Yoga and Mental Stress

Yoga, originated in ancient India combines a lot of physical, spiritual, and mental practices. It has demonstrated the potential to provide mental health benefits by stilling and calming the mind. In recent times, it gained popularity due to its practitioners’ claims of its efficacy in stress reduction. Data from various studies have shown that yoga can successfully alleviate the symptoms of depression and anxiety. [1] Yoga’s benefits in terms of both mental and physical health can offer reduction in the sympathetic tone of the nervous system. [2] The benefits of yoga can lead to favorable immune and endocrine consequences. Heart failure patients have shown a significant reduction in IL-6 and CRP with the help of yoga. [3] IL-6 and CRP refers to the inflammatory markers in the body. On the other hand, minimal reductions were visible in heart failure patients who only received conventional medical treatment. Studies have also shown that yoga has the potential to lower heart rate, body mass index, and blood pressure. [4] This article discusses the positive effects of yoga on mental stress and physical inflammation. Further, case studies are mentioned with evidence regarding how yoga can provide positive results. This article also has a holistic approach towards pain relief with the help of yoga.

What Is Stress?

When your mind perceives a major challenge or threat, it leads to the surge of different hormones and chemicals in the body. [5] Stress can trigger a biological response in the body. The brain floods your body with adrenaline and cortisol as a normal biological reaction to the stressor. [6] The fight-or-flight response gets activated in the body as soon as it can detect stress. This response revolves around fighting the stressor or running away from it. After the occurrence of the response, the body begins to relax. When the body is exposed to excessive stress constantly, it can have long-term negative consequences on health. [7] Stress isn’t necessarily a bad thing all the time as long as it’s temporary. After passing the fight-or-flight response, the heart rate should slow down. [8] Breathing should become normal, and muscles become relaxed. The body needs to return to its natural state without any long-lasting negative consequences. Severe, prolonged, or frequent stress can cause mental as well as physical damage. In 2020, around 190 million people experienced one or the other symptoms of stress. [9]

What Are The Different Symptoms Of Stress?

Some of the physical symptoms of stress are pains/aches, exhaustion, sleeping trouble, shaking, dizziness, high blood pressure, jaw clenching or muscle tension, weakened immune system, digestive issues. [10] The mental symptoms of stress are anxiety, irritability, sadness, panic attacks, depression. [11] People with chronic stress often resort to unhealthy behaviors like overeating, smoking, substance abuse, excessive alcohol consumption, gambling, or participating in internet browsing, shopping, or sex compulsively. [12]

What Are The Different Stress Hormones?

When the brain senses danger, the hypothalamus begins reacting. The hypothalamus sends hormone and nerve signals to the adrenal glands in the body. The adrenal glands begin producing several hormones to deal with the stress that the body is feeling. [5] The hormones command to face danger and elevate the probability of survival. Adrenaline or epinephrine is one such hormone that triggers the fight-or-flight response. An adrenaline rush in the body can lead to increased heartbeat, breathing rate. It helps the muscles to use glucose properly, contracts of the blood vessels, stimulation of perspiration and inhibits insulin production. [13] An adrenaline rush is beneficial for dealing with stressors, but if adrenaline surges frequently, it can damage blood vessels, can cause a high risk of stroke and heart attack or anxiety. Further, cortisol is the primary stress hormone that gets triggered in the body to deal with stressors. [14] The different functions of cortisol are increasing the amount of glucose in the blood, helping the brain to use glucose, tissue repair, restraining non-essential functions in a dangerous situation, maintaining the immune system, dampening the growth process and the reproductive system. The different functions performed by the cortisol hormone is normal for survival, but prolonged periods of cortisol levels in the body can lead to high blood pressure, weight gain, sleeping issues, type 2 diabetes, osteoporosis, brain fog, and other memory issues, a weak immune system more vulnerable to infections, and negative impact on a person’s mood. [15]

Types Of Stress

The different types of stress are acute, episodic acute, and chronic stress.

1. Acute stress: It happens to every person as it is the body’s natural reaction to deal with a challenging situation. This can be described as the stress that you feel after narrowly escaping an accident on the road. Acute stress can be something that is enjoyed by individuals. [16] It might be frightening, but at the same time, acute stress seems thrilling. Acute stress usually doesn’t cause any harm. It prepares the mind to develop more effective responses to difficult, stressful situations in the future. The body returns to its natural state when the stressful situation passes. But severe acute stress can be harmful. It can cause post-traumatic stress disorder and other mental health issues.
2. Episodic acute stress: It occurs when you experience episodes of acute stress frequently. It occurs when you are worried or anxious while suspecting something might happen. It might make you feel that your life is chaotic and crisis keeps coming into your life one after the other. Working in law enforcement or as a firefighter often triggers episodic acute stress in people. Episodic acute stress can ruin your mental well-being as well as physical health. [17]
3. Chronic stress: Having high levels of stress for prolonged periods can lead to chronic stress. It causes a severe negative impact on your mental as well as physical health. Chronic stress can cause cardiovascular diseases, weakened immune system, and high blood pressure. Chronic stress is also responsible for causing depression and anxiety in individuals. It can also lead to headaches, sleeping issues, and an upset stomach. [18]

Relationship Between Stress And Anxiety

People with high levels of stress often suffer from anxiety. Anxiety causes high levels of uneasiness, fear, and worries in individuals. When a person has both anxiety and stress, it can cause serious negative consequences on their health. They become more likely to develop different diseases such as heart disease, high blood pressure, diabetes, panic disorder, diabetes, and depression. Yoga has a positive impact on curing stress as well as anxiety induced by it.

How Can Yoga Help In Relieving Stress?

Practicing yoga can help in stimulating physical and mental reactions, which reduces anxiety and stress. The different postures involved in yoga can help in promoting flexibility, relieving tension, and releasing physical blockages such as muscle knots. It aids in the healthy release of tension and emotions. It also helps in releasing hormones like endorphins for boosting the mood of individuals. The feel-good hormone positively impacts how stress can be handled by the mind and body. It helps in the cultivation of feelings like serenity, joy, and love.

Scientific studies are reported to support the stress-relieving capacity of yoga. In a 2018 study, women were made to practice Hatha yoga thrice a week for four weeks. The results of the study after 12 sessions have shown considerable reductions in the stress, depression, and anxiety of the women. [1] The findings show that yoga can be complementary support alongside conventional treatment. It can also reduce the need for prescription drugs to a certain extent with long-term benefits on the treatment of stress, anxiety, and depression. [14] Another study was conducted in 2020 to find out the effect of yoga poses on stress hormones. The adult men involved in the study have shown that yoga stretches can reduce cortisol levels in the body. [2] The concentration of salivary cortisol decreased while the ratio of cortisol and testosterone increased. Yoga stretching for 90 minutes led to a significant improvement in the parasympathetic activities of the nervous system. The low-intensity exercises involved with yoga stretching can provide relaxation to the mind and body. It can be used for recovery after an athlete’s conditioning or high-intensity exercises. A recently reported study in 2020, yoga Nidra meditation helped in lowering stress levels. People selected for the study had busy schedules and could find out only a short duration for a yoga break. The meditation was offered in an audio file, and it was only played for 30 minutes for 30 days. After the end of 30 days, the men selected in the study showed reductions in stress levels. The men also showed signs of better sleep, mindfulness, and overall improved health. [19] Meditation involved with yoga can help in relaxing patients and helps them get rid of anxious thoughts. It leads to the expansion of alpha waves in the mind that can send the brain to a deep state of relaxation.

Breathing exercises or pranayama can also help in reducing stress levels in individuals. Pranayama calms the nervous system and improve the stress response of the body. In 2013, the study showed how pranayama could reduce stress and anxiety associated with taking a test. As part of the study, 107 MA students were made to practice pranayama for an entire semester. Only 33% of the students suffered from high test anxiety, while the others showed significant reductions in their stress levels. [20] Therefore, pranayama can be used as a technique to reduce stress and anxiety before a test and obtain better test results. The increased uptake of oxygen during pranayama is linked to lowering stress and anxiety levels. Some of the common types of pranayama are Nadi shodhana or alternate nostril breathing, kapalabhati or breath of fire, ujjayi breathing, simhasana, or lion’s breath, bhramari or humming bee breath, and sitali breath.

Yoga Poses To Relieve Stress

Some of the popular yoga poses that can help in relieving stress are as follows:

• Cat-Cow pose (Marjaryasana to Bitilasana): It allows you to connect your breathing to the movements. The pose helps in calming your mind and releasing stress. You should allow your breath to guide every movement of yours.
• Child’s pose (Balasana): This pose can help in creating an inward focus for restoring energy. It also aids physical as well as mental relaxation. You can place a cushion under the forehead, thighs, or torso to get more support.
• Legs-up-the-wall poses (Viparita Karani): It is a yoga pose that can provide deep relaxation. It also boosts lymph circulation and flows.
• Corpse pose (Savasana): This pose can help in calming your mind by letting go of tension. You need to focus on taking deep breaths while doing this pose.

What Is Inflammation?

The body activates the immune system when it encounters offending agents like toxic chemicals, bacteria, or viruses or suffers from an injury. The immune system sends out cytokines and inflammatory cells as its first responders. Cytokines are substances that can help in producing more inflammatory cells. [21] The inflammatory cells begin a response to trap the offending agents or to begin healing the injured tissues. It might result in pain, bruising, redness or swelling and also affects body systems that cannot be seen.

What Are The Various Types Of Inflammation?

The different types of inflammation are acute and chronic.

• Acute inflammation: It occurs as a response to sudden damages in your body, such as cutting your finger. The body sends inflammatory cells to the injury. The cells are responsible for beginning the process of healing.
• Chronic inflammation: The body keeps sending immune cells even when there’s no outside danger. In the case of rheumatoid arthritis, inflammatory cells attack the tissues in the joints. It leads to severe inflammation in the joints that can come and go and cause pain and deformities.

What Are The Symptoms Of Inflammation?

The different symptoms of acute inflammation are swelling, tenderness or pain, heat, flushed skin at the site of the injury, bruising, loss of movement, redness, and stiffness.

In some cases, acute inflammation remains localized to a few particular areas. But sometimes, acute inflammation might be systemic, like a viral infection. White blood cells in the body trigger inflammatory chemicals that can initiate an immune response. [22] The body starts putting all its energy towards fighting infection. Therefore, this type of acute inflammation leads to exhaustion and sickness. Some of the signs indicating this type of acute inflammation are fever, lethargy, nausea, irritability, sleepiness, sore throat, stuffy nose, runny nose, and headache. The symptoms of this type of acute inflammation can stay for a week or longer. Sometimes acute inflammation becomes more localized and causes conditions like the following:

• Acute bronchitis: It refers to the inflammation of the airways in the lungs. [23]
• Tonsillitis: It occurs when any bacteria or virus enters the nose or mouth, and the tonsils trap it. As a result, the immune system attacks the invaders causing an inflammatory response.
• Acute appendicitis: It is a condition that causes inflammation of the appendix.
• Sinusitis: It occurs due to the blockage or inflammation of the sinuses or cavities in the skull lined with tissues.

The signs of chronic inflammation are more difficult to notice. Some of the common symptoms of chronic inflammation are chest pain, abdominal pain, fever, fatigue, stiffness or pain in the joints, skin rash, mouth sores, high blood pressure, kidney disease, high cholesterol, depression, different types of cancer, osteoporosis, autoimmune disorders and neurodegenerative disorders such as Parkinson, Alzheimer’s disease. [24] Chronic inflammation can worsen quietly with only a few independent symptoms. Chronic inflammation might be subtle, but it can be a major threat to the health of individuals. [25]

What Are Some Of The Common Causes Of Inflammation?

• Autoimmune disorders: In the case of autoimmune disorders like lupus, the body begins attacking healthy tissues.
• Toxins: Exposure to industrial chemicals, pollution, and other toxins can lead to inflammation.
• Acute inflammation: Untreated acute inflammation from an injury or infection can lead to chronic inflammation.

Several lifestyle factors can also increase the risk of inflammation in the body. The factors that can increase the risk of developing chronic inflammation are as follows:

• Alcohol: Excessive alcohol consumption can often trigger chronic inflammation.
• Obesity: High body mass index that falls under the category of obesity can lead to chronic inflammation. Fat tissue is responsible for producing pro-inflammatory chemicals.
• Physical activity or inactivity: High-intensity exercises for a prolonged period as well as lack of physical activity can cause chronic inflammation.
• Chronic stress: Psychological stress is often linked to inflammation in individuals.
• Smoking: Smoking reduces the number of anti-inflammatory molecules in the body and triggers inflammation.
• Diet: Diets with high amounts of trans fat, saturated fat, and refined sugar can lead to inflammation, especially in overweight people.
• Low sex hormone: Sex hormones such as testosterone and estrogen are responsible for suppressing inflammation. In advanced, lower levels of these sex hormones are often noticed. As a result, the risk of inflammatory disease can increase.
• Age: Chronic inflammation is often found to worsen with increasing age.
• Sleep disorders: People with improper sleeping schedules have more inflammatory markers in their bodies than people who sleep for eight hours at night daily.

Inflammation And Obesity

Obesity is a type of low-grade inflammation that can lead to a chronic disorder when left untreated. Several inflammatory mediators can be released by the adipose tissue. Obesity-related inflammation is associated with the release of adipocytokines from the adipose tissue. It can predispose to a chronic inflammatory state leading to the culmination of metabolic dysregulations. This can be treated with the help of yoga practice. [26]

How Can Yoga Reduce Inflammation?

Many chronic conditions such as heart diseases, cancer, and rheumatoid arthritis can be linked to chronic inflammatory processes. Studies have been conducted to prove yoga’s relationship with inflammation. [27] Yoga has a significant impact on the levels of inflammatory biomarkers in patients with disorders related to chronic inflammation. [28] The different benefits of regular yoga in reducing inflammation are as follows:

• Reduces the level of stress hormones in the body that trigger inflammation
• Reduces the levels of pro-inflammatory molecules in the body
• Lowers the level of cytokines in the body that can trigger inflammatory pain
• It prevents inflammation that can kill cancerous cells in people with inflammation

Hatha yoga is the most popular type of yoga used for treating inflammation. The primary component of the yoga interventions was postures. But in some studies, postures were also combined with breathing and meditation. Some studies also included additional yoga practices like “om” chanting with postures, breathing, and meditation. On the other hand, yoga combined with nutritional counseling has also shown a positive impact on inflammation.

Yoga’s effects on patients with cancer are quite evident. A study has observed patients with breast cancer at varying stages. [29] Patients with colorectal cancer while undergoing chemotherapy treatment were also studied. The patients found favorable outcomes on inflammatory biomarkers after the yoga intervention. [30] The outcomes of the study were in no way linked to the varying stages of the disease. Yoga can show a reduction in the levels of IL-1B and IL-6 that primarily cause inflammation in cancer patients. [31] The amount of cortisol produced in the body is also reduced. Therefore, the cancer patients did not experience inflammation due to stress. Yoga can also increase the levels of anti-inflammatory factors and increase the levels of pro-inflammatory factors in cancer patients. The increased levels of glucocorticoid receptors, which is an anti-inflammatory factor, also signify positive results.

Studies have also reported inflammatory biomarkers associated with cardiovascular diseases. Yoga can reduce the production of inflammatory cytokines, high-sensitivity CRP, and IL-6. Increased levels of extracellular superoxide dismutase can be found in the body of individuals who practice yoga. It is an antioxidant enzyme that can protect the cardiovascular system and reduce inflammation associated with heart diseases. [32] Studies have also included people who have inflammation due to prolonged stress. In a study, industrial workers from a factory in India were included. The workers are exposed to various pollutants and occupational hazards at their workplace. A significant reduction in the inflammatory biomarkers like hs-CRP and IL-6 could be noticed after yoga interventions. Yoga also helped in the increase of the anti-inflammatory cytokine IL-10. Another study observed menopausal women with inflammation from psychological stress. The women have shown a reduction in serum cortisol levels of the yoga intervention group. One of the studies has concentrated on the inflammatory biomarkers in patients with rheumatoid arthritis. The participants in the study attended six weekly yoga sessions of ninety minutes. The participants had shown a significant reduction in the CRP levels. Lymphocyte count is also reduced with pain in the inflamed joints. A mixed study of participants with various conditions like hypertension, diabetes, bronchial asthma was conducted. Yoga triggered the reduction of IL-6, plasma cortisol levels, and increased endomorphin to help in getting rid of inflammation.

Yoga Postures That Can Reduce Inflammation

• Balasana or Child’s Pose: It is a restorative and mild inversion pose that enables your head to drop down below the hips. It stretches the hips, ankles, and back for relieving stress. Therefore, inflammation caused due to stress can be alleviated with this yoga posture.
• Supine Twist: It is a posture to wring out pain and negativity from the body. The posture helps in massaging the organs gently and improves blood flow. The gentle twist helps in increasing flexibility of the spine and alleviates chronic inflammation. The pose is perfect for improving your digestive health. Pain and inflammation in the lower back can be significantly reduced by this posture. The yoga pose can also help in getting rid of shoulder tightness. People with inflammatory pain due to desk jobs can benefit a lot from this pose.
• Ardha Matsyaendrasana or Half Lord of the Fishes pose: This yoga pose involves a deeper twist that can rescue chronic inflammation. It helps in cleansing your organs and detoxifying your digestive system.
• Virabhadrasana or Warrior pose: This pose can help in relieving muscle pain and improving respiration and circulation. When your respiration and circulation are improved, the body becomes well-equipped for dealing with stress and inflammation related to it.
• Trikonasana or Triangle pose: The pose helps in developing flexibility in the body. It also ensures that your legs and core get toned. This yoga posture can reduce stress and inflammation.
• Setu Bandhasana or Bridge Pose: It involves a gentle stretch to the chest, spine, hips, and neck. The pose can help in relieving chronic inflammation and improving blood circulation. The pose is also beneficial in alleviating mild depression and anxiety. It is a yoga posture that can create positive energy within the body.
• Twisted figure pose: It is a restorative pose that helps in soothing the nervous system and enables healing of the entire body. It can be one of your go-to poses for preventing inflammation. The pose can promote relaxation and calmness in the mind and body.

Holistic Pain Relief From Yoga

Yoga can be used as a treatment option for different types of pains and aches. It helps improve the daily function of people who face daily chronic pain due to several physical conditions. The benefits of yoga in pain relief are often linked to the fact that it connects the mind and body. Some specific poses that can help in relieving joint pain of the following types chronic back, shoulder, knee, and hip pain.

How Can Yoga Help With Overall Pain Management?

Yoga can help with overall pain management with the help of the following methods:

• Reduced inflammation: Inflammation in the body often leads to pains and aches. People with chronic inflammation in a muscle will experience severe pain in the muscle. Inflammatory pain can also occur due to autoimmune diseases. Yoga can aid pain management by reducing or getting rid of inflammation. In 2015, the study has reported how yoga can help in reducing inflammation and pain associated with it. [33] Practicing yoga for an hour every day can significantly reduce the level of inflammation in the body.
• Changes in perception of pain: Chronic pain can impact the brain to some extent and even alter the brain structure. The alteration to the brain structure caused by pain is linked to anxiety and depression. It also hampers the normal cognitive functioning of the brain. But yoga can produce an opposite effect and enables the brain to perceive less pain.
• Increased flexibility: A lack of flexibility can often cause pain in various muscle groups. Improving range of motion and flexibility can help in reducing pain. Flexibility can alleviate back pain to a great extent. Basic stretching can also be used to treat soreness in the muscles. Yoga is not all about stretching, but it incorporates a lot of stretching movements. Practicing yoga for two to three hours a week can help in improving flexibility and reducing overall pain.
• Helps with the prevention of an injury: Sustaining injury has a direct impact on pain. Injury can trigger pain and cause discomfort and soreness. Injuries also trigger pre-existing problems in the body and cause pain. Therefore, avoiding injuries can help in minimizing pain. Since yoga can improve flexibility, it can restrict you from falling on many occasions. Yoga poses can help in improving balance which will prevent you from falling. When you integrate yoga into your daily routine, you reduce the risk of falls and accidents. As a result, you will be able to avoid future pain. Even after sustaining an injury, yoga can help you recover. You need to keep moving while being gentle with yourself.

Different Types Of Yoga For Relieving Pain

You can practice a few types of yoga to relieve or alleviate pain. You should stick to one of these types of yoga if you are practicing it while being injured or experiencing pain. These types of yoga will ensure that you don’t stress yourself too much and worsen the pain. The different types of yoga are discussed below:

• Hatha Yoga: It involves the mind and body by combining breathing, postures, and meditation. It has proved to be beneficial for people who suffer from back and neck pain. [34]
• Iyengar Yoga: It can be performed while a person is injured or in chronic pain. This type of yoga focuses on the alignment of the body in each pose.
• Yin Yoga: Faster yoga practices like power yoga or Ashtanga are the opposite of Yin yoga. It revolves around stretching the connective tissues present in the joints. Yin yoga helps in making the muscles longer and stronger. It is particularly beneficial for reducing joint pain as the stretching primarily takes place in the joint.
• Restorative Yoga: It is a meditative and passive form of yoga. Restorative yoga helps in focusing on breathing while releasing tension from the body. It is a type of yoga where you need to hold your positions for a longer period. You can hold your poses for five minutes to help your body sink in properly. This type of yoga often includes props such as blankets and blocks to adapt your movements.
• Meditative Yoga: Meditative yoga revolves around the least amount of movement. It is more about relaxing the mind rather than the body. Meditative yoga classes help to improve your mental health so that you can deal with the physical pain you are experiencing.

Yoga Poses That Can Help In Relieving Pain

Some yoga poses that can help in relieving pain are as follows:

• Extended triangle: It can help in relieving pain in the back, neck, and sciatica. It can also stretch the spine and groin, which helps in reducing additional pain.
• Sphinx pose: It is a posture that can help in alleviating pain in the buttocks and back.
• Twisted figure four: It can help in releasing discomfort in the thighs and lower back.
• Thread the needle: It is a great posture for relieving pain in the shoulders, neck, and back.
• Eagle pose: It can help in reducing pain in the shoulders and arms.
• Bridge Pose: It can help in relieving pain in the knees and back.

Wrapping Up

Yoga combines physical, spiritual, and mental practices to provide a lot of benefits, including reduction of stress and inflammation in the body. Stress occurs when the mind can perceive any sense of danger. As a result, the brain surges the body with hormones like adrenaline and cortisol. A fight-or-flight response gets activated in the body to deal with the stressor but the body should return to its normal state after the stressor gets resolved. Severe or prolonged stress can bring several negative consequences to a person’s physical and mental health. Yoga helps in dealing with stress by relieving tension and triggering mood-boosting hormones. [35,36]

Inflammation, acute or chronic, can cause several serious implications in the body. Yoga has the potential to trigger anti-inflammatory molecules and reduce the amount of pro-inflammatory elements. It can help in the increase of glucocorticoid receptors and reduce inflammation in cancer patients. A significant reduction in the inflammatory biomarkers like hs-CRP and IL-6 can help in reducing inflammation associated with stress. Ninety minutes of yoga sessions weekly can help in reducing inflammation and pain associated with rheumatoid arthritis. Yoga can also trigger the reduction of IL-6, plasma cortisol levels, and increase of endomorphin to help in getting rid of inflammation.

Yoga has the potential to provide holistic pain relief in patients. It can improve the daily activities of people who experience chronic pain due to various physical conditions. From back pain to hip pain, yoga can reduce various types of pain. It can help in reducing inflammation and pain associated with it. Yoga also changes the perception of pain by the mind. [37] It can also improve flexibility and help in relieving back pain in particular. Yoga can also provide you with a better balance that reduces the risk of falls and prevents injuries. Hatha yoga, Iyengar yoga, and other types of yoga are essential for pain relief in the body. Enroll yourself in a yoga class today and begin enjoying the different benefits.

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Erectile Dysfunction and Female Sexual Dysfunction

In today’s world, Erectile Dysfunction is one of the most common dysfunctions affecting men’s sexual health [1]. Erectile dysfunction is a condition in which certain physiological and psychological factors prevent an individual from achieving or maintaining an erection [2]. This is directly correlated with reduced to non-existent sexual satisfaction leading to an overall reduced quality of life.

In 2018, a study was conducted to examine the relationship between physical activity and erectile dysfunction which discovered that erectile dysfunction affects about one third of all men [3].  Further studies conducted in 2019 confirm this by noting that the global prevalence of erectile dysfunction was between 3-76.5% and that about 140 million men are affected by this sexual dysfunction [4].

Although ED is generally regarded as a dysfunction associated with age, studies show that this condition affects men of all ages; however, the prevalence of erectile dysfunction does increase with age.  The Massachusetts Male Aging Study conducted in 1994 found that 52% of men had experienced some form of Erectile dysfunction in their lifetime [5]. About 5-15% of the men who had experienced it were between the ages of 40-70.

Although the possibility of ED increases with age, research published in the Journal of Sexual Medicine in 2013 concluded that 1 in every four patients with erectile dysfunction is a young man, which amounted to 26% at the end of the study.  In the International Index of Erectile Function, it was observed that severe ED rates were about 48.8% in younger men and 40% in older men [6].

Erectile dysfunction could result in low self-esteem, depression, and poor sexual performance, which could impose on the relationship between a man and his partner [7,8]. It is important to note that a man’s inability to get or keep an erection occasionally, may not be a sign of erectile dysfunction unless its occurrence is frequent and prolonged.  A man said to have ED must be exhibiting the following symptoms [9].

• Inability to get an erection when engaging in sexual activity.
• Inability to keep an erection long enough to have satisfactory sexual activity.
• Low sexual desire.

Several factors can be responsible for causing erectile dysfunction in men.  These causes could range from problems affecting the vascular system, endocrine system, and nervous system [10]. Furthermore, these causes could result from diseases such as

• Heart and blood vessel disease
• Type 2 diabetes
• High blood pressure
• Chronic kidney disease
• Multiple sclerosis
• Atherosclerosis and;
• Peyronie’s disease

Physical causes of erectile dysfunction in men are outlined below [11].

• Inadequate blood flow to the penis: Health issues such as hardened arteries and smoking can reduce the chances of blood flowing to the penis.
• Inability to keep blood in the penis: There is an increase in blood flow to the penis during the occurrence of sexual activity. Where blood cannot remain in the penis for the duration of sexual intercourse, erection cannot be maintained.
• Cancer treatments: Surgeries for cancers such as bladder, colon, and prostate cancer can cause erectile dysfunction in men. Furthermore, injuries that occur during treatments such as radiation therapy could result in ED.
• Negative impact of drugs: Certain drugs used for the treatment of health problems can have negative side effects, which in turn affect the ability of a man to get and maintain an erection.
• The penis does not receive nerve signals from the brain or spinal cord: Certain injuries, diseases such as Parkinson’s disease, and surgery can have adverse effects on the nerves connected to the penis and prevent it from receiving nerve signals transmitted from the brain or spinal cord. This occurrence often results in erectile dysfunction in men.  Moreover, altering testosterone levels and thyroid function, which could affect sex drive, might be an indirect cause of ED [12].

Further, emotional factor can also cause or worsen erectile dysfunction.  These emotional factors could be:

• Anxiety
• Relationship problems
• Depression
• Stress from work, family, and cultural conflicts
• Worry about sexual performance
• Lack of self-confidence

Discovering the cause of ED is essential towards finding solutions and treatment options.  To have a proper diagnosis, the patient must provide an accurate account of his history of ED if any, and the health care practitioner involved should consider any social, religious, cultural, and personal factors that could be the main source of the problem [13].

Questions to be asked to the patient should be unambiguous, with the aim being to ascertain facts. The health practitioner involved should also seek clarity on cardiovascular, endocrinological, and neurological factors that could be responsible for erectile dysfunction.  Questionnaires such as the International Index of Erectile Function (IIEF) contain relevant questions to be asked in order to determine the issue, and measure the improvement of the patient’s condition over a period of time [14].

For physical examinations, the clinician is required to perform the general examination required as well as some blood investigations depending on what has been discovered through the general examinations.

Contemporary and Alternative Medicine for Erectile Dysfunction

The available treatment for ED in men has changed considerably over the years as more studies have been conducted along with the advancements in science and technology.  There are several licensed drugs available for the treatment of ED, and they are available in 3 forms:

First Line(Oral) Therapies

The oral drugs available for the treatment of erectile dysfunction are sildenafil (Viagra), phosphodiesterase 5 inhibitors (PDE), verdanafil, tadalafil, apomorphine, and yohimbine.  Oral therapies are essential in the treatment of ED due to their non-invasive nature. The use of these injections result in no urethral or penile pain, and patients can take it discretely but must ensure they follow the recommended dosage or prescription for any visible results [10].

Sildenafil is perhaps the most well-received among the oral agents as 84% of the men who participated in the studies showed positive response whereas about less than 3% of men discontinued use of it [15].  Although most oral therapies are licensed, Yohimbine is only drug available on prescription [16].

Second Line Treatments (Injectable and Intraurethral)

Injectable and Intraurethral treatments are only considered in the treatment of erectile dysfunction after oral therapies have been tried and rejected.  These second-line treatments are primarily used by patients whose ED is rooted in organic factors.  These treatments are put into consideration after the use of oral treatments as patients are required to use them with extreme care and would need proper instruction on how to introduce the drugs into their system.  Improper application of second line treatments could result in fibrosis and penile pain [11][17].

The second-line treatments available for the ED are moxisylyte, papaverine, phentolamine, and alprostadil. Patients are expected to be monitored when receiving their initial doses to reduce the risk of a hypotensive episode, which would require medical attention.

Third Line Therapies

The third line therapies are vacuum constriction devices or rings placed over the penis.  Once the device or ring has been placed, a vacuum is created manually or with the use of a battery-powered motor.  This third-line therapy is used by men who can achieve an erection but cannot maintain one for satisfactory sexual experience.  It is also utilized by men who cannot take oral therapies and want to avoid the use of second-line therapies [18].  However, the use of vacuum constriction devices must be avoided by men with leukaemia, sickle cell disease, and those under anticoagulation therapy to prevent further complications [10].

What is Female Sexual Dysfunction?

Female sexual dysfunction (FSD) is a condition resulting from certain physiological or psychological factors that prevents a woman from having sexual satisfaction [19,20]. The Second International Consensus of Sexual Medicine further defines female sexual dysfunction to be ‘lifelong (primary) or acquired (secondary) and as situational (occurs in all situations and with all partners) [21].  It is defined by the World Health Organization as ‘the various ways in which a woman is unable to participate in a sexual relationship as she would wish.’ In 1992, the National Health and Social Life Survey noted that about 43% of women had sexual complaints [22]. An international survey conducted in 2004 with women around the ages of 40-80 found that about 39% of women who were sexually active had problems that affected their sexual experience.

The 4th edition of the Diagnostic and Statistical Manual of Mental Disorders released in 2000, classified female sexual dysfunction into four categories:

• Sexual arousal disorder: The woman experiences difficulty in getting or remaining aroused during sexual intercourse, even though she has a desire for sex.
• Sexual desire disorder: This involves a lack of interest in sexual activity or the willingness to engage in it.
• Orgasmic disorder: Recurring difficulty in having an orgasm despite sufficient stimulation and sexual arousal.
• Sexual pain disorder: Pain during sexual intercourse or stimulation.

FSD becomes more prevalent in women as they age and is generally associated with symptoms such as pain and discomfort during sexual intercourse, vaginal dryness, and low sex drive or arousal [23].  Furthermore, there are several factors that could result in sexual dysfunction in women.  Physical causes include:

• Certain drugs: Chemotherapy and other forms of cancer treatment, selective serotonin uptake inhibitors (SSRIs), and drugs such as antidepressants can have an effect on a woman’s sexual drive and ability to achieve an orgasm during sexual activity. These drugs cause hormonal levels to change when used, leading to such problems.
• Vascular disorders: Like the penis, the vagina, labia, and clitoris require increased blood flow to remain sexually aroused. Inadequate blood flow to the reproductive system can result in unsatisfactory sexual activity.
• Health conditions: Conditions such as diabetes, multiple sclerosis, arthritis, alcohol abuse, and drug addiction can affect the sexual experience of a woman. Other health conditions like vaginismus, endometriosis, ovarian cysts, vaginitis, uterine fibroids make intercourse painful and uncomfortable.
• Hormonal changes: Vaginal dryness or atrophy, which results in a painful sexual experience, may be caused by hormonal imbalances. Menopause, surgery, and pregnancy can also lead to hormonal imbalance.

Psychological factors have a role to play in female sexual dysfunction [24].  These factors include:

• Stress: Stress from work and home can make a woman unable to have an enjoyable sexual experience. Experiencing high levels of stress increases hormone cortisol levels which in turn reduces sex drive.
• Trauma: Past trauma could lead to lack of sexual satisfaction due to the fear of intimacy and anxiety that arise from it.
• Depression: Depression indicates a lack of interest in the things you do and your environment in general. This could also translate to a lack of interest in sexual intercourse.
• Relationship troubles: Women in unhappy relationships may experience sexual dysfunction due to the stress of those relationships.

When diagnosing sexual dysfunction in women, the physician or healthcare provider should ensure that the patient provides complete and accurate information on his history of sexual dysfunction [19].  The questions asked should be unambiguous and focus on establishing the physical or psychological factors that could be related to sexual dysfunction [25]. Questions related to family, sexuality, past sexual trauma or abuse, and the status of current relationships should be considered to narrow the cause of sexual dysfunction.  The Brief Sexual Symptom Checklist is a tool employed by health care professionals to ensure that they have comprehensive knowledge of their patient’s sexual history as it contains basic questions to determine the patient’s past sexual experiences [26].

A physical examination, including a pelvic examination and pap smear, should be conducted to ensure that no abnormality is present.  Abnormal findings during physical examinations are more likely to be prevalent in older women, women who do not receive medical care, and women with chronic system disease [27].

Contemporary and Alternative Medicine for Female Sexual Dysfunction

Treatment for female sexual dysfunction is currently understudied and there is not much available for women who suffer from this condition, unlike the availability of different forms of treatment for men [28].  The available treatments are: [29]

• Counselling: Women suffering from this condition can seek assistance from a health professional. Together, they can overcome emotional barriers that prevent her from having a satisfactory sexual experience.  She can engage in this counselling with her partner or go alone.
• Arousal techniques: Such patient is advised to consider various arousal techniques to increase her interest in sexual activity. This could be by making changes to your routine or incorporating some sexual materials to help with arousal.
• Medication: Premenopausal women with low sex drive, can use drugs such as Flibanserin and Bremelanotide to improve their sex drive.
• Pain management techniques: Using lubricants and trying different positions and sexual approaches could help relieve pain during sexual intercourse.

How does Yoga help with Erectile Dysfunction and Female Sexual Dysfunction?

Yoga is recognized as a form of alternative therapy and is adopted by people worldwide.  It combines physical postures called asanas with meditation and breathwork to improve health and well-being.  Yoga is practiced today as a form of relaxation and exercise and is considered an alternative treatment for pain disorders, depression, anxiety, posttraumatic stress disorder, and cancer recovery [30]. Regular yoga practice has been known to improve blood flow, aid flexibility and balance, strengthen the body, and help in the practice of mindfulness.

Practicing yoga has been established to have beneficial effects on a person’s health, but recent studies have shown that its benefits extend to a person’s sexual health.

In a study conducted in 2007, 65% of the men who participated in the study experienced a significant improvement in premature ejaculation after yoga workouts.  In another study conducted with women between the ages of 22 to 55 years, volunteers experienced a 30.38% improvement in all sexual functions after 12 weeks of yoga practice [31]. Older volunteers experienced an improvement in their arousal scores, while younger participants noticed an improvement in orgasmic quality.

In a third study conducted in 2010 with males between the ages of 24 to 60 years, it was found that there was an improvement in sexual desire, performance, intercourse, satisfaction, orgasm, erection,  and partner synchronization after 12 weeks of yoga sessions [32].

Performing yoga exercises over an extended period of time will help with erectile function by improving blood flow and cardiorespiratory fitness, as well as reducing stress.  In addition, regular yoga aids in developing a person’s confidence and overall health.

Female sexual dysfunction remains largely unexplored, it is gradually garnering the interest of health professionals and adequate research is being conducted to examine this condition, and that includes the use of yoga.  Although health professionals have not confirmed how yoga helps in improving sexual functions in females, it has shown impressive results that will be analyzed in further studies [31].

Yoga poses that can help with erectile dysfunction and female sexual dysfunction include:

1. Vajarasana
2. Kapalbhati
3. Yog mudra
4. Marjarasan
5. Pavanmukatasan
6. Viparita karani mudra
7. Matsyasana
8. Halasan
9. Ardhmatsyendra mudra
10. Paschimottoasana
11. Paravatasan
12. Bhujangasan
13. Shalabhasan
14. Naukasana
15. Bhushirasana
16. Dhanurasan
17. Hansasana
18. Chakarasan
19. Trikonasana
20. Uddiyana bandha/agnisara
21. Paranayama
22. Shava asana

These asanas are to be practiced over an extended period of time, and three repetitions of each asana are suggested [31]. Those who cannot perform the full versions of the asana can select the easier versions available to them.

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Managing Pain (LBP) with Yoga

What is lower back pain?

In our world, lower back pain is one of the most widespread musculoskeletal problems (Furlan, Clarke and Esmail), [1] which leads to substantial costs in health care. Musculoskeletal disorders are a heterogeneous class of disorders, which include degenerative disorders of osteoarthritis, inflammatory disorders like rheumatoid arthritis, and soft tissue disorders like lower back pain and fibromyalgia (Salaffi, De Angelis and Grassi). [2] Among these, lower back pain is one of the chief health issues affecting humans around the world (Andersson 1999) [3]

Lower back pain is described as the pain localized between the 12^th rib and the inferior gluteal folds, which is nonspecific in 90% of the cases (Furlan, Brosseau and Imamura). [4] Researchers have not completely comprehended the etiology of lower back pain, which is quite complicated. Many of the acute lower back pain issues are a consequence of injury in the muscles, joints, ligaments, or discs. The body responds to injury through mobilizing an inflammatory response related to healing, and this inflammation creates acute pain. Based on the origin of the pain, various symptoms can be observed during lower back pain such as:

• Dull or achy pain, contained in the lower back
• Burning, stinging pain that extends from the lower back to the backward part of the thighs, and occasionally, towards the lower legs or feet; this may involve tingling sensation or numbness
• Tightness and spasms in muscles and in the lower back, hips, and pelvis
• Pain that increases after sitting or standing for long periods of time
• Trouble in standing up erect, walking, or changing from a sitting to standing position

Common categories of back pain include mechanical pain (pain that arises mainly from the muscles, joints, and ligaments, or from bones that are located in and around the spine) and radicular pain (it occurs if a spinal nerve root becomes inflamed or impinged). Mechanical pain is localized towards the lower back, buttocks, and occasionally, the upper parts of the legs, while radicular pain might follow a nerve root pattern or dermatome downwards to the buttock and/or leg (Peloza). [5]

This condition that is extremely prevalent is a major burden on individuals and healthcare organizations (Shelerud 1998). [6] Approximately 60–85% of the world’s population is affected by lower back pain at least once in their lifetime, with 10–20% accounting for the people whose issues develop into a chronic problem (Skovron 1992)(Waddell 1998). [7] [8] In several nations such as Great Britain, Canada, Sweden, and The Netherlands, people are subject to disability from back pain, which is a major issue (Nachemson 1992). [9] Due to lower back pain, patients are limited in their day-to-day activities and might experience unsuitable neuromuscular adaptations for sustaining and/or carrying on different functions like walking, running, etc. (Hammil, Beazell and Hart 2008). [10] Clinical practice guidelines on the treatment of acute lower back pain were established and published by the US Department of Health and Human Services (currently referred to as the Agency for Healthcare Research and Quality) during the initial period of 1990s. These guidelines were categorized into three groups: 1) spinal disorders that are potentially critical, i.e., fractures, tumors, infections, and cauda equina syndrome), 2) sciatica or radiculopathy, and 3) symptoms related to back that are nonspecific. Sciatica means compression or irritation of the nerve root, while nonspecific symptoms related to back pain indicate the absence of a critical underlying spinal disorder or the involvement of nerve root. Nonspecific symptoms related to back and sciatica resolve without treatment in the majority of situations, i.e., patients can recover without needing medical care or nonsurgical therapy (Pradhan 2008). [11]

Complementary and alternative medicines (CAM) for back pain and other musculoskeletal issues/disorders

Mostly, the treatment of chronic musculoskeletal disorders is done through a biomedical model, which includes physical therapy or the prescriptive usage of pharmaceuticals (Koes, et al. 2001). [12] However, a system of therapies referred to as complementary and alternative medicine (CAM) therapies is widely used by patients with musculoskeletal conditions (P. Barnes, B. Bloom, R. Nahin). [13]

CAM represents a varied set of therapies, supplements, substances, methods, rituals, techniques, practices, systems etc., which are used by patients while making efforts to reduce health issues or for maintenance of health (Artus, P. Croft, M. Lewis). [14] Various kinds of CAM therapies include entire medical systems like homeopathy and naturopathy, practices founded on biology such as herbal products and dietary supplements, mind-body treatment such as prayer, meditation, and mental therapy, energy therapy such as therapeutic touch and Reiki, and medicine related to the body such as chiropractic care and massages (Gupta, et al. 2015). [15] The key motives behind the usage of these CAM therapies are reduction in pain and overcoming of functional limitations (Carlson and Krahn 2006), (Okoro, et al. 2012). [16] [17] Patients use these therapies either in addition to biomedical treatment or as a preferred choice of treatment (M. Eisenberg, R. C. Kessler, et al). [18] It is believed that 38% of American citizens resort to some kind of CAM therapy to deal with their chronic pain from musculoskeletal conditions.

The effects of CAM on different kinds of musculoskeletal issues have been outlined as follows:

• Lower back pain: It has been proved through studies that acupuncture, spinal manipulation, and massage might be advantageous for chronic low back pain. In 2007, the American College of Physicians/American Pain Society published guidelines for clinical practice that advocate the abovementioned practices along with five other non-pharmocologic techniques for people having back pain when no progress is observed after medication and personal care. The other techniques advocated in the guidelines were cognitive-behavioral therapy, progressive relaxation, exercise therapy, yoga, and rigorous interdisciplinary rehabilitation. Studies on other CAM approaches, such as numerous herbal medicines and prolotherapy, which are used occasionally by patients for chronic lower back pain, have also demonstrated evidence for validating their usage for this disorder.
• Arthritis: Acupuncture, herbal therapies, glucosamine/chondroitin, tai chi, and mineral baths are some of the CAM therapies that researchers have investigated for relieving pain in osteoarthritis. Some therapies among these have further been investigated for rheumatoid arthritis. On the whole, even though favorable findings have been obtained in certain research works related to CAM practices for arthritis, largely, the evidence is inadequate or inconclusive. In an organized review paper related to acupuncture for osteoarthritis, it has been demonstrated that minor improvements in pain and function might be obtained through acupuncture. Nevertheless, in a major clinical study called GAIT (Glucosamine/chondroitin Arthritis Intervention Trial), glucosamine and chondroitin sulfate, the commonly used dietary supplements, were not successful in considerably alleviating pain of knee osteoarthritis for all participants, either on using individually or in a combined form, even though the combination assisted a subgroup of patients exhibiting moderate-to-severe pain. Some reviews have detected evidence that γ-linolenic acid (derived from evening primrose and some other plant oils) might assuage pain related to rheumatoid arthritis, though more studies are required in this area. Moreover, it has been revealed from research that relief from osteoarthritis pain might be obtained from dietary supplements like devil’s claw and avocado-soybean unsaponifiables.
• Neck pain: Manual approaches (mainly mobilizing or manipulating) and acupuncture for chronic pain in neck have demonstrated conclusive evidence in research works with regards to possible advantages. A review has stated that clinical regulations usually advocate using manual approaches for neck pain, though no general consensus exists regarding the status of these approaches. [19]

A type of CAM that has become increasingly prevalent among patients suffering from musculoskeletal issues is yoga (P. Barnes, B. Bloom, R. Nahin, B. Saper, and D. M. Eisenberg, R. B. Davis, L. Culpepper, R. S. Phillips). [13, 20] Yoga consists of physical, breathing, and relaxation methods, and has been considered to offer musculoskeletal as well as psychosocial advantages, which are presently not granted by the prescriptive treatment of musculoskeletal disorders (Evans, J. C. Tsao, et al). [21]

As per the literature, studies have proved that in case of fibromyalgia and mild-to-moderate lower back pain, yogic techniques considerably improved functional outcomes in comparison with passive control interventions. Additionally, according to an early research work on the effect of yoga on osteoarthritis, an intervention based on Iyengar yoga for eight weeks improved finger range of motion in a yoga group in comparison with a regular care group.

Overall, evidence suggests that yoga is an acceptable and safe intervention, which may result in clinically relevant improvements in pain and functional outcomes associated with a range of musculoskeletal conditions. A future analysis of outcomes which take into account the amount of yoga received by participants may provide insight into any putative duration or dosage effects of yoga interventions for musculoskeletal conditions (L. Ward, et al). [22]

Considerations for yoga in patients with back pain

Fundamentally, yoga is still a method of physical movement, and like all other exercises, there is a possibility of injury, particularly involving the back. As stated by Dr. Lauren Elson, an instructor in physical medicine and rehabilitation at Harvard Medical School, the major issues often occur because people don’t adhere to appropriate guidelines while doing yoga, and they rapidly start doing yoga poses instead of gradually “lengthening” into them. This leads to a higher probability of injury.

In yoga, muscles should be used to initially form a firm basis for movement, and consequently, an appropriate form must be adhered to that gradually stretches and lengthens the body. For instance, one should avoid rotating as fast and far as possible while performing a seated spinal twist pose or ardha matsyendrasana, which is known to be extremely beneficial for lower back pain. Dr. Elson further explains “Instead, you should first activate your core muscles and feel as though the spine is lengthening. Then, twist slowly until you feel resistance, and hold for as long as it’s comfortable.”

Patients should definitely discuss with their doctor regarding whether they should commence yoga practice while suffering from lower back pain. As per Dr. Elson, yoga should be avoided while suffering from particular back issues like a spinal fracture or a herniated disc. After the patients obtain a doctor’s approval, they should inform the yoga instructor in advance regarding their specific pain and limitations, which can help in safeguarding their back from injuries. Consequently, the instructor can provide protective adjustments to particular poses or assist in guiding the patient while carrying out a pose to make sure that he/she performs it perfectly without applying stress on the back. An alternate choice is to find a yoga studio or community center that provides classes that are specially intended for alleviating back pain.

It should be noted that the bending, stretching, and twisting movements of yogic postures are regularly required by the lower back for improvement. As Dr. Elson states, “By mindfully practicing yoga, people can safely stretch and strengthen tight and aching back muscles.”

Tips/Techniques to protect the back while doing yoga

Patients should always take precautions while performing yoga for back pain. Some tips for protecting your back while doing yoga are included below.

• Twisting and extending simultaneously can compress intervertebral joints and should be avoided.
• Use props such as bolsters and blocks for extra support.
• If the person is not able to touch his/her toes while performing yoga, he/she can hold a yoga belt in his/her hands and loop it around his/her feet.
• Forward bends should be performed from a seated position and the stomach should be engaged as the body is lifted upright.
• Any move that provides discomfort should be eased or discontinued. [23]

Additionally, let’s discuss some do’s and don’ts of yogic practice for individuals with back pain:

• Don’tlose your normal lumbar curve. The back can be affected by slumping, or rounding the spine, due to working for lengthy periods in an office chair that leads to incorrect posture. While performing most yoga poses as well as all through the day, whether sitting or standing, conserving the natural inner curve in the lower back is necessary. The head’s back should be in line with the back of the pelvis, and the shoulders should be held broad and stacked right above the hips. A completely flat back is not recommended although the yoga instructor might indicate a “flat back (which is suggested to avert loss of the normal spinal curve by overarching or rounding the back),” The original curves of the spine, i.e., a slender inward curve of the lumbar spine (lower part of the back), a minor outward curve of the thoracic spine (middle/upper back), and a minor inward curve of the cervical spine (neck), are necessary for absorbing shock and for maintaining ideal health of the spine.
• Dopractice sitting and standing positions that are healthier for assistance in strengthening the back. Core support should be used during sitting or standing, with a minor lift of the lower abdominals and pelvic floor.
• Don’tlet the feet turn outwards while walking or standing. The feet being externally rotated is both an outcome and a source of shortening of the piriformis in case of several individuals. If this deep hip rotator becomes tight, the psoas (which extends from the lumbar spine till the uppermost part of the thigh) also tends to get tight, which may lead to low back pain.
• Domaintain the feet in a parallel position. When the toes incline towards turning out, the heels should be sufficiently moved outwards such that they are towards the back of the toes. In each foot, the second toes should be relatively parallel with each other, and the knees should be in line with the midpoint of the foot. This position should be maintained while sitting, standing, and walking.
• Don’tround up after a standing forward fold using straight legs. The discs of the anterior spine can be compressed through this act, which can increase the pain in the back.
• Do get up after a forward fold with slightly bent knees, and utilize core support while lifting the torso.
• Don’t neglect core strength. In case of yoga, greater emphasis is placed on stretch instead of strength. Stretching is significant in relieving tightness in back muscles, and postures that are linked to a perfect back stretch like marjaryasana, balasana, ananda bala, and supine twists provide a positive and pleasant feeling. However, these postures fail to contribute extensively to forming core strength, which is significant in case of health for the back. The support towards the front should be stable for strengthening the backward portion of a structure. Therefore, postures that involve strength of abdomen and back are necessary for back health. Strengthening of the muscles in the abdomen and back assists a more efficient alignment of the spine. These postures are recommended for practice in a yoga class that is focused on back health (B. Spindler). [24]

Some other tips for avoiding lower back pain:

• Care should be taken while sitting for long hours on the ground. Several times, this can lead to pressure on the lower back and hips.
• Bending forward in an aggressive manner initially in the morning is not recommended if the discs are swollen and susceptible to compression.
• Sitting cross-legged should be avoided for long hours. [25]

Efficacy of Yoga in Back Pain

Chronic pain distresses nearly 100 million individuals in the United States, resulting in $635 billion in annual costs, including specific medical costs and lost productivity (Simon 2). [26] Low back pain (LBP) affects 70% of the population at some point in their life, with recurrence rates as high as 85% (Hoy et al. 2028). [27] With such a high lifetime frequency, LBP is a likely source of various chronic symptoms. Chronic LBP can interfere with daily activities by limiting mobility, impairing work obligations, and severely influencing self-care, in addition to generating overall discomfort (Crown 114). [28] Despite the fact that many patients have surgeries to cure or repair patho-anatomy for LBP, many endure chronic symptoms, which can be caused by a variety of biologic and behavioral factor (Deyo 569). [29] As a result, chronic LBP comprises multidimensional problem involving psychological, physical, and social factors (Rodriguez-Raecke et al. e54475). [30] Furthermore, chronic LBP can evolve beyond chronic symptoms to a situation in which the central nervous system’s functional and morphological abnormalities are irreversible (Jain 0). [31] These functional deficiencies might also have negative psychological and emotional effects (Sullivan et al. 5). [32] Despite a wide range of therapeutic choices, persistent LBP can be difficult and expensive to manage, and 17% of adults in the U.S. seek relief from their back pain through complementary and alternative medicine (CAM) (Gou et al.1029). [33]

Yoga’s popularity has exploded during the last few years. According to global advances 2021, it is considered as one of those CAM therapies which integrate the particular human spirit with divine spirit, or the True Self  (Kebede et al.). [34] Further, the Centers for Disease Control and Prevention’s (CDC) National Health Interview Survey results suggest an increase in the use of CAM treatments (M.A., and Barbara Bloom 258. [35] CAM therapies are most commonly utilized to treat musculoskeletal problems, such as back pain and, to a lesser extent, neck discomfort (Currie and Wang 1275). [36] Yoga means “yoking” i.e “coming together” in reference to a harmonious relationship of mind–body as a medicine (His Divine Grace A.C. and Bhaktivedanta Swami Prabhupada). [37] It is an eight-limbed discipline that incorporates physical, mental, and spiritual health, according to traditional definitions. Postural alignment (“asanas”), breathing, concentration, focus, contemplation, absorption/stillness and meditation are all common features of modern Hatha yoga (Shannahoff-Khalsa 91). [38] A typical Hatha yoga class consists of a group of people who are taught by an instructor during a 60–90 minute session. The instructor instructs on proper posture, breathing, and concentration. They frequently promote positive self-esteem (Stiles). [39] Yoga refers to a set of physical and spiritual activities that originated in ancient India and are used to create profound meditation states and gain deeper harmony with the divine or inner self. It has been proposed that yoga achieves peace, inner strength, emotional and physical equilibrium by combining asanas (Hatha yoga postures) with breathing patterns (pranayama), meditation (dhyana) that are primarily focused on isometric muscle contractions (Posadzki and Parekh 66). [40] Hatha yoga as mild postures for relaxation, as well as Iyengar yoga for breathing methods and physical postures, are commonly used in trials of yoga for chronic pain therapy (K. Williams et al. 2066). [41]

Yoga offers a wide range of clinical and nonclinical uses. For instance, LBP  is one of the most frequent musculoskeletal issues in today’s culture, and it costs a lot of money to treat (Gou et al. 1029; Kosinski et al. 6). [33, 42] Patients with LBP often notice how back pain often hampers their daily activities. Patients sometimes may develop improper neuromuscular responses in order to maintain and/or preserve functions such as walking, jogging, and other activities (Burström et al.612; Furlan E155). [43, 44] Yoga may lower LBP, however the mechanisms by which this is accomplished are less researched. Some contributing factors include a rise in tissue flexibility and oxidation, as well as a calming effect and the release of enkephalins or endorphins in the lower back (Pilkington et al.; K Nespor). [45,46] The literature on yogic practices for pain treatment has not yet been critically assessed, to our knowledge. However, when documented, the adverse events associated with doing yoga to treat musculoskeletal disorders were minor and not life-threatening. This is mostly due to the degree of intricacy and multidimensionality of forces visible in yoga activities (Seidler et al. 322; Furlan et al. 1669). [44, 47] Some authors claimed that yoga activities have no negative consequences when practiced correctly, however the general and comprehensive indications and contraindications of various yoga exercises must be carefully followed.

Postures of Yoga and Pain Relief Mechanism

Back discomfort is frequently caused by strain such as muscle sprains, ligament sprains, and carrying weight incorrectly, all resulting in an unexpected and awkward action. This sprain can cause LBP and the Yoga Asanas/postures are helpful in relieving this pain. Some of the common postures/asanas are Setu Bandha Sarvangasana, Balasana, Bhujangasana, Adho mukha svanasana, Marjarasan, Uttanasana, Parshvakonasana, Savasana (K. A. Williams et al. 107). [48] These asanas relieve the back pain with different mechanisms for stretching and relieves the fascia of the muscle, hence decreasing the pain. For instance, Setu Bandhasana stretches the spine and reduces the back soreness. Balasana relieves lower back tension by stretching the spine, which decompresses it and relieves pain. By engaging your back muscles, Bhujangasana extends your core and abdominal muscles. Adho Mukha Svanasana treats back pain by resolving body imbalances and strengthens the back. The combination of Marjaryasana and Bitilasana relaxes the back muscles. Similarly, all the mentioned asanas combined aid the process of relieving the back ache (Petering and Webb 550; Telles et al. 69). [49,50]

Few of the studies have examined how yoga might help people with back ache. For example, Lee et al and Sherman et al. studied various mediators such as brain derived neurotrophic factor (BDNF), serotonin, dehydroepiandrosterone (DHEA), cortisol to understand the mechanism of yoga therapy for reliving back pain (Sherman, Wellman, et al.; Lee et al.). [51, 52] In addition, Sherman et al. also looked into psychological aspects that could be mediating yoga’s effect on back pain. These factors involved stress, psychological discomfort, cognitive appraisals, fear avoidance, positive states of mind, neuroendocrine function and physical activity. DHEA and cortisol levels in saliva samples were used to gauge neuroendocrine function. The purpose was to see which metric in the yoga, stretching, and self-care groups had the greatest impact on back-related dysfunction. The most important factors that contributed to yoga’s benefit were self-efficacy and hours of back exercise. A minor amount of sleep disruption was also a factor. Cortisol and DHEA levels had little influence (Sherman, Wellman, et al.). [51]

Further, Lee et al. examined the effects of yoga in premenopausal women with persistent low back pain. The yoga group experienced less pain, more BDNF, and the same amount of serotonin. In contrast to the untreated control group where, pain was higher, BDNF was lower, and serotonin was lower. This suggests that the positive effects of yoga are linked to increased BDNF levels in the blood and stable serotonin levels. The study was limited to gender and sample size (Lee et al.). [52]

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Yoga Traditions

There are a variety of traditions that contribute to our overall understanding of yoga. In Hinduism, the main traditions are Bhakti Yoga, Laya Yoga, Jain Yoga, Karma Yoga and Hatha Yoga. Hinduism had also played a part in the traditions of Buddhism and is therefore also included in the historical context of what comprises Buddhist Yoga traditions.

Hatha Yoga

In terms of both philosophy and practice, Hatha yoga [1] composes a major part of our current understanding of what is “yoga”. Hatha yoga focuses on systematic practices (including asana postures) which are meant for spiritual, mental and physical growth. The practices of Hatha Yoga are mainly taken from three Hinduism texts [39].

These texts [5] are Shiva Samitha, Hatha Yoga Pradipika, and Gheranda Samhita. Another valuable text for Hatha Yoga is Gorakshantah’s book Goraksha Samhita [2], written in the 11th century. Many yogis consider Gorakshananth to be the main figure to develop and popularize hatha yoga we practice today.

There are other notable hatha yoga texts [5] such as the Sritattvanidhi, Joga Pradīpikā, and Hatha Ratnavali. There is also a big overlap of hatha yoga and asana and pranayama [6] series from Vajrayana Buddhism, including tummo.

Buddhist Yoga

Buddhist yoga includes a wide array of methods to reach key virtues called 37 aids to awakening. Enlightenment or nirvana [8] is the ultimate goal of Buddhist Yoga [6]. To reach awakening [7], Buddhist texts use other terms to describe spiritual practices, including Jhāna and dhyāna [10]. Buddhist yoga practices focus on meditation, contemplation, and mindfulness, including the Anapanasati, or mindfulness of breath.

The most important mental qualities for Buddhist yoga practice were considered vipassana [20] (insight, seeing the true nature of things) and Samatha (calm, stable, focused mind).
The true nature is usually explained as all things and beings being without self, a belief called Anatta (not-self) These qualities also demand an understanding of dukkha [20] (suffering) and anicca (impermanence).

As Buddhism developed, new yogic practices [23] emerged. Mahayana meditation is one of those practices, and it has also included yogic methods such as mantra chanting and visualization meditation.

New ideas were also developed in the Theravada [8] school, which is considered to be more conservative than other practices. The most renowned system which describes new meditation practices and ideas is the Visuddhimagga.

Tantric Buddhism developed methods that are still present in Tibetan Buddhist yoga, such as guru yoga and deity yoga.

Jain Yoga

Jain yoga is one of the crucial practices in Jainism [10], along with ahimsa, or practice of nonviolence and the practice of austerities, known as tapas. The ultimate goal of Jain yoga is the liberation of Atma (Self) [37] from karma [40], which keeps the Self in the cycle of reincarnation. Purification [1] is only possible by reducing one’s collected karma, and when achieved, the practitioner will reach absolute knowledge.

Early Jain yoga included multiple methods of practice, including meditation, contemplation, and reflection. All the types of practice were mentioned in Jain yoga’s earliest written records [3], including Uttarādhyayana-sūtra and Sthananga Sutra and
Āvaśyaka-sūtra.

Through the centuries, Jain yoga adopted Hindu practices [16], particularly ideas from Patanjali’s [23] yoga and Tantric yoga [22]. In modern times, the most popularized Jain meditation method is the system of Ācārya Mahāprajña which incorporates mantras, breath control, and bandhas.

Raja Yoga

Often called classical and ashtanga [1] yoga, raja yoga is mainly based on one of the best-known yoga texts, the Yoga Sutras of Patanjali. The sutras describe eight limbs one should practice attaining Samadhi (the highest state of consciousness).

Raja yoga encompasses philosophy and metaphysics [37] derived from traditional Brahmanism, as well as self-development practices that include breath work, meditation, and asanas (the latter of which do not seem to be emphasized in any of the foundational and epic texts of yoga) [3]. Raja yogis teach that reality is dualistic and divides into nature (Prakriti) and persons (puruṣas) [5]. The goal of the system is for our person, our true self, to witness our nature and thereby experience a liberated state. To achieve this, one needs to isolate from Prakriti, through meditation, which leads us to a heightened state of awareness.

In Raja yoga, physical practices are only steps for achieving Samadhi (“total self-connectedness”) [70].

Vedanta

Vedanta encompasses multiple schools and philosophies. The focus of Vedanta [6] is the study of Upanishads. The Brahma Sutras of Upanishads focus on reaching the absolute Self by obtaining the knowledge of Brahman [7].

The most influential sub-school of Vedanta is Advaita Vedanta [15], which unlike most schools that are dualistic proposes monism. The focus of the school is Jñāna yoga [15], which prioritizes knowledge and leads towards one realizing their Atman (Self) and its relation to Absolute consciousness, or Brahman.

Adi Shankara who lived in the 8th century is the best-known figure of this tradition, and he developed upon the old Jñāna yoga books. The practitioners of Jñāna are focused on learning the scriptures [20] and listening to their guru [20], after which they reflect and meditate on the teachings to achieve the truth.

The practitioner also needs to develop different qualities, including discrimination, knowledge, faith, endurance, and temperance. Advaita yoga is in its essence a practice of meditation that allows us to identify our true Self with the Universal Consciousness [31].

Yoga-Vāsiṣṭha is a text which explains the principal ideas of Advaita through parables and short stories. The book takes inspiration from old Advaita Vedanta [25] yoga gurus and was one of the most influential texts on Hindu yoga until the 12th century.

Another important text which explains Advaita yoga is the Yoga-Yājñavalkya [31]. It focuses on teachings that are still taught to this day and includes the ten Yamas and Niyamas, as well as asanas. The book also includes meditation, pranayama (breathwork), and pratyahara exercises [22] (the withdrawal of the senses, as taught by Patanjali).

Tantric yoga

There is no single definition of Tantra yoga [3]. It can be defined as the practices described in Buddhist and Hindu texts from the 9th and 10th centuries. These books describe yogic practices which propose the visualization of deities. This is achieved through drawing mandalas [1], male and female gods, as well as the use of sexual techniques, chakras, and mantras. The ultimate goal of these techniques is achieving good health and spiritual liberation.

Laya yoga and Kundalini yoga

Although Laya yoga [31] and Kundalini [20] yoga are usually considered to be a part of Hatha yoga, they are also commonly considered as individual schools. Of the two, Kundalini gained popularity as a separate school after Yogi Bhajan began teaching it around 1972 [20].

Laya yoga is focused on meditative absorption, which allows the practitioners to transcend all their memories and experiences by losing the mind in the greater Self-Consciousness. Laya yoga prescribes a variety of techniques, including practicing mudras, listening to nada (the inner sound), and awakening the Kundalini in the body (spiritual energy).

The last technique, or the practice of awakening the spiritual energy [7] of the body, is sometimes called Kundalini yoga. It uses mudras (ritual body gestures) and pranayamas [40] (breath work) to wake up the Kundalini energy, also called shakti.

The Shakta and Shaiva schools of yoga are focused on uniting the divine energy with the universal consciousness. The best-known way for practicing this method is awakening the energy at the lowest chakra [16] and uniting it with the highest chakra, or the absolute consciousness.

Bibliography

1. Feuerstein, Georg. “The Deeper Dimension of Yoga: Theory and Practice”. 2003. pp.42, 54, 151, 395. https://books.google.com/books?id=QKWmOAnl8KwC
2. Hirschel, Meta Chaya. “Vital Yoga: A Sourcebook for Students and Teachers”. 2011. p.33 https://books.google.com/books?id=BX-RGFPzSfEC
3. Singleton, Mark. “Yoga Body: The Origins of Modern Posture Practice”. 2010. pp. 29, 33, 51, 204, 237. https://books.google.com/books?id=4oAjDgAAQBAJ
4. Yoga Anatomy By Leslie Kaminoff, ‎Amy Matthews https://books.google.com/books?id=CvB6DwAAQBAJ
5. Reddy K., Ramesh. “National Service Scheme Opportunities in Community Development”. 2020. p. 306, 309. https://books.google.com/books?id=e74OEAAAQBAJ
6. Boccio, Frank Jude. Feuerstein, Georg. “Mindfulness Yoga: The Awakened Union of Breath, Body, and Mind”. 2005. pp. iv, xxvi, xxxviii, 21, 54, 70.
https://books.google.com/books?id=bAt5ZufYhrYC
7. Pandit, M.P. Sri. Dhyana (meditation). 1978. https://books.google.com/books?id=oq4jDAAAQBAJ
8. Titmuss, Christopher. “The Buddha’s Book of Daily Meditations: A Year of Wisdom, Compassion, and Happiness”. 2001. pp. 106, 122 https://books.google.com/books?id=t2s1aOJiRH8C
9. Right Concentration: A Practical Guide to the Jhanas By Leigh Brasington https://books.google.com/books?id=GHMDCwAAQBAJ
10. Yao, Zhihua. “The Buddhist Theory of Self-Cognition (Routledge Critical Studies in Buddhism)”. 2005. p. 16. https://books.google.com/books?id=_uYR4sSsoSIC
11. Fundamentals Of Buddhism: Learn More About Dukkha And The Path to Liberation By Davina Craiger https://books.google.com/books?id=lFyLzgEACAAJ
12. The Three Signata: Anicca, Dukkha, Anatta By Oliver Hector de Alwis Wijesekera https://books.google.com/books?id=gvZ4ngEACAAJ
13. Mahāyāna Buddhist Meditation: Theory and Practice By Minoru Kiyota, ‎Elvin W. Jones https://books.google.com/books?id=s9KGFPr_zrQC
14. The Path of Purification: Visuddhimagga By Buddhaghosa https://books.google.com/books?id=B_UWm9xLDVQC
15. Lingham, Durgadas (Rodney). “Traditional Yoga: Insights into the Original Yoga Tradition, Book 1, The Original Yoga System”. 2016. pp. 18, 27, 77, 118.
https://books.google.com/books?id=KiPwBQAAQBAJ
16. Chapple, Christopher Key. “Yoga in Jainism”. 2016. p. 5. https://books.google.com/books?id=gqbbCgAAQBAJ
17. The Soul of Jainism: Philosophy and Teachings of Jain Religion By Dr. Shiv Sharma https://books.google.com/books?id=JDPjCwAAQBAJ
18. Jaina Sutras, Part I By Hermann Jacobi https://books.google.com/books?id=GlinDZnKVzoC&lpg=PP1
19. The Yoga Sūtras of Patañjali By Swami Satchidananda https://books.google.com/books?id=Q_SyMgEACAAJ
20. Newcombe, Suzanne. O’Brien-Kop, Karen. Routledge Handbook of Yoga and Meditation Studies. 2020. https://books.google.com/books?id=Hef5DwAAQBAJ
21. Patanjali Yoga Sutras By Swami Vivekananda https://books.google.com/books?id=yGcWEAAAQBAJ
22. Thakar, Vimala. Glimpses of Raja Yoga: An Introduction to Patanjali’s Yoga Sutras (Yoga Wisdom Classics). 2004. https://books.google.com/books?id=A6nHDAAAQBAJ
23. Grinshpon, Yohanan. “Silence Unheard: Deathly Otherness in Patanjala-Yoga (Suny Series in Hindu Studies)”. 2001. page 77, 130 https://books.google.com/books?id=lzEULrHJcu4C
24. Raja Yoga Yatra 1: Understanding Asana and Pratyahara By Swami Niranjanananda Saraswati https://books.google.com/books?id=aJAmygEACAAJ
25. Badarayana, and Rau S., Subba (transl.). “The Vedanta-sutras”. 1904. Reprint 2008. https://books.google.com/books?id=WO4oAAAAYAAJ
26. Adi Shankaracharya: Hinduism’s Greatest Thinker By Pavan K. Varma https://books.google.com/books?id=hl0muQEACAAJ
27. Forms of Indian Philosophical Literature and Other Papers By V. S. Kambi https://books.google.com/books?id=KnE9AAAAIAAJ
28. The Buddha and His Dhamma: A Critical Edition By B.R. Ambedkar, ‎Akash Singh Rathore, ‎Ajay Verma
https://books.google.com/books?id=FIAyDwAAQBAJ
29. Extracting the Essence of the Sruti By Toṭakācārya, ‎Michael Comans
https://books.google.com/books?id=j-eq605vuwUC
30. The Yoga of Sage Vasishta By Swami Niranjanananda Saraswati https://books.google.com/books?id=2mq7vQEACAAJ
31. Callahan, Darren. “Yoga: An Annotated Bibliography of Works in English, 1982 – 2005”. 2007. pp. 53, 159 https://books.google.com/books?id=CS9zBgAAQBAJ
32. A Brief History of Yoga: From Its Tantric Roots to the Modern Yoga Studio By Ramesh Bjonnes https://books.google.com/books?id=kNG1uAEACAAJ
33. Yoga-Darsana: Comprising the Sutras of Patañjali with Bhāṣya of Vyāsa https://books.google.com/books?id=XZjaXwAACAAJ
34. The Psychology of Yoga: Intergrating Eastern and Western Approaches for Understanding the Mind By Georg Feuerstein https://books.google.com/books?id=ipN9tgAACAAJ
35. Introduction to Laya Yoga By Swami S. D. Ramayandas https://books.google.com/books?id=ipN9tgAACAAJ
36. The Kundalini Yoga Experience: Bringing Body, Mind, and Spirit Together By Darryl O’Keefe and Guru Dharma Sindh Khalsa https://books.google.com/books?id=cnV_XGs9lHgC
37. Avalon, Arthur. “Shakti and shakta”. 2016. https://books.google.com/books?id=TBE1EAAAQBAJ
38. The Complete Illustrated Book of Yoga By Swami Vishnu Devananda
https://books.google.com/books?id=ryAYG0gNJP0C
39. Samskrti. Franks, Judith. “Hatha Yoga Manual II”. (1979).
https://archive.org/details/hathayogaitscont0000burl
40. Byrant, Edwin. “Yoga Sutras of Patanjali”. Internet Encyclopedia of Philosophy, University of Tennessee at Martin, no publication date, https://iep.utm.edu/yoga/

History of Yoga

Currently, yoga is being practiced all over the globe in both its traditional forms and contemporary forms. [1] Owing to its expertise in yoga, India is widely regarded and admired globally. This is one of the major reasons for India being a major attraction that draws foreign explorers who are in search of ancient knowledge. [2] Regarding the origins of yoga, two types of theories exist: as per the linear model, the Vedas indicate that yoga has Aryan origins; mostly, this model has been advocated by Hindu scholars. According to the synthesis model, yoga is an amalgamation of Aryan elements with native, non-Aryan practices, and this theory is supported by western scholars. [3], [4] Moreover, the word “yoga” traces its origin to the Sanskrit word “Yuj,” which implies “to join or attach.” Therefore, the word “yoga” denotes a sense of union, i.e, the connection or union with our inner being. [2], [5] A yogi or yogini (referred to woman) is defined as an individual who practices yoga or follows the philosophy of yoga with a high degree of dedication. [6]
Different References to Yoga in History

* Indus Valley Civilization: Evidence of yogic practice in the ancient age was detected by some researchers in the archaeological artifacts obtained from the Indus Valley civilization in Sind, which showed progress from around 2500 B.C. [1] Hence, the practice of yoga was of extreme significance in the Dravidian era. Certain seals among the artifacts of Mohenjo Daro depict images of gods and goddesses in yogic postures. [2] The central figure of the Pashupati seal is believed to display an “asana” posture, according to some scholars of yoga such as Werner, McEvilley, and Eliade. These scholars are of the opinion that the pre-Aryan heritage had an important role to play in the development of yoga. [1]

* Vedas: The Vedas, a large set of religious texts having origins in ancient India were codified between 1200 and 900 B.C. References to yogic-like practices were found in the Vedic texts. [7], [8] In the Atharvaveda and the Brahmanas, techniques for breath control and vital energies have been described. [9]

* Upanishads: The first occurrence of the word “yoga” is observed in the Kathopanishad (around 3rd century B.C.), [1] where the following is stated in sloka 11— “Tam yogamithi manyanthe, sthiram indiram dharanam.” The preceding statement implies that firm control over senses is regarded as yoga. Yoga is the highest state achieved when there exists perfect control over the mind and the five senses and a stable intellect is attained. [2], [10] The Svetasvatara Upanishad summarizes a process through which the body can be maintained in an upright position while the regulation of mind is done through restraining the breath. A six-fold process of yoga has been explained in the Maitri Upanishad — (1) control of breath (pranayama), (2) detachment of the senses (pratyahara), (3) meditation (dhyana), (4) placing of the concentrated mind (dharana), (5) philosophical study (tarka), and (6) absorption (samadhi). These terms (excluding tarka) will, at a later stage, account for five of the eight elements of Patanjali’s astangayoga scheme. [1]

* Samhitas: In chapter-5, sloka 9 of Siva Samhita, it is conveyed that yoga can be divided into four classes — mantrayoga, hathayoga, layayoga, and rajayoga. In chapter-3, sloka 84, it is stated that 284 asanas (postures) exist in yoga, and the following four are suggested to be practiced among them — siddha, padma, ugra, and swastika. [11]

* Mahabharata and Bhagwad Gita:  In the Mokshadharma section of the 12th chapter (Shanti Parva) of the Mahabharata (around 3rd century B.C.), an ancient form of yoga referred to as nirodhayoga (yoga of cessation) has been described. [12] In nirodhayoga, emphasis is placed on progressive detachment from the contents of empirical consciousness such as thoughts, sensations, etc. until the realization of purusha (self) is attained. [13] Overall, in Mahabharata, the purpose of yoga is stated as the unification of the individual ?tman with the universal Brahman that encompasses everything. [9]
The Bhagavad Gita is an essential part of the Mahabharata and is the chief holy scripture of the Hindus. The Gita too contains elaborate lessons related to yoga. It contains a complete chapter (ch. 6) that is devoted to conventional yoga practice. The Gita outlines three major classes of yoga, namely karma yoga (yoga related to action), bhakti yoga (yoga related to devotion), and jnana yoga (yoga related to knowledge). [14]

* Buddhist Era: Various treatises were established by the Buddhist tradition of Abhidharma, and these treatises were instrumental in further expansion of the teachings on Buddhist phenomenological theory and yogic methods. In Buddhist yoga, a broad range of techniques are included that aim towards acquiring essential virtues or qualities known as the 37 aids to awakening. The eventual goal of Buddhist yoga is bodhi (awakening) or nirvana (cessation), which is conventionally considered to be the permanent end of suffering (dukkha) and rebirth. Developments occurred in the diverse Buddhist traditions at a later stage, resulting in novel innovations in yogic methods. Prominent texts like Yog?c?rabh?mi-??stra (compiled in the 4th century) contain Indic meditation teachings of Mahayana Buddhism. Furthermore, the meditation practices of Mahayana established and adopted novel yogic techniques, for instance, the use of mantra and dharani and visualization techniques. Chinese Buddhism, which is one of the oldest forms of Buddhism in history, established its own yogic practices, like Hua Tou and the Chan practice of Koan introspection. Similarly, tantric techniques were developed and adopted by Tantric Buddhism. The yogic systems of Tibetan Buddhism are based on these tantric methods. [15]

* Yoga Sutras of Patanjali: It is generally considered that Patanjali’s Yoga Sutras are the first compilation of the formal yoga philosophy. The compilation was done by sage Patanjali in India who collected knowledge related to yoga from ancient traditions and combined and organized them in a text. This text is one of the most significant classical texts in Hinduism and has gained a lot of attention and interest from all over the globe. The main characteristic of Patanjali’s Yoga sutras is its description of ashtanga (or “eight-limbed” yoga), which includes yama (abstinences), niyama (observances), asana (yogic postures), pranayama (control of breath), pratyahara (detachment of the senses), dharana (mental focus), dhyana (to meditate), and ultimately, samadhi (attaining liberation). [16] Modern yoga tradition regards Patanjali’s Yoga sutras to be one of the foundational texts of classical yoga philosophy. [13]

* Hatha Yoga: The tenth to eleventh century witnessed the rapid emergence of a novel regimen of yoga referred to as the “yoga of forceful exertion” or hatha yoga, [17] as described in works such as Yogavasistha and the original Goraksa Sataka. 15 The features of Patanjali’s Yoga sutras are combined with posture and breathing exercises in hatha yoga. [15], [18], [19], [20] It involves enhancing asanas into complete body postures, the use of which is widely prevalent in the current age. Overall, hatha yoga, in combination with its numerous modern variants, is the most popular style of yoga today, and in a way, represents yoga as a whole in the current scenario. [15]

* Modern Form of Yoga: Around the mid-19th century, yoga and other subjects of Indian philosophy drew the attention of an educated western society. The first Hindu scholar who involved in active advocation and propagation of the features of yoga to the western society was Swami Vivekananda, who travelled to the United States and Europe in the 1890s. Vivekananda believed that practicing yoga involves psychological benefits along with simultaneous spiritual advancement. He explained that yoga also assists in emphasizing on the self, which he considered to be in compatibility with the modern democratic emphasis on an individual. Swami Vivekananda garnered a lot of praise and appreciation for his detailed and inspirational explanations on yoga, which aroused huge interest among the Western scholars. The Western society’s opinion on yoga was also largely influenced by certain theosophists, including Madame Blavatsky. [21], [15] In 1899, Ida C. Craddock (1857–1902), who was an active advocate of yoga in America, founded the Church of Yoga. [22] Another notable scholar in modern yoga was the social radical and tantric modern yoga advocate Pierre Bernard (1876–1955). His followers continued to instruct yoga well into the second half of the 20th century. [23] The founder of the Self-Realization Fellowship and a noted yogic guru from India, Swami Paramahansa Yogananda (1893–1952), happens to be the second Indian guru who journeyed from India to the United States and received a huge following among American citizens who showed interest towards modern yoga and Indian spirituality. [24], [25], [26]
It was in the 19th century that modern yoga went completely global. Entrepreneurial gurus tactically took part in the global market and achieved success in marketing yoga through establishing continuity between their yoga brands and prevailing values and requirements. [27], [28] Consequently, modern yogic methods underwent a transformation from mostly being controversial, elite, or countercultural ones to pop culture varieties. [27] In the current age, modern yoga is commonly prescribed as a part of self-development and is considered to impart increased beauty, strength, and flexibility as well as reduce stress levels. [27], [29], [30]
In the present day, yoga has emerged as a part of popular culture in urban regions all over the globe. Yoga has advanced into a worldwide multi-billion-dollar business, and it continues to thrive as an important aspect of the lifestyle of humans around the world. [27]

Bibliography
1. Singleton, M. (2010). Yoga Body: The Origins of Modern Posture Practice. Oxford University Press.
2. Sitharamiah, A. (1980). Outline of history of Yoga. Bulletin of the Indian Institute of the History of Medicine (Hyderabad), 15-22.
3. Crangle, E. F. (1994). The Origin and Development of Early Indian Contemplative Practices, 12, 13.
4. Williams, M. M. (1964). Buddhism in its Connection with Brahmanism and Hinduism and in its contrast with Christianity. Chaukhamba Amarabharati Prakashan.
5. Saraswati, S. S. (2008). Asana Pranayama Mudra Bandha. Yoga Publications Trust.
6. Swami, M. (1999). Hatha Yoga Pradipika. Bihar School of Yoga.
7. Jacobsen, K. A. (2005). Theory and Practice of Yoga: Essays in Honour of Gerald James Larson. Brill.
8. Werner, K. (1977). Yoga and the ?g Veda: An Interpretation of the Ke?in Hymn (RV 10, 136). 289-302.
9. Jacobsen, K. A. (2012). Yoga Powers. Brill.
10. Chinmayananda, S. (2018). Kathopanishad. Chinmaya Prakashan.
11. Vasu, S. C. (1990). The Siva Samhita. Munshiram Manoharlal Publishers.
12. Singleton, M. and J. Mallinson (2017). Roots of Yoga. Penguin Classics.
13. Whicher, I. (1998). The Integrity of the Yoga Darshana: A Reconsideration of Classical Yoga. SUNY Press.
14. Flood, G. D. (1996). An Introduction to Hinduism. Cambridge University Press.
15. White, D. G. (2011). Yoga in Practice. Princeton University Press.
16. Satchidananda, S. (2012). The Yoga Sutras of Patanjali. Integral Yoga Publications.
17. Birch, J. (2011). The Meaning of hat?ha in early Hat?hayoga. Journal of the American Oriental Society, 527-554.
18. Larson, G. G. (2016). Encyclopedia of Indian Philosophies (Vol. 12): Yoga: India’s Philosophy of Meditation: v. XII. Motilal Banarsidass.
19. Zorn, Y. W. (1970). Yoga for the Mind. Paperback Library.
20. Burley, M. (2000). Hatha-Yoga: Its Context, Theory and Practice. Motilal Banarsidass Publishers.
21. Meade, M. (2016). Madame Blavatsky: The woman behind the myth.
22. Schmidt, L. E. (2010). Heaven’s Bride: The Unprintable Life of Ida C. Craddock, American Mystic, Scholar, Sexologist, Martyr, and Madwoman. Basic Books.
23. Love, R. (2010). The Great Oom: The Improbable Birth of Yoga in America. Viking adult.
24. Yogananda, P. (2003). Man’s Eternal Quest. Yogoda Satsanga Society of India.
25. Yogananda, P. (2004). The Science of Religion.
26. Yogananda, P. (2016). Autobiography of a Yogi. Yogoda Satsanga Society of India.
27. Jain, A. (2014). Selling Yoga: From Counterculture to Pop Culture. Oxford University Press.
28. Holt, D. B. (2002). Why Do Brands Cause Trouble? A Dialectical Theory of Consumer Culture and Branding. Journal of Consumer Research, 70-90.
29. Michelis, E. D. (2005). A History of Modern Yoga: Patanjali and Western Esotericism. Continuum International Publishing Group Ltd.
30. Newcombe, S. (2007). Stretching for Health and Well-Being: Yoga and Women in Britain, 1960-1980. Asian Medicine: Tradition and Modernity, 37-63.

Science of Yoga Series

Yoga and Asthma

This Science of Yoga chapter is about the practice of yoga and pranayama and their potential benefits for individuals suffering from respiratory problems such as asthma. We will focus this article on several peer-reviewed journals and research findings from three countries.

Some of the available research on this topic originates from smaller teams with less resources. However, the 2017 study headed by Kaminsky, along with other Researchers at University of Vermont College of Medicine and the Baylor College of Medicine in Texas certainly doesn’t seem small. Kaminsky, et al., “successfully demonstrated that pranayama was associated with improved exercise tolerance in patients” suffering from moderate-to-severe Chronic Obstructive Pulmonary Disease COPD. Furthermore, the study’s results were obtained by individuals who were trained to teach pranayama but who were not professional yogis (meaning that learning the techniques does not require a complex set of teachings or long commitment). Kaminsky, et al., presented a very optimistic prognosis: “pranayama may have significant clinical benefits for symptomatic patients with COPD”. As usual, the study ends with a disclaimer about the need for additional studies with more resources (Kaminsky).

Researchers from the Respiratory Medicine Unit, City University, Nottingham, focused on pranayama breathing as well. Practitioners of yoga tend to experience the benefits of pranayama breathing techniques exercises directly but for individuals with pulmonary problems additional tools had to be included in the research. The team led by Singh, et al., used a Pink City lung (PCL) – a device which mimics pranayama breathing exercises – to measure the effects of controlled breathing in a hospital trial. The primary effect of asthma is the restriction of the airways, which in turn limits the amount of breath one can inhale. It is estimated that 4,000 individuals die from asthma in the United States alone. Singh, et al., noted improvements resulting from yogic techniques but – as usual – make a call for additional research on the topic of yogic breath control and asthma. The study notes that Western medicine has largely ignored this all-important topic (Singh).

In another experiment at the Central Research Institute for Yoga in New Delhi, forty-six children with asthma were trained in yoga in a controlled trial. Yoga training appeared to provide a “significant increase in pulmonary function and exercise capacity” (Jain).

The peer-reviewed journal Alternative Therapies in Health and Medicine published research with asthmatic children, which generally supported Jain’s findings. The Turkish team, led by Fulya Tahan from the Erciyes University School of Medicine “observed a significant improvement in maximum forced expiratory volume” (Tahan).

At the Northern Colorado Allergy Asthma Clinic, researchers attributed yoga to a “significant” change in students’ ability to remain mentally positive, feel more relaxed and to tolerate exercise longer as compared to the non-yoga group. The yoga group was able to use their beta adrenergic inhale less often, as well. Thus, yoga was shown as a beneficial addition to a medical treatment plan of asthma (Vedanthan).

Similarly, and even more directly, researchers at the All India Institute of Medical Science in New Delhi noted the benefit of yoga’s relaxing effects. Specifically, Khanam, et. al, state that yoga provided “the reduction in sympathetic reactivity and improvement in the pulmonary ventilation by way of relaxation of voluntary inspiratory and expiratory muscles” (Khanam).
It should be noted that some of the research on asthma and yoga is not fully conclusive due to a lack of resources and data. However, the results look promising for those who suffer from asthma and are considering yoga as a form of exercise, therapy or just as a way to stay active and be more social.

We can likewise conclude that the practice of yoga and pranayama will not be a cure-all for asthma but will likely be a good complimentary treatment for your already-existing medical and exercise regime.

References

Jain, S. C., Rai, L., Valecha, A., Jha, U. K., Bhatnagar, S. O., & Ram, K. (1991). Effect of yoga training on exercise tolerance in adolescents with childhood asthma. The Journal of asthma : official journal of the Association for the Care of Asthma, 28(6), 437–442. https://doi.org/10.3109/02770909109110627

Kaminsky, D. A., Guntupalli, K. K., Lippmann, J., Burns, S. M., Brock, M. A., Skelly, J., DeSarno, M., Pecott-Grimm, H., Mohsin, A., LaRock-McMahon, C., Warren, P., Whitney, M. C., & Hanania, N. A. (2017). Effect of Yoga Breathing (Pranayama) on Exercise Tolerance in Patients with Chronic Obstructive Pulmonary Disease: A Randomized, Controlled Trial. Journal of alternative and complementary medicine (New York, N.Y.), 23(9), 696–704. https://doi.org/10.1089/acm.2017.0102

Khanam, A. A., Sachdeva, U., Guleria, R., & Deepak, K. K. (1996). Study of pulmonary and autonomic functions of asthma patients after yoga training. Indian journal of physiology and pharmacology, 40(4), 318–324.

Singh, V., Wisniewski, A., Britton, J., & Tattersfield, A. (1990). Effect of yoga breathing exercises (pranayama) on airway reactivity in subjects with asthma. Lancet (London, England), 335(8702), 1381–1383. https://doi.org/10.1016/0140-6736(90)91254-8

Tahan, F., Eke Gungor, H., & Bicici, E. (2014). Is yoga training beneficial for exercise-induced bronchoconstriction?. Alternative therapies in health and medicine, 20(2), 18–23.

Vedanthan, P. K., Kesavalu, L. N., Murthy, K. C., Duvall, K., Hall, M. J., Baker, S., & Nagarathna, S. (1998). Clinical study of yoga techniques in university students with asthma: a controlled study. Allergy and asthma proceedings, 19(1), 3–9. https://doi.org/10.2500/108854198778557971

Effect of Yoga on Lower Back Pain

By now you know that yoga is a CAM practice that includes a number of disciplines such as asanas, pranayama, and meditation. According to 2018 report, yoga’s popularity has consistently grown over the last decade, with around 28% of adults in the U.S preferring yoga (U.S, 2018). [53] The number of modern yoga practitioners in the U. S. is estimated to be around 28.75 million people. According to published research, yoga helps ease back ache and minimize physical and functional disability caused by it. However, due to insufficient statistical power and variance in the outcome measures utilized between investigations, these studies have produced mixed results (Swain and McGwin 11). [54] The objective of this study was to investigate the impact of yoga on impairment associated with chronic LBP diseases using a robust meta-analysis and systematic review (Crow et al.3). [55]

Physical functionality

In a small scale study (controlled randomized experiment), the yoga group demonstrated advances in balance and flexibility, as well as decreased depression and functional disability (Mary Lou Galantino 49). [56] Similarly, in a 16-week controlled randomized experiment, patients with LBP treated with Iyengar yoga therapy were compared to a control group to validate the effectiveness of yoga. The findings provide evidence that the yoga practitioners reported less ache and functional impairment than the control group (K. A. Williams et al. 107). [48] Further, Williams et al. again attempted a 24-week research and proved significantly decreased functional impairment, pain severity, and depression in the yoga practitioners (K. Williams et al. 2066)]. [41]

An intense seven-day residential yoga programmed for patients with LBP was completed by 80 patients with LBP (Tekur, Chametcha, et al. 637). [57] Yoga’s impact on disability, quality of life and flexibility were investigated. The intervention group meditated, did yoga exercises, chanted, and attended lectures on a daily basis. The control group had a regular schedule that included exercise, educational lectures, non-yogic breathing exercises, and watching nature shows. This control differs from the standard controls utilized in previous studies. Between the two groups, there was a significant difference in disability, with the yoga group benefiting more than the control. The yoga members improved their flexibility and pain levels more than the control (Tekur, Singphow, et al. 10). [58]

Another study enrolled 53 persons who had previously participated in either physical therapy or a yoga intervention to treat LBP, outcome predictors were investigated. At 6 weeks, there were no substantial variations in disability. In both the groups, back pain was found to be the key indicators of health status, pain and disability. The back pain scale was used to examine a person’s belief in their ability to affect results by their individual activities. The criteria of self-selection unfairness in this study is a serious drawback, as the participants were previously enrolled into the physical therapy or yoga groups before the investigation (Evans et al.11). [59] Likewise, two large randomized trials have looked at the effects of yoga on physical functioning. The comparative study was carried out by Tilbrook et al. for 12-week comparing adults following yoga programmed (long-term effectiveness) versus a back pain instruction booklet. At 3, 6, and 12 months, the yoga members reported a significantly superior back function than the group following booklet (Tilbrook et al. 569; Cox et al.187). [60, 61] For individuals with LBP, Sherman et al. compared yoga routine to self-care instruction booklet method. With time, all of the cohorts’ function and symptoms improved. When compared to the self-care group, the yoga and stretching groups achieved equal outcomes (Sherman, Cherkin, Wellman, et al. 2019). [51] The authors concluded that the physical benefits of yoga outweigh the mental benefits.

Further, the 8-week pilot study was carried out with adult women suffering from musculoskeletal disorders such as osteoarthritis with LBP looked at the benefits of yoga on balance and gait. When compared to pre-study levels, the subjects’ balance and gait characteristics improved statistically. (Ülger and Yaĝllulger 13). [62]

Pain

Yoga has been shown to be useful in relieving pain related to chronic LBP in a number of studies. The pain-related anxieties of movement and pain beliefs were all assessed by Williams et al as the study compared the educational control group and the yoga intervention. The results found a two-fold reduction in pain and pain medication use (K. A. Williams et al.107). [48] There was no substantial difference in movement anxieties or pain attitudes, possibly because the study lacked statistical power to detect these differences. Williams et al. went on to show that a 24-week Iyengar yoga programme can help people with chronic LBP. Individuals in the yoga group improved their pain intensity more than those in the control group (K. Williams et al. 2066). [41]

The effect of yoga on back pain in low-income, racially diverse people was investigated by Saper et al. Following the 12-week treatment, respondents’ average LBP intensity for the preceding week was drastically reduced from 7 to 5 regardless of whether they attended once or multiple times yoga classes (Saper et al.). [63] Further, due to the complexities of pain, Sherman et al. noted pain “bothersomeness” rather than pain severity. Subjects reported their back pain on an 11-point scale ranging from “not at all” to “extremely” troublesome during the preceding week in accordance to a 3-month yoga, exercise, or book education intervention (Sherman, Cherkin, Wellman, et al. 2019). [64] All of the therapies were beneficial, but the exercise and yoga groups showed the most improvement.

The “bothersomeness” of back pain was investigated in people who had previously had either a physical therapy or a yoga intervention. Both interventions were effective, and after 6 weeks of treatment, there were no substantial differences between the physical therapy and yoga groups. However, the yoga group’s baseline structures were such that they had less back ache and functional disability to begin with. In participants with nonspecific chronic low back pain, a randomized controlled trial looked at the effects of Iyengar yoga on pain severity and overall health-related quality of life. The researchers assessed yoga therapy to traditional exercise therapy over a six-month period (GS et al. 48). [65] Both programs had a considerable impact, but the yoga intervention had the bigger influence.

Psychological effect

To date, the scientific literature on yoga’s influence on psychological health has not been fully described. In a study of veterans with back pain, Groessl et al. looked at the effects of yoga on psychological conditions like mental depression and effect on quality of life (Groessl, Weingart, Aschbacher, et al. 1123). [66] They discovered considerable reductions in depression, as well as a trend toward significant gains in the SF-12’s Mental Health Scale. The amount of home practice reported by the individuals tended to correlate with the improvement in depression. In participants with chronic LBP, the effects of Iyengar yoga on depression were evaluated. Subjects in the yoga group improved more than those in the control group in terms of depression. The yoga group was given substantial attention than the control group, which was one of the study’s limitations. The lack of controls for physical activity between the groups was another limitation (Groessl, Weingart, Johnson, et al. 832). [67] Further, Tekur et al. compared yoga group to the controls and discovered that the yoga group improved much more on the psychological state of their mind and the quality of life. This residential study, however, included more features than the standard Hatha or Iyengar yoga interventions (e.g., 8 hours of interactive talks, chanting, and meditation sessions per day (Tekur, Chametcha, et al. 637). [58] In addition, this was a one-week follow-up study. Similarly, with the mental health condition, one randomized controlled experiment (Tilbrook et al. 569) and an associated pilot research (Cox et al.187) compared yoga to “usual care.” [60, 61] The pilot study indicated no significant differences, however the sample size was small (n = 20). The power of their follow-up study was sufficient. At the 3-, 6-, and 12-month examinations, they found no substantial differences in psychological functions or mental health (although the 3 and 6 month assessments demonstrated a trend towards improvement). According to these reports, yoga is beneficial in lowering ache and functional disability, as well as increasing physical and psychological function.

Safety Data of Yoga for back pain

LBP is a physical disease that has a high recurrence rate and a high rate of partial recovery. As a result, it’s not uncommon to see some negative outcomes while investigating patients with back discomfort (Kamper et al. 9). [68] Yoga positions, on the other hand, do not appear to pose a significant risk to healthy persons or patients with back pain. In one study, one adverse event was documented among 30 patients who were randomly assigned to yoga. During the trial, a participant had symptoms of osteoarthritis and was diagnosed with a ruptured disc (K. A. Williams et al.107). [48] The Institutional Review Board decided that the adverse event was unrelated to the yoga postures after conducting a medical review. In the yoga versus exercise experiment, there were no significant adverse effects recorded among the 101 participants (Sherman, Cherkin, Erro, et al. 849). [69] One yoga student dropped out owing to migraine, and another exerciser hurt her back and received help from a chiropractor. Sherman et al. identified an equivalent incidence of moderate adverse effects (mainly briefly increased LBP) in both the yoga and the standard stretching interventions. A significant occurrence occurred once in the 87 yoga class participants, a herniated disc. One person in the control group with self-care treatment experienced severe pain. Despite all of these negative events, the stretching and yoga groups had reasonably better results overall. [64] Finally, safety data from the most latest and significant trials demonstrate a 10%–15% occurrence of substantially improved LBP discomfort, with two cases of herniated disc discovered. There appear to be certain concerns linked with yoga. However, the majority of individuals believe to gain large benefits due to yoga interventions with little or no negative effects (Sherman, Cherkin, Wellman, et al. 2019). [70] Overall, yoga appears to be a more well established intervention as the health sector transitions from treating acute illnesses to treating chronic diseases, and healthcare providers pursue to establish preventive measures to combat the enduring diseases that plague modern society. Since yoga is a reflective activity, it may be useful for military veterans who are dealing with the long-term effects of wartime stress.

Conclusion

Yoga appears to be just as helpful as other non-pharmacologic therapy at reducing back pain’s functional impairment. When compared to conventional treatments/therapies, it proves to be more successful in reducing the recurrence of LBP or dipping the pain severity. Yoga may help with depression and other psychological co-morbidities by maintaining serotonin or BDNF levels in the blood. Yoga demonstrates to be a safe way to treat persistent low back pain.

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