Yoga for low back pain as effective as stretching exercises: Study

By Dr. Ananya Mandal, MDOct 25 2011

Study shows that weekly yoga classes eased pain and improved functioning in some people with chronic lower back pain. However the effects of yoga were not much different from usual stretching exercises.

The latest study shows that participants in both types of classes had better functioning and fewer symptoms after three months than back patients who were only given a book with advice on preventing and managing pain.

“We've known for a while... that exercise is good for back pain,” said Dr. Timothy Carey, from the University of North Carolina, Chapel Hill, who wrote a commentary published with the study. Yoga, he added “seems to be a perfectly good option for people with back pain, but it is not a preferred option.”

Finding that yoga and stretching had about equal effects means it was probably the stretching involved in yoga - and not the relaxation or breathing components of the practice - that helped improve functioning and pain symptoms, researchers report today in Archives of Internal Medicine.

The study involved 228 adults with long-lasting back pain who were divided into three groups. Patients in the first two groups went to either weekly yoga or stretching classes for 12 weeks and were asked to practice on their own between classes. Both types of classes focused on stretching and strengthening the lower back and legs. Patients in the third group were given a book with back pain-related exercise and lifestyle advice and information on managing flare-ups.

After the 12-week program, people who had gone to the group classes reported significantly lower scores on a questionnaire measuring how much pain interferes with daily activities, compared to those given the book. The questionnaire rated daily “disability” level on a scale of zero to 23, with 23 being the most severe.

At the 12-week mark, the exercise groups had dropped from an initial average score of 10 in the yoga group or nine in the stretching group to between four and five in both groups. The people who received the book started with an average score of nine and at 12 weeks had dropped to about a seven.

Additionally 60 percent of people in the yoga group reported improvements in pain, compared to 46 percent in the stretching classes and just 16 percent of people who only got the books. And at both the end of class sessions and three months later, twice as many of the class participants reported cutting back on pain medications, such as non-steroidal anti-inflammatories (NSAIDs) - about 40 percent versus 20 percent in the book group.

“Here is an option that is something worth trying,” said Karen Sherman from the Group Health Research Institute in Seattle, who led the study. With either stretching or yoga classes, she said, practice is a must for patients. “There is absolutely no treatment that works for everybody... (but) if they're willing to practice, they should go ahead and give it a try.”

Carey said the findings suggest that the best type of exercise for people with back pain depends on their preferences and what's convenient. “It's important that people do exercise they enjoy,” he said -- that way, they're more likely to stick with it. And, “you don't need to drive 50 miles to the nearest yoga class if there's not one near you,” Carey added.

Scott Duke, a sports chiropractor in New York City who was not involved in the study, says he's not surprised by the results. “I recommend flexibility exercises to every single lower back pain patient I have,” he says. “Therapeutic stretching combined with relaxation and deep breathing absolutely helps low back pain.” The study should encourage physicians to incorporate stretching into their standard treatment protocol for back pain, Duke says. “Doctors today are looking for ways patients can be more proactive and take care of their own back pain, versus having to go to somebody to get treated,” he adds.

Sherman said attending a single yoga or stretching session costs about $20, but probably varies in different parts of the country. That would be cheaper than other options for managing lower back pain, such as acupuncture and massage or talk therapy. And, she added, “Once a person learns how to do these in a way that's safe for them, they can do them on their own.” While the study didn't include people with severe back pain - so the findings don't necessarily apply to them - Carey said that “almost anyone with back pain can benefit from stretching exercises.”

“Find a class geared toward beginners, and an instructor who has experience working with and making adjustments for people with chronic pain,” Sherman recommends. “Go to class, practice at home, and see if it works. And if not, try another class.”

The study was funded by the National Center for Complementary and Alternative Medicine. Roughly 80% of adults experience low back pain at some point in their lives, and as many as 8% will experience chronic symptoms that last three months or longer. Primary care physicians regularly prescribe painkillers and muscle relaxants to these patients with varying degrees of success, or refer patients to physical therapists, chiropractors, or other specialists.