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Lower Back Pain Relief from Yoga

yoga back painA new study, published at the beginning of the month in the Annals of Internal Medicine reports that yoga is effective for lower back pain, adding to the evidence already supportive this non-surgical therapy for chronic back conditions. The study, carried out in the UK, looked at a three-month yoga program, with twelve sessions in total, to improve back function and relieve pain. Functional improvements were noted but the therapy did not seem to result in significant changes in pain or overall health although patients were more confident in managing pain and carrying out normal activities compared to the control group receiving standard care.

The Largest Trial to Date

Many studies have been carried out into the use of yoga to alleviate back pain and improve mobility but none have been quite so extensive as this latest trial. Over three hundred subjects were followed for up to a year, with the initial programme of yoga lasting just three months. This allowed the researchers to determine to what extent the therapy continued to provide benefit, if any, and whether improvements were due to time or able to be attributed to the yoga itself. David J. Torgerson, PhD, of the University of York’s Department of Health Sciences noted that the benefits of the three-month yoga course were maintained in many participants, most probably due to their continued practice of yoga at home.

Improving Back Health with Yoga

All of those participating in the trial were given education booklets on back pain and usual care, with 156 of the 313 subjects also offered Iyengar Yoga classes once a week for three months. The yoga teachers, importantly, had extra training in back care, which may mean that it is difficult to generalize the benefits of treatment to all yoga classes. Each session lasted an hour and a quarter and Alison Trewhala, DBL, one of the twelve teachers who was also an investigator involved with the study explained the potential for yoga to aid in pain-relief as well as improve mobility, strength, relaxation, and awareness of posture. Understanding the function and importance of a healthy back is thought to help patients become more aware of caring for their spines and also more positively focused on overall health.

Continued Yoga Practice Improved Back Function


Attendance at three of the first six yoga sessions and at least another three throughout the study was 60%, and 82% of the patients in the treatment arm said they were practicing yoga at home in the first three months. This figure dropped to 65% at the six month mark and just 60% at twelve months. A more significant difference in the Roland Morris Disability Questionnaire results was seen in the first three months, although a slightly less impressive but still significant benefit was seen at both six and twelve months, after the formal yoga classes had ceased. This questionnaire assesses the ability of patients to carry out tasks which are affected by low back pain, with a change of 1.1 to 2.5 on the scale generally considered significant. Those practicing yoga had, on average, 2.17 fewer activity restrictions at three months and 1.57 at twelve months, which the authors of the study deemed significant.

Specialist Yoga Instructors

Problems with the study include the aformentioned specialist training of the yoga practitioners, which may not mirror available facilities for all those with chronic or recurrent back pain, as well as missing data for twenty-one intervention group patients and eighteen usual care subjects. Although there is a widespread view that natural treatments are preferable to pharmaceuticals in terms of side-effects and adverse events, this trial found that 8% of those in the yoga group experienced some unwanted consequences of the treatment. One such adverse event was deemed serious and likely related to the yoga, although it may be that any exercise would have resulted in the same severe pain. Other adverse events were considered non-serious and mostly related to pain increases. Just 1% of the usual care group had reported adverse events however, including one accident and one death.

Alternative Therapies for Back Pain

It is difficult to compare such a trial with other lower back pain treatments as different methodologies are often used, and patients differ between trials in terms of severity of pain, disability, and even simple factors such as age. Torgerson and his fellow researchers noted this in their paper, although it does appear that yoga is more effective for improving back function in comparison to cognitive behavioural therapy, exercise and manipulation, and a short course in the Alexander technique (although not a longer twenty-four session course).

Yoga No Better than Stretching for Back Pain

low back pain yoga stretches

Not all yoga poses are good for back pain so find an experienced teacher.

Other, recent studies looking into yoga therapy for back pain include that of Sherman, et al, from the Group Health Research Institute in Seattle. Published in the Archives of Internal Medicine just last month, their study looked at stretching, regardless of whether this was in a formal yoga class, in improving moderate chronic low back pain in adults. Yoga did appear more effective than a self-help book but no more so than stretching classes in terms of functional improvements or symptom reduction. Similarly to the newer trial, the benefits were long-lasting, even after treatment ceased. The wealth of evidence amassing to support the use of yoga, or similar physical therapy programme, for lower back pain might mean that it soon becomes part of standard care for the condition. Interestingly, the comparable effect of general stretching and yoga for low back pain implies that the benefits are not down to the psychological or emotional aspects of yoga that many feel contribute to improved ability to deal with pain and chronic illness.

Recommending Yoga for Back Pain

Regardless of the mechanism of effect, the use of yoga to relieve chronic low back pain has been shown effective and is more likely to be of additional benefit to general health than routinely-used back pain-specific self-help books. Indeed, in Sherman’s study it was found that patients undertaking yoga practice or stretching used less medication overall to manage pain, which could appeal to those looking at ways of reducing the cost burden of an ageing population with increasing problems with back health. It has even been suggested that treatments with a wealth of evidence behind them be encouraged through the minimization of copayments when considering the medical costs. Future trials are needed to look at the effectiveness and safety of stretching and yoga for more severe chronic low back pain however, as those carried out so far have concentrated mainly on mild to moderate functional disability and pain.


References

Karen J. Sherman, PhD, MPH; Daniel C. Cherkin, PhD; Robert D. Wellman, MS; Andrea J. Cook, PhD; Rene J. Hawkes, BS; Kristin Delaney, MPH; Richard A. Deyo, MD, MPH. A Randomized Trial Comparing Yoga, Stretching, and a Self-care Book for Chronic Low Back Pain. Arch Intern Med. Published online October 24, 2011.

Tilbrook HE, Cox H, Hewitt CE, Kang’ombe AR, Chuang LH, Jayakody S, Aplin JD, Semlyen A, Trewhela A, Watt I, Torgerson DJ. Yoga for chronic low back pain: a randomized trial. Ann Intern Med. 2011 Nov 1;155(9):569-78.

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