The Effect of a Stretch and Strength-Based Yoga Exercise Program on Patients With Neuropathic Pain Due to Lumbar Disc Herniation

Pelin Yildirim, MD; Alper Gultekin, MD

Disclosures

Spine. 2022;47(10):711-719. 

In This Article

Abstract and Introduction

Abstract

Study Design: Randomized controlled trial.

Objective: To investigate the effect of a stretch and strengthbased yoga exercise program on neuropathic pain due to LDH.

Summary of Background Data: LDH with neuropathic pain influences treatment outcomes negatively. Most yoga poses include the parameters of spinal training and help reduce pain and disability in patients with low back injuries. We hypothesized that yoga positively affects both LDH and neuropathic pain by increasing mobilization, core muscle strength, and spinal and hamstring flexibility.

Methods: In total, 48 patients with neuropathic pain due to LDH were randomly assigned to a control group and a yoga group. All patients underwent a patient education program. In addition, the selected yoga exercise was taught and performed to the yoga group for one hour twice weekly for 12 weeks. Neuropathic pain (Douleur Neuropathique 4 for diagnosis; Leeds Assessment of Neuropathic Symptoms and Signs for severity), low back pain (the short-form of McGill Pain Questionnaire), disability (Oswestry Disability Index), and function (modified Schober and passive knee extension test) were measured blind before and at the one-, three-, and six-month follow-ups. The patient global assessment was applied at the six-month followup. The intention-to-treat analysis was performed in this study.

Results: The intention-to-treat analysis showed a statistically significant difference in neuropathic pain, patient global assess ment, low back pain, disability, and function in favor of the yoga group at post-treatment. The between-group effect sizes were moderate at six-months follow-up.

Conclusion: It was determined that the selected stretch and strength-based yoga exercise could be a promising treatment option for neuropathic pain due to LDH.

Level of Evidence: 2

Introduction

Neuropathic pain is a complex heterogenous disorder that causes loss of function and disability and whose pharmacological management involves many decisions related to treatment costs, duration, and adverse effects. In addition, the number needed to treat for all first-line drugs that reduce pain is in the range 3.5 to 7.7,[1] and these drugs can lessen pain by 30% to 50%.[2] Lumbar disc herniation (LDH) is considered one of the most common causes of neuropathic pain and results from compression of one or more spinal nerve roots.[3] LDH with neuropathic pain influences treatment outcomes negatively. A recent article concluded that low back pain (LBP) often has an under-recognized neuropathic component, which can be challenging to manage and requires improved treatment strategies.[4] Although a new and rapidly growing area within pain research has begun to focus on exercise-induced changes due to neuroplasticity, the scarcity of randomized controlled studies hampers the utilization of exercise as a therapeutic tool for patients with neuropathic pain.[5]

An effective rehabilitation protocol for LDH should increase spinal stability, which is necessary to permit and control movement, carry loads, and protect the spine and nerve roots. Research suggests a dose-response relationship between the loading and disc regenerative processes.[6] A variety of exercise programs has been proposed for the treatment of symptomatic LDH, such as activity as usual, McKenzie exercises, flexibility exercises, and core stabilization exercises.[7] It was also demonstrated that lumbar radiculopathy could be treated effectively with spinal mobilization with leg movement.[8] Most yoga poses involve spinal training, such as mobilization, breathing, and balance, as well as provide core strengthening with lower extremity stretching.

A recent meta-analysis reported that yoga is effective in improving pain and disability in individuals with LBP,[9] but there is insufficient evidence to recommend the use of an exercise program as a stand-alone treatment for neuropathic pain due to LDH.[9–11] We hypothesized that yoga positively affects both LDH and neuropathic pain by increasing mobilization, core muscle strength, and spinal and hamstring flexibility.

Therefore, the primary purpose of this randomized clinical trial was to investigate the effect of a stretch and strengthbased yoga exercise program on neuropathic pain and patient global assessment. Second, we evaluated LBP, disability, and spinal and hamstring flexibility to answer the hypothesis that increasing the latter reduces pain and disability.

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