Yoga and stretching are equally effective for easing low back pain
Low back pain is extremely common; about 80% of us will experience an episode at some time in our lives. The pain usually goes away in a couple of months or so, but it often recurs. Some people develop a chronic form that lasts three months or longer. There are many treatments for chronic low back pain, but none have proved highly effective. Now, a large controlled trial has found that both yoga and stretching exercises are helpful in improving function and reducing symptoms. Results were published in Archives of Internal Medicine (Oct. 24, 2011).
The study. Researchers at Group Health Cooperative, a large nonprofit health care organization in Seattle, recruited 228 women and men with back pain and assigned them at random to 12 weekly 75-minute classes of yoga (92 patients) or conventional stretching exercises (91 patients), or to reading a self-care book on chronic low back pain (45 patients). The yoga classes were led by experienced instructors of viniyoga, which modifies the traditional postures for people with physical limitations. Licensed physical therapists led the stretching exercise classes. Both the yoga and stretching exercise groups were given handouts and instructional videos and encouraged to practice for 20 minutes on non-class days. Self-care participants were given The Back Pain Helpbook, which provides information on back pain and advice about exercising. In telephone interviews with participants at six weeks, 12 weeks, and 26 weeks after the program began, researchers assessed back-related physical functioning with a standardized questionnaire and asked participants to rate their pain on a 10-point scale.
The results. Yoga and stretching exercises produced similar improvements in physical function — and were much more effective than the self-care book. The impact on pain levels was less pronounced, but the number of yoga and stretching participants who reported using medications for their back pain in the week before each of the telephone interviews dropped by a quarter to a third throughout the study (medication use in the self-care group didn't decrease until the final interview). The benefits of yoga and stretching persisted at the final interview — three months after classes had ended. The lead author of the study, Dr. Karen J. Sherman, describes yoga and stretching as "good, safe options for people who are willing to try physical activity to relieve their moderate low back pain."
Limitations and implications. This study was larger than most, which means the findings are more likely to be accurate. And it was a randomized controlled trial, the kind that allows the strongest conclusions. But it does have some limitations. The back pain of the participants was moderate, so it's unclear whether yoga and stretching would be equally helpful for people with more severe symptoms or functional limitations. Also, the yoga and stretching exercise regimens overlapped, with both emphasizing the trunk and legs; and the slow, careful stretching may have had some of the same relaxation effects as yoga. "In retrospect," says Dr. Sherman, "we realized that these stretching classes were a bit more like yoga than a more typical exercise program would be." A week after this study was published, yoga got another thumbs-up for back pain. A randomized trial involving 313 British adults with back pain published in Annals of Internal Medicine (Nov. 1, 2011) found that a 12-week yoga program produced greater improvement in back function than usual care. If you're considering yoga for low back pain, Dr. Sherman cautions that the regimen should be "therapeutically oriented, geared for beginners, and taught by instructors who can modify postures for participants' individual physical limitations."
Resources: You can watch a video about the Seattle study at www.health.harvard.edu/yogaUS and one about the British study at www.health.harvard.edu/yogaUK.