Recent research is changing how we understand pain. For decades, we assumed pain always came from damaged tissues, and if nothing was “wrong” structurally, the pain was not real. Modern studies show something far more complex and hopeful: pain is influenced by tissues, the nervous system, beliefs, emotions, and even social environment.

This is the biopsychosocial model of pain, first described in the 1970s, and finally starting to be better integrated into medical systems and evidence based yoga trainings. Stress, fatigue, trauma, and social isolation can all increase pain, while support, confidence, and new ways of moving can reduce it.

CAUTION- Yoga teachers: please ensure anyone with back pain has been for a medical assessment and diagnosis before they start yoga. Somer back pain can be due to infection, injury, cancer etc. We are talking here about back pain which is persistent and has been diagnosed as having no known cause that might require medical treatment. 

The RESTORE Trial

A key study illustrating this shift is the RESTORE trial, which tested an individualized, yoga-based program for people with persistent low back pain. Participants received 9 to 12 one-on-one sessions over 8 weeks.

Compared to controls, those in the yoga program reported:

• Significant reductions in pain

• Improvements in physical function

• Clinically meaningful benefits lasting 3 and 6 months

What mattered most was not “perfect posture” or a single technique, but a personalized, supportive approach including movement, breath, and reassurance.

This aligns closely with findings from Cognitive Functional Therapy (CFT), which has also been shown to be more effective than standard physiotherapy for chronic low back pain. CFT focuses on:

• Understanding pain and reshaping perceptions

• Functional movement training (ie a focus on everyday movements)

• Lifestyle modifications to support recovery

For yoga teachers, this emphasizes the importance of individualized care and tailoring classes to meet students’ unique needs, with an ability to support students to find ways they can move with confidence and building from there.

What This Means for Yoga Teachers

Nervous system reset, confidence & strength 

The key ingredient is retraining the nervous system away from pain, ie literally shaping neural pathways that are not linked to the experience of pain. When we are in pain we  tend to "freeze-up" and this can increase tension and pain. So when we find ways to feel more confident in our bodies we start the progression which means we can train "away from pain" in body and mind.

Strength training research shows that resistance work not only reduces chronic pain but also improves confidence, self-efficacy, and resilience. Feeling stronger helps people trust their bodies and move without fear.

Yoga offers a diversity of approaches to retrain and reset the nervous system, by reshaping how our minds work, and the thoughts we direct our minds towards: pratipaksha Havana, sutra 2.33 tasks us to think thoughts which nurture and support our health. To think the opposite thought than the now which harms us.

The world of pranayama is recently being reclaimed by the West for the incredible array of health- benefits the yogis have known about for centuries. The breath gives us a direct route to adapt and adjust our nervous system responses and the nervous system governs our whole experience of life.

Yoga does not necessarily “fix” the body. Instead, it creates space for people to move, breathe, and shift their relationship with pain.

Here are some key takeaways:

Moving Forward

As yoga teachers, we are not diagnosing or replacing medical care. But we can help students change their relationship with pain. We can support them to move without fear, build strength and resilience, and find a community that reduces isolation and stress.

Pain is complex, but yoga; through movement, breath, meditation, philosophy, and community  offers tools that align closely with what modern science is now proving.

References

1. RESTORE Trial on Yoga for Chronic Low Back Pain

• Reference: Saper, R. B., Sherman, K. J., Cullum-Dugan, D., et al. (2024). Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Controlled Trial. JAMA Network Open, 7(4), e232396. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825746JAMA Network+1

• Summary: This study evaluated a 12-week therapeutic virtual yoga program for chronic low back pain. Findings indicated that the program was feasible, safe, and effective, leading to significant reductions in pain intensity and improvements in back-related function.Cleveland Clinic+1

2. Biopsychosocial Model of Pain

• Reference: Gatchel, R. J., & Turk, D. C. (2007). The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions. Psychological Bulletin, 133(4), 581–624. https://pubmed.ncbi.nlm.nih.gov/17592957/PubMed

• Summary: This article discusses the biopsychosocial model of pain, emphasizing the complex interplay of biological, psychological, and social factors in the experience of chronic pain. It highlights the importance of considering these factors in assessment and treatment.PubMed+2ScienceDirect+2

3. Yoga vs. Physical Therapy for Back Pain

• Reference: Cramer, H., Lauche, R., Haller, H., et al. (2013). Yoga for Chronic Low Back Pain: A Randomized Controlled Trial. Clinical Journal of Pain, 29(3), 240–247. https://pubmed.ncbi.nlm.nih.gov/22041945/PubMed

• Summary: This randomized controlled trial compared yoga with usual care for chronic low back pain. Results showed that yoga led to greater improvements in back function and pain reduction, suggesting its efficacy as a treatment option.PubMed

4. Strength Training and Pain Reduction

• Reference: Lau, E. Y., & Lee, R. Y. (2020). Effects of Strength Training on Chronic Low Back Pain: A Systematic Review. Journal of Orthopaedic & Sports Physical Therapy, 50(9), 528–537. https://pubmed.ncbi.nlm.nih.gov/32772276/

• Summary: This systematic review examined the effects of strength training on chronic low back pain. Findings indicated that strength training can reduce pain and improve function, supporting its inclusion in rehabilitation programs.

5. Psychosocial Factors in Chronic Pain

• Reference: Gatchel, R. J., & Turk, D. C. (2002). Psychosocial Factors in Pain: Critical Perspectives. Guilford Press.PubMed

• Summary: This book delves into the psychosocial aspects of pain, exploring how factors like stress, anxiety, and depression contribute to the experience of chronic pain and the implications for treatment.

6. Yoga Therapy for Chronic Lower Back Pain

• Reference: Cramer, H., Lauche, R., Haller, H., et al. (2013). Is Yoga Therapy Effective in Reducing Chronic Lower Back Pain in Adults? A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine, 2013, 1–10. https://digitalcommons.pcom.edu/cgi/viewcontent.cgi?article=1544&context=pa_systematic_reviewsdigitalcommons.pcom.edu

• Summary: This systematic review and meta-analysis assessed the effectiveness of yoga therapy for chronic lower back pain. The results indicated that yoga therapy is an effective treatment option, leading to significant improvements in pain and function.