According to recent research, yoga is no less effective than physiotherapy in relieving chronic mild to moderate back pain.
Yoga as Therapy for Back Pain
Balance is nice. Especially when you practice yoga. That’s why it’s also nice that I can now bring balance after a less positive article about yoga from last week.
Researchers from Harvard compared three different treatment methods for mild and moderate (yet chronic) back pain [1]:
- Yoga. 12 weeks, once a week.
- Physiotherapy. 15 sessions over 12 weeks.
- Educational material through a book and newsletters about therapy for back pain. 12 weeks.
After this, the 320 participants (aged 18 to 64) were followed for another 40 weeks to see how long they continued with yoga or the exercises learned from the physio.
The degree of pain and immobility was assessed through questionnaires before, after 12 weeks, and at the end of the year.
In both the yoga group and the physio group, about half of the participants experienced reduced pain and increased mobility after 12 weeks. About half also reduced their pain medication. In the education group, only 14 percent reported a decrease in pain, 25 percent claimed to be more mobile, and 25 percent reduced medication use.
Yoga: More than just Exercises
After a year, these benefits from yoga and physiotherapy remained equally present, provided that participants continued with the exercises after 12 weeks. However, in the physio group, a disproportionately large number of participants dropped out. Not only did this pose a weakness for the research itself (missing data), but it also demonstrated a greater motivation for yoga than for the exercises learned from the physiotherapist.
To be clear: The researchers do not claim that yoga is better for mild to moderate chronic back pain. They strictly do not even claim that yoga performs equally well. Formally, they speak of ‘noninferiority’; yoga would at least not work worse.
Others go further:
Yoga may offer an alternative approach to the treatment of low back pain. The benefits of yoga may be greater than those of exercise alone because yoga offers a combination of physical exercise with mental focus, and patients are taught good posture, self-awareness, and self-care along with relaxation.
This is the conclusion of British researchers following their comparison of the effect of yoga with conventional treatment methods [2]. They refer to previous research indicating the limitations of physical exercises as treatment [3-5].
“Yoga Safe for Back Pain”
Earlier this year, the results of a study from the University of Maryland were published. They compared as many studies as possible on the effect of yoga on back pain, evaluating them for reliability and strength. In total, they compared 12 studies involving 1080 participants. Most studies focused on yoga styles such as Iyengar, Hatha, or Viniyoga.
From this, a positive effect of yoga compared to no treatment in improving mobility after 3 and 6 months was evident. However, according to them, the effect on pain relief was not significant enough to speak of a so-called ‘minimal clinically relevant difference’. Another conclusion is that there is little difference between yoga and other exercises aimed at back pain. They also cannot score the reliability of completed questionnaires very high.
Additionally, the risks of the different treatment methods were examined. Yoga and physical exercises naturally carried the risk of complaints arising from the treatment itself. However, these risks were comparable, and in both cases, no serious complaints arose from the treatment.
The researchers conclude with the almost obligatory mantra that more research is needed to gain more certainty and insight.
References
- Saper RB, Lemaster C, Delitto A, Sherman KJ, Herman PM, Sadikova E, et al. Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial. Ann Intern Med. [Epub ahead of print 20 June 2017] doi: 10.7326/M16-2579
- Tilbrook HE, Cox H, Hewitt CE, Kang’ombe AR, Chuang L, Jayakody S, et al. Yoga for Chronic Low Back Pain: A Randomized Trial. Ann Intern Med. 2011;155:569-578. doi: 10.7326/0003-4819-155-9-201111010-00003
- UK BEAM Trial TeamUnited Kingdom Back Pain Exercise and Manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ 2004;329:1377.
- Hayden JA, van Tulder MW, Malmivaara AV, Koes BW. Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med 2005;142:765-75.
- Johnson RE, Jones GT, Wiles NJ, Chaddock C, Potter RG, Roberts C, et al. Active exercise, education, and cognitive behavioral therapy for persistent disabling low back pain: a randomized controlled trial. Spine (Phila Pa 1976) 2007;32:1578-85.
- Wieland LS, Skoetz N, Pilkington K, Vempati R, D’Adamo CR, Berman BM. Yoga treatment for chronic non-specific low back pain. Cochrane Database Syst Rev. 2017 Jan 12;1:CD010671. doi: 10.1002/14651858.CD010671.pub2. Review. PubMed PMID: 28076926; PubMed Central PMCID: PMC5294833.
