YOGA for Healthy Lower Backs (YHLB) 12-Week Course

Evidence-based, Long-Term Self-Management, Mind/Body Back-Care Programme

INFORMATION FOR GPs and Health Professionals – UK

PLEASE SEE REVIEWS OF PREVIOUS PARTICIPANTS ATTACHED.

  • 12-Class research-led (EBM) course, taught in groups (12 maximum)
  • 12 x 1¼ hr classes taught once a week (with breaks for practising self-management)
  • Teaches:- pain-relieving poses (to pre-empt, or help with, acute phases); gradual strengthening and stretching movements designed to improve mobility, body posture , breathing and relaxation techniques for long-term self-care
  • Initial teacher telephone consultation; Registration process; Class 1 Assessment
  • Teacher available before and after class to give individual advice
  • Fully-resourced: EBM student manual , 4-track Relaxation CD, home practice sheets
  • Constitutes a comprehensive package of self-care:-
- 15+ hours of taught group (but person-centred) classes
- 52+ hours of supported self-management (home practice - 30 minutes daily, then
2 x weekly as a preventative once pain subsides)
- 2+ hours individual support (pre-, post-, inter-class)
- 3-4 months course duration, offers continuity of care (same teacher)
- 12+ months additional support during attendance at missed classes
- Lifetime of self-management with simple and effective yoga tool-kit
- Motivation to incorporate simple relaxation/ breathing/ mindfulness/ postural techniques into daily life; back-care education
- Encouragement to return to increased physical activity levels, e.g. getting back to the gym / sports / hobbies / return to workplace
  • Once only course (course attendees are guaranteed 12 classes, i.e. catch-up opportunities for missed classes, but would NOT need repeat ‘treatment doses’)

Where?:

  • At the purpose built Yoga Sanctuary, Sheffield Road, Rotherham S60 1DA
  • Tutor : Sharada Rao, a fully qualified British Wheel of Yoga and a Certified Iyengar Yoga Tutor. Trained YHLB qualified teacher (Yoga for Healthy Lower Backs ). Please visit www.yogasanctary.org for more detailed information.

Currently being offered at a reduced rate £200.00 + £65.50 YHLB RESOURCES PACK TO BE PURCHASED BEFORE COURSE STARTS. Please see below for details*.

*1. Before Course - For access onto the course, you will need to purchase your YHLB RESOURCES PACK before the course starts from our not-for-profit social enterprise www.yogaforbacks.co.uk website ‘Get Resources’ page (recommend you choose ‘Option PLUS CD’) https://www.yogaforbacks.co.uk/promotional-resources/ = £60 (plus £5.50 P&P) (Not keen or able to make purchases online? - Please talk to your YHLB teacher asap asking them to obtain this for you.) This Pack helps you long-term. Life-long tool kit.

Payment for this 12-week course that helps you to help yourself forever can be made in 2 instalments as under:

2. Class 1 - £100 = Teaching Fees payable directly to teacher

3. Class 7 - £100 = Teaching Fees payable directly to teacher

Actual YHLB Course Costs: with patient contribution can work out to be

  • Current costs = £300 pp
  • Private sector = £224-300 pp = bargain rates to get the programme to more people.
  • Course valued at £292 per person (Spine Journal 2012, NICE)
  • ?- Patient Contribution of £65.00 for resources and P&P charges of £5.50 = £65.50 to x ‘mind/body programme prescription’ charges / ‘commitment contract’

? - Funders pay £200 per patient covers:- Resources: book, CD, practice sheets, hand-outs, quality assurance, governance, Course Set-Up, Registration Process, initial telephone consultation, Venue Hire, Teaching Fees, Teacher Support, Outcome Measure Collation, Bookings, Course Set-Up

How to refer to YHLB? – (social enterprise)

  • Give patients YHLB Trifold leaflet and/or Course Attendee sheet
  • Find a Teacher on www.yogaforbacks.co.uk website ([email protected] for SW)
  • Perhaps speak about YHLB’s Simply Relax App (free via NHS GPs, CCG-commissioned) for reducing stress/ tension/ pain – http://h.bhealthy.mobi/simplyrelax
  • Ask patients to email teachers to get on Wait-List for a course
  • Ask CCG, Public Health, Council whether the course can be subsidized for some / all

Why?:

  • GPs and patients have confidence in its evidence-base
  • ‘De-medicalizes’ back pain treatments within Primary Care for improved outcomes
  • Back pain patients cost the NHS double the cost of non-back-pain patients!
  • Free up your time by helping these ‘heart-sink’ patients (75% of those attending GP surgery with low back pain will re-present within 12 months)
  • This model of providing care offers extremely good value, i.e. 15 hrs of fully-supervised exercise (YHLB) versus NHS physiotherapy / chiropractor package, where average = 4 x 20 minute sessions = Total 1hr 20mins? (AQP)
  • Once-off ‘early intervention’ (video), preventative, holistic course – compared to patients often requiring repeated referrals to physiotherapy/ chiropractors, etc.
  • Encourages long-term positive lifestyle and behavioural changes
  • Addresses other ‘biopsychosocial’ aspects that may be perpetuating, or linked to, back problems e.g. anxiety, stress, MSK issues, tension headaches.
  • Educational, interactive, active course (not a passive treatment); ‘patients’ become ‘students’; empower patients to improve physical and mental health
  • Gap in care pathway provision (worsening:- financial constraints; new NICE GLs = reduction in meds., treatments, Secondary Care investigations/ procedures)
  • NICE recommends group exercise, including yoga, as a ‘first step to managing low back pain’ (November 2016)
  • Case study average attendance of 9/12 classes = enjoyment, commitment
  • Very gentle, mindful movements and poses - likely to do lots of good
  • Prior investment = 11+ years research and development work; 500++ people’s passions and efforts; estimated £438,500++ financial investment (charity, Universities, yoga teachers, social enterprise, publisher, conferences, etc.)

Research Findings (University of York / Arthritis Research UK / Cornwall Study):

  • Offered a YHLB course, over 12 months, participants had average of 3.8 days off sick compared to control group’s 12.3 days = 70% reduction
  • Significant 30% improvement in general daily functioning (doubled in recent study)
  • Participants report 63% improvement in their ability to “control and cope with back pain on their own”
  • Cost-effective within NHS and dominant treatment for society and workplaces

In the Community alongside GP Care. Case Study Examples:

- Trained, regulated, nationally- accredited teachers of original randomised control trial intervention, available throughout UK (Registered with Yoga for Healthy Lower Backs Institute accredited with British Wheel of Yoga, Sport England’s yoga governing body)

- GP Surgery Patients NHS Pilots (2016-17) – Dr Anna Huette, GP Registrar as part of SW Deanery Leadership Scholarship NHS England Health Ed. programme and QIP (Penryn)

- ‘Social prescribing’ project (St. Austell)

- NHS Staff Scheme for Cornwall Primary Care Trust - Alison Trewhela, yoga researcher, University of Exeter Med. School specialist tutor, project lead and designer of YHLB

- NHS courses for patients from 6+ GP practices in Cornwall commissioner promise of inclusion in back pain care pathway redesign and MSK contract provision

- Rotherham – NHS Staff Scheme

- Norfolk and Kent – Councils; Kent – GP Surgery

- AHSN NENC and SWAHSN support

Who is it suitable for? (also see Patient Info sheet):

Patients with history of back pain, prepared to commit to programme

Holistic approach, i.e. also beneficial for those with emotional, mental factors contributing to their back pain (STartBack tool predictor)

People appreciate learning methods of “getting back in control of their back condition” (men especially, who like this empowering short course)

Those with injuries/ illnesses preventing more strenuous forms of exercise/ activity

People of all shapes and sizes, provided they can get up and down off the floor (perhaps with help of chair and wall)

Ideally patients will not attend Class 1 in an acute phase (usually appropriate later)

Designed for beginners to yoga (who may be very unfit and inflexible), but also suitable for those with prior yoga experience

Those who: want to help themselves for the present and also the future; who have tried multiple approaches without success

Comparative Average Costs and Benefits:

- One private physiotherapy or chiropractor consultation could cost £40 with some patients

having weekly sessions for months or years = £1000s

- 16 weekly NHS prescriptions (average time of YHLB course) = £134

- A cappucino @ £2.50 per day for 16 weeks = £280

- Council gym membership for 12 weeks = £100

- NHS CCG spend on AQP provision for back and neck pain in 2014-2015 = £2 million

N.B. excludes Secondary Care investigations, procedures, surgery.

- NHS AQP = physiotherapy/ manip. package (average of 4 sessions) = £126 pp

- Cost of rehabilitation programme (COPD - average cardiac BHF) = £307-£477 pp

- Cost of referral to Outpatient consultant or attendance at A&E = £114-£132 (gov.uk)

- Cost of 1700 patients with complex LTCs in one CCG = £36 million p.a. (Right Care) – YHLB

could help reduce e.g. inoperable chronic back pain, fibromyalgia, depression with MSK

- Back Pain Patients are twice as costly to the NHS as non-back pain patients. Annual NHS Cost for ‘back pain patients’ = £1076 compared to ‘non-back-pain patients’ = £516 pa (London School of Economics & Political Sciences studied 100,000+ NHS patients 2013).......

...Turning just 50 patients into non-back-pain patients could save £18,000 p.a. after payment of £200 pp cost to NHS for YHLB cost = good investment and happy patients.

Prior background investment YHLB represents:- 11+ yrs design, evaluation, post-research development; effort, work and passion of 500++ people (researchers, charity, publisher, national bodies, teachers); £438,500++ investment (£285,000 = charity funding plus estimated University of York pilot trial, paper editing, educational resource accessibility, teachers travelling and paying for training courses, CPD courses, presenting at conferences).

Case Studies and Health Professional Testimonials (more available)

“This course is unique...this is absolutely what I would do, if I had back pain...and it helped my frozen shoulder” Back Pain Specialist Physiotherapist, Pain Clinic

“No more A&E visits and meds for me – I have learnt how to prevent my muscle spasms”

“Very pleased to have avoided surgery and enjoying being happily back at work”

With Its Specificity and Quality-Assured Evidence-Base, YHLB is Not the Same As.....

- Going to the gym (limited supervision; not always appropriate)

- Going to exercise classes (REPS offer 4hr low back pain course! Could be too strenuous)

- Going to general yoga class (may not be appropriate)

- Going to a yoga therapy 1-1 (evidence shows improved outcomes in groups)

- Going to a physiotherapist (mainly addresses acute phase; unlikely to empower long-term)

- Going to osteopath / chiropractor (passive; physical; acute phase; short-term)

- Going for CBT (does not address the physical)

More information - Trifold Leaflets, Introducing YHLB to GP Practices/ Health Professionals document, Mission Statement (Research Refs., Case Studies), www.yogaforbacks.co.uk, [email protected]

RCGP Website Links:- Alison Trewhela’s 2016 Yoga for Healthy Lower Backs Presentation

plus Dr. A Huette’s Yoga GP Quality Improvement Pilot Project Powerpoints

http://www.rcgp.org.uk/learning/wales-and-south-west-england/tamar-faculty/cornwall-gp-cpd-meetings.aspx

YOGA for Healthy Lower Backs Programme Course Content

Patients become Students, i.e. they are educated, they study, they learn (140-page book)

Pain-relieving positions to pre-empt (deal with) acute phases (Pain-relieving pose ‘Menu’ sheet)

Pain perception – reality checks (and notice when body feels ‘good’)

Breathing techniques

Mindfulness

Mental focus

Relaxation (YHLB 4-track relaxations CD; Simply Relax app)

Antidote to stress and tension – yoga techniques

Culturing positive mental attitude

Confidence in back’s health (less fear; return to more normal ‘biopsychosocial’ function)

Self-reliance and self-care (with support of yoga programme)

Postural awareness and postural re-education

Stretching

Strengthening

Mobilising

Joint alignment

Yoga practice sequences for home practice (x 5)

Healthy movement patterns (during yoga and daily life)

How to stand, sit, walk and lie comfortably

A&P education re MSK back function

12 classes reinforce and consolidate learning over time for positive behavioural changes

“YES – You can do something to help yourself!”

12 Class Themes

Each of the 12 lesson plans thread a clear positive philosophical theme throughout the class for contemplation. Course attendees’ mental, emotional, social, psychological wellbeing is positively affected, thus allowing them to reduce their experience of pain.

1. Introduction to Yoga - Relaxation (sukha) – Soften and Pacify – “Let Go and Relax”

2. Steadiness of Body, Breath, Mind – (sthita/dharana) – “Steady and Still- Quiet Mind”

3. Posture + Symmetry (asana) – Comfortable, Confident and Efficient within Body – “How to Stand, Sit and Lie Comfortably”

4. Awareness – (svadhyaya/sarira prajna) self-observation – “You have a Body all the time, NOT just when it aches”

5. Mobility – movement (karmayoga) – health to the joints - “Get out the oil-can!”

6. Height, Space, Lift – Defy Gravity (rajas/akash) – “Lift Off and Grow Tall”

7. ‘Intelligence’ and Life – (prana prajna) Body wants to be Healthy and Comfortable – Potential for Health – The Soul wants to allow happiness to shine out – “Your Cells are Full of Life”

8. Stretch – Space for Joints – Healthy Muscles – Increased Circulation – Antidote to Stress (moksa)- “Don’t Turn into Tanned Leather – Stretch and Release”

9. Strengthen – Body, Mind and Belief in Yoga (sthira)– “Stronger in Body and Mind”

10. Added Benefits – (saucha/sarva) e.g. less anxious, enhanced immune function, fewer headaches, lower blood pressure – not Just Health for Low Back, but also organs and systems, e.g. endocrine, nervous, digestive, respiratory, excretory, cardio-vascular, senses – “Feeling ‘Wholistically’ Healthy”

11. Positivity – Notice Improvements, Acknowledge Path to Comfort and Health – (ananda) Joy - “Power of Intention”

12. Long-term – Reinforce Reasons Why we Continue to do Yoga (tapas/sadhana), e.g. facets joints need movement, muscles need to be used, tissues need to know they are needed, circulation is aided by movement and muscle use, discs need movement and horizontal rest for health, when the mind is at ease so is the body, possible to slip gracefully and effortlessly into mature age without disability – yogis are the example e.g. B.K.S.Iyengar – Opportunities for Further Yoga Classes or How to Continue to Practice at Home - “Keep Up Your Yoga”

Compiled by YHLB Institute and YHLB Steering Group for Cornwall with support from SWAHSN. 2017

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