt, and Fleming (2007)
found that among clients who practiced yoga and used
opioid therapy for pain, 81.8% reported that yoga was
helpful. Reducing the need for a controlled substance
benefits all involved; employees can continue to func-
tion at work and perform duties such as operating equip-
ment and heavy machinery that can be hazardous if they
are impaired.
No one treatment is beneficial to all workers who
suffer from chronic back pain. Practitioners should en-
sure that their clients understand that managing a chronic
condition requires some trial and error, and that they need
to have reasonable expectations of success from any form
of therapy they choose (Deyo, Mirza, Turner, & Martin,
2009).
359

I N S U MM A R Y
Yoga to Treat Nonspecific
Low Back Pain
Carter, C., Stratton, C., & Mallory, D.
AAOHN Journal 2011; 59(8), 355-361.
1 Low back pain is a common reason adults seek
health care. It can present a significant financial
burden to employers, employees, and health
insurance companies.
2 Most acute back pain will resolve in 4 to 6 weeks
with minimal intervention. Back pain lasting more
than 12 weeks is considered chronic and may
require treatment.
3 Yoga is an ancient form of exercise that brings
balance to mind, body, and spirit through the use
of postures, breathing, and meditation.
4 Scientific evidence supports the use of yoga as
therapy for nonspecific chronic low back pain.
Conclusions and Recommendations
From this review, the authors conclude that current
evidence supports yoga therapy for nonspecific chronic
low back pain. Guidelines regarding which style of yoga
is best and how often it should be practiced to meet treat-
ment outcomes requires further exploration. Workers with
chronic low back pain need encouragement to take an ac-
tive role in their treatment plan and must be made aware
of the nonpharmacologic therapies that may benefit them.
Clinicians need to explore with their clients the evidence
supporting conventional as well as alternative therapies
that may reduce pain, maintain or improve functional
ability, and enhance quality of life.
References
American College of Occupational and Environmental Medicine.
(2008). Chronic pain. In Occupational medicine practice guide-
lines: Evaluation and management of common health problems and
functional recovery of workers (pp. 73-502). Beverly Farms, MA:
OEM.
American College of Physicians and American Pain Society. (2007).
Diagnosis and treatment of low back pain: A joint clinical practice
guideline from the American College of Physicians and the American
Pain Society. Retrieved from www.annals.org/content/147/7/478.
full#fn-group-1
Barnes, P. M., Bloom, B., & Nahin, R. L. (2008). Complementary and
alternative medicine use among adults and children: United States,
2007 (National Health Statistics Reports no. 12). Retrieved from
www.cdc.gov/nchs/data/nhsr/nhsr012.pdf
Chou, R. (2010). Pharmacological management of low back pain.
Drugs, 70(4), 387-402.
Chou, R., & Huffman, L. H. (2007). Nonpharmacologic therapies for
acute and chronic low back pain: A review of the evidence for an
360
Downloaded from whs.sagepub.com at CORNELL UNIV on September 5, 2016
American Pain Society/American College of Physicians clinical
practice guideline. Annals of Internal Medicine, 147, 492-504.
Chou, R., Qaseem, A., Snow, V., Donald, C., Cross, J. T., Shekelle, P., et
al. (2007). Diagnosis and treatment of low back pain: A joint clinical
practice guideline from the American College of Physicians and the
American Pain Society. Annals of Internal Medicine, 14(7), 478-
491.
Deyo, R. A., Mirza, S. K., Turner, J. A., & Martin, B. I. (2009, Janu-
ary-February). Overtreating chronic back pain: Time to back off?
Journal of the American Board of Family Medicine, 22(1), 62-68.
Deyo, R. A., & Weinstein, J. N. (2001). Low back pain. New England
Journal of Medicine, 344(5), 363-370.
Fleming, S., Rabago, D. P., Mundt, M. P., & Fleming, M. F. (2007).
CAM therapies among primary care patients using opioid therapy
for chronic pain. BMC Complementary and Alternative Medicine,
7(15). doi:10.1186/1472-6882-7-15
Galantino, M. L., Bzdewka, T. M., Eissler-Russo, J. I., Holbrood, M. I.,
Mogck, E. P., Geigle, P., et al. (2004). The impact of modified Hatha
yoga on chronic low back pain: A pilot study. Alternative Therapies
in Health and Medicine, 10(2), 56-59.
Godges, J. J., Anger, M. A., Zimmerman, C., & Delitto, A. (2008). Ef-
fects of education on return-to-work status for people with fear-
avoidance beliefs and acute low back pain. Physical Therapy, 88(2),
231-239.
Groessl, E. J., Weingart, K. R., Aschbacher, K., Pada, L., & Baxi, S.
(2008). Yoga for veterans with chronic low back pain. Journal of
Alternative and Complementary Medicine, 14(9), 1123-1129.
Guideline for the evidence-informed primary care management of low
back pain. (2009). Retrieved from www.topalbertadoctors.org/
informed_practice/clinical_practice_guidelines/complete%20set/
Low%20Back%20Pain/backpain_guideline.pdf
Hardt, J., Jacobsen, C., Goldberg, J., Nickel, R., & Buchwald, D. (2008).
Prevalence of chronic pain in a representative sample in the United
States. Pain Medicine, 9(7), 803-812.
Hayes, M., & Chase, S. (2010). Prescribing yoga. Primary Care, 37,
31-47.
Institute for Clinical Systems Improvement. (2008). Health care guide-
line: Adult low back pain. Retrieved from www.icsi.org/low_back_
pain/adult_low_back_pain__8.html
International Association of Yoga Therapists. (2011). Mission. Re-
trieved from www.iayt.org/site_Vx2/about/mission.aspx?AutoID
=&UStatus=&ProfileNumber=&LS=&AM=&Ds=&CI=&AT=&
Return=
Lewis, A., Morris, M. E., & Walsh, C. (2008). Are physiotherapy exer-
cises effective in reducing chronic low back pain? Physical Therapy
Reviews, 13(1), 37-44.
Mannion, A. F., Horisberger, B., Eisenring, C., Tamcan, O., Elfering,
A., & Mller, U. (2009). The association between beliefs about low
back pain and work absenteeism. Journal of Occupational and En-
vironmental Medicine, 51(11), 1256-1266.
National Center for Complementary and Alternative Medicine. (2008).
Yoga for health: An introduction (NCCAM publication no. D412).
Retrieved from http://nccam.nih.gov/health/yoga/introduction.
htm
National Center for Complementary and Alternative Medicine.
(2010). Chronic pain and CAM: At a glance (NCCAM publica-
tion no. D456). Retrieved from http://nccam.nih.gov/health/pain/
D456.pdf
National Institute for Health and Clinical Excellence. (2009). Low back
pain: Early management of persistent non-specific low back pain.
London: Author.
Quinn, F., Hughes, C., & Baxter, D. (2006). Complementary and al-
ternative medicine in the treatment of low back pain: A systematic
review. Physical Therapy Reviews, 11, 107-116.
Saper, R. B., Sherman, K. J., Cullum-Dugan, D., Davis, R. B., Phil-
lips, R. S., & Culpepper, L. (2009). Yoga for chronic low back
pain in a predominantly minority population: A pilot randomized
controlled trial. Alternative Therapies in Health and Medicine,
15(6), 16-27.
Sherman, K. J., Cherkin, D. C., Erro, J., Miglioretti, D. L., & Deyo,
R. A. (2005). Comparing yoga, exercise, and a self-care book for
chronic low back pain: A randomized controlled trial. Annals of In-
ternal Medicine, 143(12), 849-856.
Copyright American Association of Occupational Health Nurses, Inc.
Slade, S. C., & Keating, J. L. (2007). Unloaded movement facilitation
exercise compared to no exercise or alternative therapy on outcomes
for people with nonspecific chronic low back pain: A systematic
review. Journal of Manipulative and Physiological Therapeutics,
30(4), 303-311.
Tan, G., Craine, M. H., Bair, M. J., Garcia, M. K., Giordano, J., Jensen,
M. P., et al. (2007). Efficacy of selected complementary and alterna-
tive medicine interventions for chronic pain. Journal of Rehabilita-
tion Research & Development, 44(2), 195-222.
Tekur, P., Singphow, C., Nagendra, H. R., & Raghuram, N. (2008). Ef-
AAOHN Journal Vol. 59, No. 8, 2011
Downloaded from whs.sagepub.com at CORNELL UNIV on September 5, 2016
fect of short-term intensive yoga program on pain, functional dis-
ability, and spinal flexibility in chronic low back pain: A randomized
control study. Journal of Alternative and Complementary Medicine,
14(6), 637-644.
Whitehouse, R. (2006). Back pain and the integrated health and disabil-
ity program. National Underwriter Life and Health, 20, 28.
Williams, K., Abildso, C., Steinberg, L., Doyle, E., Epstein, B., Smith,
D., et al. (2009, September 1). Evaluation of the effectiveness and
efficacy of Iyengar yoga therapy on chronic low back pain. Spine,
34(19), 2066-2076.
361