Yoga Improves Back Function in Patients With Low Back Pain

Megan Brooks

October 31, 2011

October 31, 2011 — A study released today provides more evidence that yoga can help patients who suffer from chronic low back pain. Conducted in the United Kingdom, the study found that a 12-session, 3-month yoga program led to greater improvements in back function than usual care.

Dr. David J. Torgerson

However, yoga did not yield greater reductions in pain or improvements in overall health compared with usual care. "Although there was no evidence of pain reduction at 12 months, confidence in performing normal activities despite pain improved more in the yoga group than usual care group at 3 and 6 months," the study team notes.

In terms of yoga studies for low back pain, this study is "the largest to date, with over 300 participants, and it has the longest follow-up of any trial," investigator David J. Torgerson, PhD, from the University of York's Department of Health Sciences, United Kingdom, told Medscape Medical News.

"We followed them up for 12 months (9 months after they had finished the yoga), and found that the benefit of yoga was sustained for this length of time, probably because a proportion of participants continued to practice yoga after they had completed their formal course," he said.

Based on the findings in this study, "yoga could be recommended as a therapy for chronic low back pain," Dr. Torgerson said.

The study was published November 1 in the Annals of Internal Medicine.

Benefit "Sustained"

The study involved 313 adults with chronic or recurrent low back pain. All of them received a back pain education booklet and usual care. In addition, 156 were offered Iyengar yoga classes (12 classes total, once weekly). The yoga classes were given by 12 yoga teachers who had extra training in back care. Each class lasted 75 minutes.

In a statement, Iyengar yoga teacher and study investigator Alison Trewhela, DBL, said: "Yoga aims to treat the whole person — not just the physical." The yoga program offers "poses for pain-relief and mental calming; mobilizing, stretching, strengthening and relaxation; improving awareness of posture; education about how a healthy back functions; and positive mental focus," she explained.

Sixty percent of patients in the yoga group attended at least 3 of the first 6 sessions and at least 3 other sessions. In the first 3 months, 82% said they practiced yoga at home on their own, 65% were practicing yoga at home at 6 months, and 60% were practicing yoga at home at 12 months.

At baseline, yoga and usual care group participants had mean Roland-Morris Disability Questionnaire (RMDQ) scores of 7.84 and 7.75, respectively. Scores on the RMDQ range from 0 (best) to 24 (worst).

The researchers report that the yoga group had better back function at 3 months (the primary outcome) and at 6 and 12 months (secondary outcomes) than the usual care group.

Table. Adjusted Mean Change in RMDQ Score From Baseline With Yoga and Usual Care

RMDQ 3 Months (95% CI) 6 Months (95% CI) 12 Months (95% CI)
Yoga −2.14 (−3.00 to −1.29) −2.42 (−3.27 to −1.57) −2.04 (−2.90 to −1.19)
Usual care 0.03 (−0.89 to 0.94) −0.94 (−1.86 to −0.02) −0.48 (−1.39 to 0.43)
Difference* −2.17 (1.03 to 3.31) −1.48 (0.33 to 2.62) −1.57 (0.42 to 2.71)

*Between-group difference in means

CI = confidence interval

"Although there is no consensus, a change of 1.1 to 2.5 on the RMDQ has been recommended as clinically important," the investigators note in their report. "In this trial, we found that individuals offered yoga benefited from, on average, 2.17 fewer limited activities at 3 months and by 1.57 fewer limited activities at 12 months."

They note that they were missing data for the primary outcome for 21 yoga participants and 18 usual care participants, and differential missing data were observed (more so in the yoga group) for secondary outcomes.

The yoga and the usual care groups had similar back pain and general health scores at 3, 6, and 12 months, and the yoga group had higher scores on the Pain Self-Efficacy Questionnaire at 3 and 6 months, but not at 12 months.

Twelve (8%) of the 156 yoga patients reported adverse events; 1 adverse event was deemed as serious and possibly or probably related to yoga (the patient had experienced severe pain but had a history of severe pain after any physical activity).

The other 11 adverse events in the yoga group were nonserious and were mostly related to increased pain. Adverse events were reported in 2 (1%) of the 157 patients in the usual care group (1 accident/injury, 1 death).

Yoga Comparatively Effective

Other interventions for low back pain that have been evaluated in randomized controlled trials include exercise and manipulation, the Alexander technique, and cognitive behavioral therapy, Dr. Torgerson and colleagues note in their report.

Comparing the findings of their study with these other techniques, they say, "suggests that group yoga may improve back function (as measured by the RMDQ) more than exercise and manipulation, cognitive behavioral treatment, and 6 sessions of 1-on-1 Alexander technique but not as much as 24 sessions."

They caution, however, against "overanalyzing these results because the comparisons are indirect." Further research is needed to compare yoga directly with these other treatments, they say.

Additional support for yoga in chronic back pain comes from a study published online October 24 in the Archives of Internal Medicine.

As reported by Medscape Medical News, the study found that stretching, regardless of whether it is achieved via yoga classes or conventional stretching exercises, has moderate benefits in adults with moderately impairing chronic low back pain.

In a comparative effectiveness study, the researchers found that yoga classes were more effective than a self-help book, but not more effective than stretching classes, in improving function and reducing symptoms resulting from chronic low back pain, with benefits lasting at least several months.

The author of a comment on the article in the Archives of Internal Medicine called the results from this trial "actionable" for practice because they reinforce the evidence that exercise is safe and moderately beneficial for chronic low back pain.

"Health care providers should feel comfortable referring patients to either yoga or [physical therapy–]led classes; either seems to be helpful," writes Timothy S. Carey, MD, MPH, from the Sheps Center for Health Services Research, University of North Carolina, Chapel Hill.

The current study was supported by Arthritis Research UK. Disclosures can be viewed on the journal's Web site.

Ann Intern Med. 2011;155:569-578. Abstract

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