Case Report

Integrative Medicine Case Reports, Volume 2, Issue 1 (January), 2021

 

Integrated Approach of Yoga Therapy towards Chronic Low Back Pain: A Case Report

Reshma P. Jogdand1*, Shekhar Mukhiya Sunuwar2, Amit Singh3 and R. Nagrathna4

Department of Life Sciences, SVYASA University, Bangalore1,3,4
The School of Yoga and Naturopathic Medicine, SVYASA University, Bangalore2

     

KEY WORDS

 

ABSTRACT

Lower back pain
Yoga therapy
Naturopathy
Physiotherapy
Quality of life

 

This case report represents the patient of lower back pain (LBP) who visited Arogyadhama (SVYASA University, Bangalore). Patient was suffering from low back pain and multiple joint pain at the time of visit and 14 days Yoga intervention was provided to the patient for pain management, which helped the patient in relieving the pain and improving the muscular strength and quality of life significantly. The present case study is an attempt to provide IAYT (Integrated approach of Yoga therapy) practices in combination with naturopathy and physiotherapy for the maintenance of LBP profile and symptoms.

doi: 10.38205/imcr.020115

*Corresponding Author:
Reshma P. Jogdand
Department of Life Sciences,
SVYASA University, Bangalore
Contact no: +91-9449164937
E-mail: reshma.bnys@gmail.com

 

Introduction

Chronic low back pain (CLBP) is a chronic pain syndrome of the lower back region lasting at least for 3 months. It is the most common musculoskeletal condition affecting the adult population. Many authors define CLBP as pain that lasts beyond the expected period of healing (1). CLBP is a main cause of physical disability worldwide and needs significant government assistance and financial help to resolve the issue (2). Non-specific LBP does not have any recognizable pathology (such as infection, tumor, osteoporosis, rheumatoid arthritis, fracture, or inflammation) and traits (3). 

Commonness of incessant LBP IS 4.2% among the adults in the age group of 24 to 39 years and 19.6% among 20 to 59 years (5). Among nine investigations, six show prevalence of LBP in about 3.9%–10.2% people aged 18 or more, whereas other three investigations shows prevalence range of the same between 13.1% and 20.3%. LBP predominance was noticed 25.4% among Brazilian population while it was 15 to 45% in French human services laborers. Pervasiveness of CLBP is evaluated to be 5.91% in Italy (2). The prevalence of acute and CLBP in adults doubled in the last decade and continues to increase dramatically in the aging population,
affecting both men and women in all ethnic groups (6).

Side effects, pathology, and radiological appearances are ineffectively associated with CLBP. Intensity of pain is indefinite in about 85% of individuals suffering from CLBP. About 4% of individuals with CLBP in essential consideration has pressure breaks, and about 1% are known to be associated with tumor. The commonness of prolapsed intervertebral plate among individuals with CLBP is about 1% to 3%, while Ankylosing spondylitis and spinal diseases are more uncommon. These findings can’t be used for an authoritative conclusion on incessant LBP. Different factors, other than physical, may be associated with progression of CLBP which includes hazard factors such as substantial physical work, bowing, turning, lifting and Psychosocial chance elements, such as nervousness, gloom, and mental worry, at work. Having a past history of LBP and a more extended span of critical hazard factors for chronicity. One efficient survey of described that some mental components such as trouble, burdensome state of mind, and somatization are related with an expanded danger of constant LBP. Working environment and individual factors are also thought to be associated with the progress of interminable LBP (4).

Case presentation

Recruitment of patient

A 51 year old female from Telengana who visited Prashanti Kutiram (Arogyadhma) SVYASA for treatment of her CLBP was enrolled as a participant for this case study after taking her written consent and explaining her about the treatment regimen. She was kept in section ‘E’, which deals with spinal disorders and back pain. She resided in the campus for a period of 14 days (6th March, 2020 to 19th March, 2020). Yoga therapy, which included loosening practices (Table 1), Pranayams (Table 2), breathing practices (Table 3) and asanas (Table 4) was combined with Naturopathy (Table 5) and Physiotherapy (Table 6)s for her CLBP treatment. Specific diet plan (Table 7) was also followed by participant. Below is a treatment regimen that was provided to the patient during her stay in SVYASA.

IAYT Protocol

Treatment Regimen

Loosening Practice (7)

Table 1: Loosening practices followed by participant

S. No.

Practice

Duration per session

Frequency per day

Duration of intervention

1

Ankle movement

10 times

2 times a day

2 weeks

2

Feet movement inward-outward

10 times

2 times a day

2 weeks

3

Ankle rotation

10 times

2 times a day

2 weeks

4

Butterfly

20 times

2 times a day

2 weeks

5

St. leg raising

5 times

2 times a day

2 weeks

6

Shoulder Rotation

10 times

2 times a day

2 weeks

7

Upper arm stretch

10 times

2 times a day

2 weeks

8

Vertical stretch of knee

10 times

2 times a day

2 weeks

9

Neck movement

10 times

2 times a day

2 weeks

10

Side leg raising

10 times

2 times a day

2 weeks

11

Alternate foot knee

10 times

2 times a day

2 weeks

12

Sideward bending

10 times

2 times a day

2 weeks

13

Cross leg L.S

10 times

2 times a day

2 weeks

14

Hip stretch

10 times

2 times a day

2 weeks

15

Back stretch with alternate leg

10 times

2 times a day

2 weeks

16

Full butterfly

10 times

2 times a day

2 weeks

17

Alternate & both leg raising

10 times

2 times a day

2 weeks

18

Side leg raising

10 times

2 times a day

2 weeks

Pranayama (8)

Table 2: Pranayams followed by participant

 

Pranayama

Duration of procedure

Frequency

Duration of Intervention

1

Nadishuddhi Pranayama

27 Rounds for each nostril

4 times a day

2 weeks

2

Brahmari

9 Rounds

2 times a day

2 weeks

3

Naadaanusandhna

5 Rounds

2 times a day

2 weeks

Deep Relaxation Technique (10–15 minutes) (9)

Each session of passive exercise, pranayama was completed with D.R.T. (Deep Relaxation Technique). Deep Relaxation Technique (D.R.T.) is a deeper and more intense form of relaxation. For making participant comfortable during relaxation session, DRT was done in Savasana (Corpse Pose) because it is generally done for 15 minutes.

Breathing Practices (10)

Table 3: Breathing practices followed by participant

S. No.

Breathing Practices

Duration of procedure

Frequency

Duration of Intervention

1

Hand Stretch Breathing

2 minutes

2 times a day

2 weeks

2

Hands In and Out Breathing

2 minutes

2 times a day

2 weeks

3

Ankle stretch Breathing

2 minutes

2 times a day

2 weeks

4

Tiger Breathing

2 minutes

2 times a day

2 weeks

Yogasana (11)

Table 4: Asanas followed by participant

 

Yogasanas

Duration of procedure

Frequency

Duration of Intervention

 

Standing Position

 

 

 

1

sasankasana

2 minutes

2 times a day

2 weeks

2.

Dorsal stretch (naukasana)

2 minutes

2 times a day

2 weeks

3

Pavanmuktasanakriya (without lifting the head)

2 minutes

2 times a day

2 weeks

4.

Bhujanagasana

2 minutes

2 times a day

2 weeks

5

Dorsal stretch

1 minute

2 times a day

2 weeks

6

salabhasana

2 minutes

2 times a day

2 weeks

7

Walking

 

2 times a day

2 weeks

8

Side leg raising

1 minute

2 times a day

2 weeks

Naturopathy (12)

Table 5: Naturopathy treatment followed by participant

S. No.

Treatments

Duration (minutes)

Frequency

Periods

1

Mud pack

15

1 time a day

1 week

2

Salt water bath

45

1 time a day

1 week

3

Mustard pack

30

1 time a day

1 week

4

Hot fomentation

15

1 time a day

1 week

5

Vibro massage

15

1 time a day

1 week

Physiotherapy (13)(14)

Table 6: Physiotherapy treatment followed by participant

S. No.

Treatments

Duration (minutes)

Frequency

Periods

1

ix. IFT

5

1 time a day

1 week

2

x. Ultrasound

5

1 time aday

1 week

Diet Protocol (8)

The participant was advised to take naturopathic diet consecutively for 14 days of her stay in Prashanti kuteeram. The pattern was as follows.

Lunch: (boiled diet) 1 chapati, 1 cup adl, 1 cup rice, buttermilk, 100 gm boiled vegtables (beans + pumpkin + beetroot + methi + spinach + knolkhol)
Dinner: (Raw diet) 2–3 slices fruits (papaya + watermelon + pomegranate/muskmelon), Vegetable salad (cucumber + pomegranate + beetroot + carrot), Butter milk.

Table 7: Weekly diet plan followed by participant

 

8:00 am

10:00 am

12:00 pm

2:00 pm

5:00 pm

7:30 pm

8:30 pm

Saturday

Ash gourd juice

Barley water

Lunch

Buttermilk

Ash gourd juice

Dinner

Kashayam

Sunday

Carrot juice

Watermelon

Lunch

Buttermilk

Carrot juice

Dinner

Kashayam

Monday

Bottle gourd juice

Musk melon

Lunch

Buttermilk

Bottle gourd juice

Dinner

Kashayam

Thuesday

Bottle gourd

Watermelon

Lunch

Buttermilk

Bottle gourd

Dinner

Kashayam

Wednesday

Ash guard juice

Carrot juice

Lunch

Buttermilk

Ash guard juice

Dinner

Kashayam

Thursday

Carrot juice

Ash guard

Lunch

Buttermilk

 

Dinner

Kashayam

Friday

Breakfast

Pongal + buttermilk

Buttermilk

Dinner

Diagnosis

Reduction of low back pain was noticed.

Table 8: Score of different parameters before and after the treatment regimen

Parameters

DOA

DOD

Pulse Beats/min

80 bpm

74 bpm

BP in mmHg

130/70 mm/Hg

148/98 mm/Hg

Respiratory Cycles/min

17 cpm

11 cpm

Bhramari Time (Sec)

15 sec

15 sec

Symptoms score

03

01

Straight leg raising
Lt/Rt in degree

80/80

90/90

Sit and reach

46 cm

47 cm

Pain Scale Reading

09

05

Discussion

It was observed that the patient was able to maintain a healthy living by adopting IAYT which may have helped improving the patient’s overall health. During her stay she had undergone above mentioned yoga practice, meditation, relaxation techniques, Naturopathy treatments and Physiotherapy practices.
There was marked positive changes in all vitals including Blood pressure, Respiratory rate and there was significant improvement in symptoms score and good number of reduction in straight leg raising and sit and reach scale.

image

Fig. 1: Bars represent the intensity of different parameters diagnosed during treatment period of 14 days.

Conclusion

Overall treatment of Yoga combined with physiotherapy, naturopathy and specific diet plan helped her to reduce LBP and symptom score such as difficulty in performing day to day activities and disturbed sleep due to pain and helped her to maintain the better quality of life. Above mentioned integrated treatment can be recommended to the patients with CLBP.

Acknowledgement

First of all, I bestow in front of Lord Dhanavantari and express deepest gratitude to the almighty. In addition I would like to acknowledge the following people who played an instrumental role in the completion of this project. I express my appreciation to the blessings of my gurus and salutations to my parents and all my teachers. I am grateful to Dr. Nagarathna and Dr. Amit Singh of research for sharing their thoughts with other people. Special thanks to a person who motivated me for this work is Dr. Amit singh, his guidance and support makes me more strong and confident to study in this area.

I am appreciative to section therapist for their guidance and allowing me to provide Yoga therapy to their patients and their immense support in my presented work. My love and regards goes to my loving parents for their endless support and encouragement finally, my hearted thank to my husband Mr. Sumit Aundhekar for extending his support through out my work. I express my gratitude to all the Participants, as they were the true inspiration and purpose.

Authorship contribution

RJ and SM has written Article.
RN guided to write article.
AS has contributed in a treatment planning.

Informed consent

Yes.

Source of funding

Nil.

Conflict of interest

Nil.

 

Received Date: 04-07-20; Revised Date: 24-08-20
Accepted Date: 15-09-20

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