Sun Salutation yoga in patients with subacute low back pain: a feasibility study
More details
Hide details
Department of Sport Science, Faculty of Sport Science, Yogyakarta State University, Yogyakarta, Indonesia
Submission date: 2021-05-03
Acceptance date: 2021-08-11
Publication date: 2022-05-31
Physiother Quart. 2022;30(4):1-6
The roles of yoga in improving symptoms in chronic low back pain (LBP) have been established. However, evidence of Sun Salutation yoga feasibility in subacute LBP is lacking. This feasibility study examined the adherence, safety, and potential effect size of Sun Salutation yoga in improving pain, functional disability, and quality of life among patients with subacute LBP.

Overall, 20 patients with subacute LBP (65% females, age: 35 ± 10 years) were enrolled in a 6-week Sun Salutation program. The protocol adherence and safety were self-reported by participants during weekly monitoring. Pain was assessed with visual analogue scale (VAS) and numeric rating scale (NRS), functional disability with Oswestry Disability Index (ODI) and Roland-Morris Questionnaire (RMQ), while quality of life with the Short Form Health Survey (SF-12). Pre- and post-intervention data were analysed by using the paired t-test or Wilcoxon signed-rank test per data distribution. Effect size was evaluated.

All patients adhered to the study protocol and no adverse effects were reported. Pain, functional disability, and quality of life improved significantly after the intervention. Effect sizes were very large for pain (3.87 and 3.97 for VAS and NRS), functional disability (1.94 and 3.24 for ODI and RMQ), and quality of life (2.34 and 4.62 for SF-12 physical and mental composite score).

The adherence and safety of Sun Salutation yoga in subacute LBP patients were demonstrated, with large effect sizes for improving pain, functional disability, and quality of life. Randomized controlled trials are recommended to confirm the findings.

Dixit RK, Schwab JH. Low back and neck pain. In: Stone JH (ed.), A clinician’s pearls and myths in rheumatology. Dordrecht: Springer; 2009; 447–459.
Hayashi Y. Classification, diagnosis, and treatment of low back pain. Jpn Med Assoc J. 2004;47(5):227–233.
Fatoye F, Gebrye T, Odeyemi I. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatol Int. 2019;39(4):619–626; doi: 10.1007/s00296-019-04273-0.
Andarini S, Arif AZ, Al Rasyid H, Wahono CS, Kalim H, Handono K. Factors associated with health care seeking behavior for musculoskeletal pain in Indonesia: a cross-sectional study. Int J Rheum Dis. 2019;22(7):1297–1304; doi: 10.1111/1756-185X.13536.
Shmagel A, Foley R, Ibrahim H. Epidemiology of chronic low back pain in US adults: data from the 2009–2010 National Health and Nutrition Examination Survey. Arthritis Care Res. 2016;68(11):1688–1694; doi: 10.1002/acr.22890.
Shipton EA. Physical therapy approaches in the treatment of low back pain. Pain Ther. 2018;7(2):127–137; doi: 10.1007/s40122-018-0105-x.
Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin C-WC, Chenot J-F, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791–2803; doi: 10.1007/s00586-018-5673-2.
Carter C, Stratton C, Mallory D. Yoga to treat nonspecific low back pain. Am Assoc Occup Health Nurs J. 2011;59(8):355–362; doi: 10.3928/08910162-20110718-01.
Gellhorn AC, Chan L, Martin B, Friedly J. Management patterns in acute low back pain: the role of physical therapy. Spine. 2012;37(9):775–782; doi: 10.1097/BRS.0b013e3181d79a09.
Wieland LS, Skoetz N, Pilkington K, Vempati R, D’Ada­mo CR, Berman BM. Yoga treatment for chronic non-specific low back pain. Cochrane Database Syst Rev. 2017;1(1):CD010671; doi: 10.1002/14651858.CD010671.pub2.
Chang DG, Holt JA, Sklar M, Groessl EJ. Yoga as a treatment for chronic low back pain: a systematic review of the literature. J Orthop Rheumatol. 2016;3(1):1–8; doi: 10.13188/2334-2846.1000018.
Cramer H, Lauche R, Haller H, Dobos G. A systematic review and meta-analysis of yoga for low back pain. Clin J Pain. 2013;29(5):450–460; doi: 10.1097/AJP.0b013e31825e1492.
Sengupta P. Health impacts of yoga and pranayama: a state-of-the-art review. Int J Prev Med. 2012;3(7):444–458; doi: 10.13016/LXQD-LC0O.
Kelly Z. Is yoga an effective treatment for low back pain: a research review. Int J Yoga Ther. 2009;19(1):103–112; doi: 10.17761/ijyt.19.1.r810550078602214.
Saper RB, Lemaster C, Delitto A, Sherman KJ, Herman PM, Sadikova E, et al. Yoga, physical therapy, or education for chronic low back pain: a randomized noninferiority trial. Ann Int Med. 2017;167(2):85–94; doi: 10.7326/M16-2579.
Bhutkar MV, Bhutkar PM, Taware GB, Surdi AD. How effective is sun salutation in improving muscle strength, general body endurance and body composition? Asian J Sports Med. 2011;2(4):259–266; doi: 10.5812/asjsm.34742.
Stec K. Dynamic Suryanamaskar: Sun Salutations. Bangalore: Swami Vivekananda Yoga Prakashana; 2012.
Chiarotto A, Maxwell LJ, Ostelo RW, Boers M, Tugwell P, Terwee CB. Measurement properties of Visual Analogue Scale, Numeric Rating Scale, and Pain Severity subscale of the Brief Pain Inventory in patients with low back pain: a systematic review. J Pain. 2019;20(3):245–263; doi: 10.1016/j.jpain.2018.07.009.
Kahl C, Cleland JA. Visual analogue scale, numeric pain rating scale and the McGill Pain Questionnaire: an overview of psychometric properties. Phys Ther Rev. 2005;10(2):123–128; doi: 10.1179/108331905X55776.
Grotle M, Brox JI, Vøllestad NK. Cross-cultural adaptation of the Norwegian versions of the Roland-Morris Disability Questionnaire and the Oswestry Disability Index. J Rehabil Med. 2003;35(5):241–247; doi: 10.1080/16501970306094.
Husky MM, Farin FF, Compagnone P, Fermanian C, Ko­vess-Masfety V. Chronic back pain and its association with quality of life in a large French population survey. Health Qual Life Outcomes. 2018;16(1):195; doi: 10.1186/s12955-018-1018-4.
Fairbank JCT. Why are there different versions of the Oswestry Disability Index? A review. J Neurosurg Spine. 2014;20(1):83–86; doi: 10.3171/2013.9.SPINE13344.
Roland M, Fairbank J. The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine. 2000;25(24):3115–3124; doi: 10.1097/00007632-200012150-00006.
Ware JE Jr, Kosinski M, Keller SD. A 12-item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–233; doi: 10.1097/00005650-199603000-00003.
Arovah NI, Heesch KC. Assessment of the validity and reliability of the Indonesian version of Short Form 12 (SF-12). J Prev Med Hyg. 2021;62(2):E421–E429; doi: 10.15167/2421-4248/jpmh2021.62.2.1878.
Cohen J. A power primer. Psychol Bull. 1992;112(1):155–159; doi: 10.1037/0033-2909.112.1.155.
Christakou A, Boulnta F. The effectiveness of hydrotherapy in patients with chronic low back pain. Physiother Quart. 2020;28(3):32–38; doi: 10.5114/pq.2020.95772.
Honcharov A, Ruban L, Litovchenko A, Okun D, Turchinov A. Physical therapy for old-timer athletes with chronic back pain. Physiother Quart. 2020;28(2):20–24; doi: 10.5114/pq.2020.92475.
Colgrove YM, Gravino-Dunn NS, Dinyer SC, Sis EA, Heier AC, Sharma NK. Physical and physiological effects of yoga for an underserved population with chronic low back pain. Int J Yoga. 2019;12(3):252–264; doi: 10.4103/ijoy.IJOY_78_18.
Kuvačić G, Fratini P, Padulo J, Antonio DI, De Giorgio A. Effectiveness of yoga and educational intervention on disability, anxiety, depression, and pain in people with CLBP: a randomized controlled trial. Complement Ther Clin Pract. 2018;31:262–267; doi: 10.1016/j.ctcp.2018.03.008.
Hampton AR, Temte EG, Barrett BP. Individually tailored yoga for chronic neck or back pain in a low-income population: a pilot study. Int J Yoga. 2020;13(1):70–72; doi: 10.4103/ijoy.IJOY_23_19.
Verbrugghe J, Agten A, Stevens S, Hansen D, Demoulin C, Eijnde BO, et al. Exercise intensity matters in chronic nonspecific low back pain rehabilitation. Med Sci Sports Exerc. 2019;51(12):2434–2442; doi: 10.1249/MSS.0000000000002078.
Goode AP, Coeytaux RR, McDuffie J, Duan-Porter W, Sharma P, Mennella H, et al. An evidence map of yoga for low back pain. Complement Ther Med. 2016;25:170–177; doi: 10.1016/j.ctim.2016.02.016.
Hunter SD, Tarumi T, Dhindsa MS, Nualnim N, Tanaka H. Hatha yoga and vascular function: results from cross-sectional and interventional studies. J Bodyw Mov Ther. 2013;17(3):322–327; doi: 10.1016/j.jbmt.2012.10.009.
Malhotra P. Surya namaskar: a way to relax the mind. Sleep Med Dis Int J. 2017;1(6):133–135; doi: 10.15406/smdij.2017.01.00028.
Chaudhary DK, Singh K. The effect of surya namaskara on flexibility of school level athletes. Int J Phys Educ Sports Health. 2019;6(6):94–97.
Vaibhav A, Shukla S, Singh OP. Surya Namaskar (Sun Salutation): a path to good health. Int J Pharmacol Res. 2016;6(7):224–230.
Hsieh C-YJ, Adams AH, Tobis J, Hong C-Z, Danielson C, Platt K, et al. Effectiveness of four conservative treatments for subacute low back pain: a randomized clinical trial. Spine. 2002;27(11):1142–1148; doi: 10.1097/00007632-200206010-00003.
Marin TJ, Van Eerd D, Irvin E, Couban R, Koes BW, Mal­mivaara A, et al. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain. Cochrane Database Syst Rev. 2017;6(6):CD002193; doi: 10.1002/14651858.CD002193.pub2.
Journals System - logo
Scroll to top