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Hot Yoga with Physical Therapy for Low Back Pain Hot Running head: HOT YOGA WITH PHYSICAL THERAPY FOR LOW BACK PAIN HOT YOGA AS A SUPPLEMENT TO PHYSICAL THERAPY FOR LOW BACK PAIN AS A WORK-ACQUIRED MUSCULOSKELETAL INJURY _____________________________________________________________________ A Case Report Presented to Marieb College of Health and Human Services Florida Gulf Coast University In Partial Fulfillment of the Requirement for the Degree of Doctor of Physical Therapy ____________________________________________________________________ By Cheryl Theresa Montecer, PT 2017 HOT YOGA WITH PHYSICAL THERAPY FOR LOW BACK PAIN APPROVAL SHEET This Case Report is submitted in partial fulfillment of the requirements for the degree of Doctor of Physical Therapy _________________________________ Cheryl Theresa Montecer, PT Approved: June 2017 _________________________________ Kathy SWanick, DPT, MS, OCS Committee Chair / Advisor _________________________________ Ellen Donald, PhD, PT Committee Member The final copy of this case report has been examined by the signatories, and We find that both the content and the form meet acceptable presentation standards of scholarly Work in the above-mentioned discipline. HOT YOGA WITH PHYSICAL THERAPY FOR LOW BACK PAIN ACKNOWLEDGEMENTS The completion of this case report Was made possible through the generous participation of Joe Degonia, PTA as the subject in this study. I Would also like to thank Morgan Lemos PT, DPT for her expertise in the examination of the participant and also for alloWing me to observe a treatment session. I Would also like to extend my gratitude to my professors Dr. Kathy SWanick and Dr. Ellen Donald for their mentorship in the accomplishment of this case report. HOT YOGA WITH PHYSICAL THERAPY FOR LOW BACK PAIN 1 Table of Contents Abstract ……………………………………………………………………………………………………………………. 2 Introduction ……………………………………………………………………………………………………………… 3 Patient History and Systems RevieW …………………………………………………………………………. 6 Clinical Impression 1 …………………………………………………………………………………………………. 7 Examination ……………………………………………………………………………………………………………… 8 Table 1 ………………………………………………………………………………………………………………. 10 Clinical Impression 2 ………………………………………………………………………………………………… 12 Intervention ……………………………………………………………………………………………………………. 12 Physical Therapy …………………………………………………………………………………………………. 13 Hot Yoga ……………………………………………………………………………………………………………. 14 Outcome ………………………………………………………………………………………………………………… 15 Table 2 ………………………………………………………………………………………………………………... 17 Discussion ………………………………………………………………………………………………………………. 21 References ……………………………………………………………………………………………………………… 23 HOT YOGA WITH PHYSICAL THERAPY FOR LOW BACK PAIN 2 ABSTRACT Background and Purpose. LoW back pain, as a Work-acquired musculoskeletal injury (WAMI) is prevalent among physical therapists. Research suggests that yoga is a groWing practice that is used as an effective therapeutic tool in alleviating pain through postures that increase flexibility and improve function. The objective of this case report is to illustrate the establishment and application of an approach of hot yoga in combination With physical therapy in the management of loW back pain on a physical therapist assistant (PTA) Who sustained a Work-acquired musculoskeletal injury. Case Description. A 47 year-old male PTA With a five Week history of loW back pain participated in this case report. The PTA Was chosen based on a musculoskeletal injury sustained at Work Who demonstrated loW back pain With numbness on his right anterolateral thigh, tightness and tenderness of his loWer thoracic and lumbar spine. The intervention consisted of seven physical therapy sessions and seven hot yoga classes. Outcomes. After four Weeks of intervention, loW back pain resolved, right thigh numbness significantly decreased from 100% to 10%, and trunk flexibility increased With absence of tenderness at the thoracolumbar junction. Discussion. A significant decrease in back impairment Was observed on a patient With sub-acute loW back pain after participation in the intervention of physical therapy and hot yoga. Clinical trials in the future are required to evaluate the thermoregulatory mechanism, the physiological and biomechanical effects of hot yoga, and Whether it is a beneficial complement to physical therapy in the rehabilitation of loW back pain. HOT YOGA WITH PHYSICAL THERAPY FOR LOW BACK PAIN 3 INTRODUCTION Physical therapists are at a substantial risk for work-acquired musculoskeletal injury (WAMI). In a prior study by Campo et al,1 susceptibility to hazardous elements for WAMI is due to patient encounter that involves lifting, repositioning, transferring and performing manual therapy. High levels of force application are involved in these activities Which may have to be completed in unhealthy postures. These movements facilitate the risk for loW back injury especially When executed on a bent, twisted or awkWard positions, and repetitive tasks. Age is also associated With WAMI. As physical therapists age, focus should be geared in the development of strategies that Will promote injury-free environment. In another study by Darragh et al,2 physical therapists Who sustained an injury to the loW back area had the highest incidence of 41% in comparison to injury of the neck Which Was 35%, hand 28%, shoulder 24% and the upper back 28%. Yoga utilizes postures for stretching, strengthening and flexibility that could be advantageous to the management of loW back pain.3 Yoga has affirmative results in general With pain reduction and the improvement of spine function as indicated by recent studies.4 Yoga integrates physical movement With mindful practices. Chronic pain is a mind-body experience so several researchers and people Who experience chronic pain practice yoga for remedy and comfort.5 Breathing exercises (pranayama), postures (asanas) and meditation (dhyana) are key elements in Hatha yoga Which is an ancient practice in the management of persistent pain. Randomized clinical trials are groWing suggestive of yoga as an approach to address this issue.6 Current evidence based on a HOT YOGA WITH PHYSICAL THERAPY FOR LOW BACK PAIN 4 systematic revieW on non-pharmacological therapies for chronic loW back pain indicates that yoga, as a form of mind-body intervention, has a moderate strength of evidence. This study is for the American College of Physicians Clinical Practice Guideline.7 Physical therapists who have extensive credibility can also advocate yoga as an adjunct in the management of loW back pain thus contributing to the effectiveness of the practice. LoW back pain interventions of physical therapy consist of therapeutic exercises, manual therapy, motor control exercises, spinal manipulative therapy, aerobic conditioning, physical modalities and advice on ergonomics. In a study by Azevedo et al,8 there is strong evidence that physical therapy implementation of dynamic exercises provides efficacious treatment of chronic loW back pain (CLBP). This study also implies these exercises have been advocated by majority of clinical practice guidelines in the management of this condition together With results of several systematic revieWs. Heat is a therapeutic modality utilized for the treatment of paraspinal muscles and simple muscle strain disorders. Heat is efficacious on an injured muscle that is appropriate to be stretched, as it enhances the viscoelasticity of collagen in the tissues. Moist heat is recommended since heat is absorbed deeper into the muscle tissue. Heat increases blood floW that causes vasodilatation Which in turn contributes to the elimination of metabolic Wastes. This also leads to the absorption of nutrients that aids in tissue repair. The metabolic by-products from injured muscles that particularly activate pain fibers are expelled so analgesia is experienced.9 The integrative approach in the assessment and treatment of chronic pain is a groWing recognition in the physical therapy profession that acknoWledges both HOT YOGA WITH PHYSICAL THERAPY FOR LOW BACK PAIN 5 biomedical and psychosocial obstacles to the return of function.10 Since the biopsychosocial approach is the gold standard for the management of chronic pain, yoga With a holistic path may appeal in the rehabilitation of WAMI.11 There are several studies on yoga that address loW back pain, but yoga combined With heat has not been thoroughly researched. For the purpose of this case report, yoga is performed in a hot and moist environment With temperature of 105oF and 40% humidity. This type of atmosphere Will facilitate sWeating that may enhance the beneficial effects of yoga as a non-pharmacological solution to loW back pain. Caution should be taken by those Who take medications and also have conditions that may lead to heat intolerance. Medications to control hypertension such as vasodilating agents, alpha blockers and calcium channel blockers may lead to orthostatic hypotension When a person is exposed to systemic heat. An individual With hyperthyroidism may have heat intolerance. It is advisable to receive clearance from a health care professional. Hydration hours prior to hot yoga is also highly recommended. The objective of this case report is to demonstrate hoW hot yoga With physical therapy assisted in the rehabilitation of a physical therapist assistant (PTA) Who suffered a Work-related musculoskeletal disorder. PATIENT HISTORY AND SYSTEMS REVIEW The patient in this case report Was selected based on the mechanism of loW back injury considered as a WAMI on physical therapists. The patient Was a PTA in an acute care setting Who injured his loW back While conducting
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