Yoga Can Ease Chronic Low Back Pain

Yoga classes were linked to improved back-related function and diminished symptoms from chronic low back pain in the largest randomized controlled trial of yoga to date in the United States, according to findings published in the Archives of Internal Medicine.

Intensive stretching classes also proved beneficial, reported lead author Karen J. Sherman, PhD, MPH, of Group Health Research Institute and colleagues.

“We found yoga classes more effective than a self-care book—but no more effective than stretching classes,” said Dr. Sherman, noting that back-related function was better and symptoms were diminished with yoga at 12 weeks. Clinically significant benefits including less use of pain medications lasted at least 6 months for both yoga and stretching, with thorough follow-up of more than 9 in 10 participants.

In the trial, 228 adults in 6 cities in Washington were randomly assigned to 12 weekly 75-minute classes of either yoga or stretching exercises or a self-care book that provided information on causes of back pain and advice on exercising, lifestyle modifications, and managing flare-ups. Participants in the trial typically had moderate—not severe—back pain and relatively good mental health, and most had been at least somewhat active before the trial started.

The class participants received instructional videos and were encouraged to practice at home for 20 minutes a day between their weekly classes. Primary outcomes measured were back-related functional status and how much the back pain was bothering the patients. Telephone interviews were conducted at baseline, and at six, 12, and 26 weeks after randomization.

In 2005, Dr. Sherman and her colleagues conducted a smaller study that found yoga to be effective in easing chronic low back pain. The new study sought to confirm those results in a larger group and to compare yoga to stretching in terms of benefits realized.

Both the yoga and stretching classes emphasized the torso and legs, according to researchers. The yoga classes also used breathing exercises, with a deep relaxation at the end. The stretching classes focused heavily on the hamstring and hip flexors and rotators.

“We expected back pain to ease more with yoga than with stretching, so our findings surprised us,” Dr. Sherman said in a statement. “The most straightforward interpretation of our findings would be that yoga’s benefits on back function and symptoms were largely physical, due to the stretching and strengthening of muscles.”

The stretching classes, however, included a lot more stretching than in most such classes, with each pose held for a relatively long time, they found. “People may have actually begun to relax more in the stretching classes than they would in a typical exercise class,” she added. “In retrospect, we realized that these stretching classes were a bit more like yoga than a more typical exercise program would be.”

The authors concluded that both yoga and stretching can be effective, safe options for individuals who are willing to try physical activity to relieve moderate low back pain. “But it’s important for the classes to be therapeutically oriented, geared for beginners, and taught by instructors who can modify postures for participants’ individual physical limitations,” Dr. Sherman noted.

In a related commentary, Timothy S. Carey, MD, MPH, of the University of North Carolina called the study “an excellent example of a pragmatic comparative effectiveness trial,” noting that the Institute of Medicine has identified chronic back pain as a priority condition for such studies.

Click on the video below for more information on the study.