Congratulations to yoga! It is beginning to come up in the world as a treatment for back pain. (I knew it all along.) Up until recently, the relatively few studies on yoga for back pain suggested that it might have positive effects on things like pain levels, disability and depression. (Research shows that depression and other psychological factors play an important role in recurrent back pain.)
For example, in 2009, a randomized clinical trial at West Virginia University that involved 90 participants with lower back pain compared those who did an Iyengar yoga class twice per week for six months to those who had "usual care" for that same six months. (Iyengar yoga is a type of hatha yoga that emphasizes body alignment.) The yoga students not only came away with the three benefits mentioned above (improved pain levels, disability and depression), but overall, yoga students tended to rely less on pain medication than the usual-care group, according to researchers.
Comparative-Effectiveness Research for Yoga and Back Pain
The year 2011 saw the publication of two comparative-effectiveness studies looking at yoga as a treatment for lower back pain. With comparative-effectiveness studies, researchers observe the benefits and harms of different treatments or strategies in real-world settings. Such research is part of the push by President Obama to improve health by promoting evidence-based information to patients and practitioners alike.
Both studies were randomized-controlled trials, which seek to understand how two or more treatments compare with one another. Generally, randomized-controlled trials are solid studies that yield reliable information.
One study compared yoga to usual care for lower back pain. Usual care consisted of whatever the inviting doctors were giving to their patients before the study, which was likely a combination of exercise, pain control and physical therapy. There were 39 medical practices involved, meaning there was an excellent chance that there were 39 different versions of "usual care'.
The other study compared yoga to stretching and to the reading of a self-care booklet.
Yoga and Back Pain Study No. 1: Yoga Versus Going to the Doctor
The first study, a three-year, multi-site project from Britain, compared the effectiveness of yoga and usual care for people who experienced chronic or recurrent low back pain. The results were published in the Annals of Internal Medicine in November.
What I really liked about this study was the care that was taken to standardize the yoga instruction, as well as the inclusion of axillary materials to help participants address their lower back pain in a holistic way.
Everyone who participated received a self-care booklet that addressed lower back pain. People in the yoga group also received a relaxation CD that included guided relaxations, color meditations and breath and mental positivity meditations. The yoga program was specifically focused on pain relief. The yoga students were also given a manual to help them incorporate what they learned in class into a daily practice they could do at home.
About half of the 313 study participants (156) did a gently progressive yoga program that lasted 12 weeks and included multiple yoga teachers. Multiple yoga teachers were employed because evidence from previous studies involving only one yoga instructor had been seen as weak. The teachers were given a special training program for this project.
Researchers looked at disability levels of all study participants at three, six and 12 months. They wanted to see what effect yoga may have had on pain, general health and pain self-efficacy. (Self-efficacy means genuine confidence that you know what to do about your pain, and that you do it.) To obtain the data, researchers sent a survey to the participants, and about 313 participants responded.
Well, it turns out that those who did yoga reported better back function (the absence of which is related to disability) than the usual-care group. This was the case throughout the entire study period. As far as general health, both groups fared about equally well.
At first, the yoga group did better with pain self-efficacy, but at 12 months, the two groups were about equal.
Even though the two groups reported equal pain levels at 12 months, "the self-efficacy score shows that in general, the yoga participants felt less limited by their pain and a greater ability to control their pain," says Debbie Turczan, M.S.P.T., clinical specialist in physical therapy, New York Presbyterian Hospital/Weill Cornell Medical Center, in New York.
Yoga and Back Pain Study No. 2: Yoga Versus Stretching and Reading a Self-Care Handbook
The second study compared doing viniyoga to doing conventional stretching exercises, with a lot of emphasis on leg and hip stretches, and to using a self-care booklet (called The Back Pain Helpbook) for 228 people with moderate impairment from chronic lower back pain (and no sciatica). Viniyoga is a form of yoga that emphasizes the coordination of gentle movement with breathing. The results from this study were published in the Archives of Internal Medicine in October 2011.
Approximately 90 participants did yoga for 75 minutes once per week for 12 weeks; 90 did a 75-minute exercise class that consisted of 52 minutes of stretching plus aerobics and strengthening work; 45 received the booklet. The researchers wanted to know about back function and how much the participants’ pain bothered them at the 12-week mark. They also evaluated for these outcomes at six and 26 weeks.
At the 12-week evaluation, researchers found that study participants who did yoga saw greater improvements in their back functioning than those who did nothing but read the self-care booklet. At no point was yoga better than stretching for lower back pain. The two activities – stretching and yoga - yielded about the same results.
"This study shows that, generally speaking, movement itself is important in the management of low back pain," says Turczan. "Both the yoga and stretching groups participated in activities that had a significant focus on back and leg stretching, and both had similar outcomes. This study confirms what many therapists already know: That movement is an important component of any back-pain recovery program."
Though the practice of yoga dates back several thousand years, it is just getting started in our medical system. Turczan concludes: "Yoga is a generally safe activity. It could, in my opinion, be prescribed by more physicians as a means of maintaining health and wellness. And it has an important role to play in (injury) prevention, because maintaining strength and flexibility can be a big help in avoiding injuries."
Sherman KJ, Cherkin DC, Wellman RD, Cook AJ, Hawkes RJ, Delaney K, Deyo RA. A Randomized Trial Comparing Yoga, Stretching, and a Self-care Book for Chronic Low Back Pain. > Arch Intern Med. 2011 Oct 24. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed?term=Sherman%20KJ%2C%20Cherkin%20DC%2C%20Wellman%20RD%2C%20et%20al.%20A%20randomized%20trial%20comparing%20yoga%2C">http://www.ncbi.nlm.nih.gov/pubmed?term=Sherman%20KJ%2C%20Cherkin%20DC%2C%20Wellman%20RD%2C%20et%20al.%20A%20randomized%20trial%20comparing%20yoga%2C>http://www.ncbi.nlm.nih.gov/pubmed?term=Sherman%20KJ%2C%20Cherkin%20DC%2C%20Wellman%20RD%2C%20et%20al.%20A%20randomized%20trial%20comparing%20yoga%2C
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. http://www.ncbi.nlm.nih.gov/pubmed/22041945">http://www.ncbi.nlm.nih.gov/pubmed/22041945>http://www.ncbi.nlm.nih.gov/pubmed/22041945
Turczan, D. MSPT, Clinical Specialist in Physical Therapy at New York Presbyterian Hospital/Weill Cornell Medical Center in New York Email Interview. November 2011.
Pear, R. US to Compare Medical Treatments. New York Times. Feb. 15, 2009 http://www.nytimes.com/2009/02/16/health/policy/16health.html
Agency for Healthcare Research Quality. AHRQ's Career Development and Postdoctoral Training Awards for Comparative Effectiveness Research Fact Sheethttp://www.ahrq.gov/fund/training/cdpostcer10.htm#research
Woby, S.R., Roach, N.K., Urmston, M., & Watson, P.J. (2007). The relation between cognitive factors and levels of pain and disability in chronic low back pain patients presenting for physiotherapy. European Journal of Pain.
National Institutes of Health. Research Spotlight. Iyengar Yoga for Chronic Low-Back Pain Shows Promising Results. NCCAM website. Sept. 2009. http://nccam.nih.gov/research/results/spotlight/112409.htm