Peter Wehrwein

Yoga can help ease low back pain

You might have read about a study published last week in the Archives of Internal Medicine that showed yoga helps with low back pain.

Now there’s similar study out today in the Annals of Internal Medicine (one must be careful about confusing the Annals with the Archives!). British researchers compared a 12-week yoga program with usual care provided by the National Health Service (please hold your wise cracks about the National Health Service). Their results showed that yoga classes were more effective than routine care at improving “back function,” which means it reduced back-related problems that interfered with everyday activities like walking, standing, climbing stairs, and so on.

Yoga wasn’t a total success, though. The 156 people in the yoga group reported pain levels that were similar to the 157 randomly assigned to get usual care.

Last week’s yoga study

Like today’s study in the Annals, last week’s study in the Archives was sizable (228 volunteers), which is usually a good sign. Too many studies of yoga—and of alternative medicine in general—have too few subjects, so they can’t be anything but the trial balloons of health research: creative and thought-provoking but rather easily shot down.

Other good things about the Archives study: it was conducted by investigators in the research branch of Group Health Cooperative, a large nonprofit health care organization in Seattle with an excellent reputation, and was funded by National Center for Complementary and Alternative Medicine, which is part of the National Institutes of Health and was created about 10 years ago for the express purpose of evaluating nontraditional treatments like yoga in well-designed trials.

Yoga vs. stretching

The Archives study included a small “self-care” group for comparison purposes. But what makes the study stand out—and, in my opinion, more interesting than the British study in the Annals—is that the main comparison was between yoga and exercise classes that were specially designed for the study. The exercise classes included some warm-ups and strength exercises, but most of the time (about 50 minutes) was spent taking people through 15 different stretching exercises targeting the trunk and legs.

As the study’s lead investigator, Karen Sherman, noted in a video made by Group Health to publicize the study, the yoga and the exercise classes were pretty similar from a physical perspective. She also points out that all that stretching, done carefully for almost an hour, may have had some of the relaxation effects of yoga.

So you might say the study compared yoga with the very yoga-like.

And the results showed that it ended in a tie, with yoga and the exercise classes having a similar effect on people’s back pain, as measured by self-reported “bothersomeness” and, as in the British study, by the effect on back-related problems with walking, standing, and so on.

Yoga becomes practical

So where does this leave us? Several thoughts come to mind.

First, it’s been shown over and over again that while exercise may not cure all that ails us, it can reliably ameliorate many conditions. The problem is getting ourselves to “just do it”—and in a regular way. My hunch is that yoga does have some special—perhaps unique—effects on people. But any endeavor that creates some kind of obligation to exercise is likely to be beneficial if it induces regular exercise, be it yoga classes, muscle-stretching exercise classes, zumba workouts, or simply a regular walk.

Second, yoga is now commonly available. Virtually every health club and Y offers yoga classes, and yoga studios seem to be everywhere. Because it is so common, yoga has the added advantage these days of being a practical choice.

In an email to me, Karen Sherman, the Group Health investigator, agreed that yoga classes will be more accessible to back pain patients than specially designed stretching classes. “However, there will be some people who would find yoga ‘weird’ or ‘against their religion’ and for those folks, I hope some PTs [physical therapists] offer an intense stretching class,” Sherman wrote.

But I wonder whether yoga has lost most, if not all, of its weirdness factor because it is so common. What do you think?

And a third thought: while yoga is generally safe, if you are using it to treat a condition, it’s good idea to talk it over with the doctor who is treating that condition, especially if the condition is back pain.

Yoga may be good for many bad backs, but it may be too much for some of them. In the British study published in the Annals, five (3%) study volunteers who were randomized to yoga reported that their back pain increased and that the increase was related to yoga. Three others had pain elsewhere that they believed was related to yoga.

And in the Group Health study in the Archives, 13 of the 87 (15%) yoga class participants reported mild to moderate problems that were mainly related to back pain, and one person suffered a herniated disc.

Comments:

  1. Cassie Miller

    This is true that yoga can really help lower back pain that really can help everyone especially those dancers. It can also relieve stress and can be a mind relaxing exercise. The good thing is that everyone can do it by doing the steps gradually so you can perform it well. Maybe its good to do it with full mind set and no other emotions will bother you.

  2. Vince

    Yoga is gaining popularity more and more these days especially when speaking of treatment on back pains. I never tried this before but I know a lot of people recommend this because it works on them.

  3. kathleen

    Although no one treatment works for everyone, many aspects of yoga make it ideal for treating back pain and neck pain. For example, studies have shown that those who practice yoga for as little as twice a week for 8 weeks make significant gains in strength, flexibility, and endurance, which is a basic goal of most rehabilitation programs for back pain or neck pain.

  4. kathleen

    Thank you for this blog post, it was just what I was looking for.

  5. eden

    i love yoga thanks for this blog.

  6. Peter Bloch

    Possibly the best way to deal with chronic low back pain that is not caused by serious medical conditions will prove to be the Alexander Technique. A major study published in the British Medical Journal in 2008 found that 24 lessons in the technique reduced chronic low back pain by an average of 86% even a year after the lessons were completed. A similar large Randomised Controlled Trial (RCT)is just starting in England to determine the effectiveness of the technique for neck pain. Results are expected to be similar to the back pain study.

  7. Eduardo Barrera

    As a self-proclaimed divorce counselor for stretching… an exercise itself cannot hurt you. Stretching in the ways we were taught is showing its harm primarily in the ways people are moving without awareness or being proprioceptively challenged. By forcing a range of motion, the stretch reflex can kick in and the muscles re-contract back to a set point.

    Thus the exercise or pose is not what is the problem… it is relearning how to move and this is where our healthy animals can show us the way through the act of pandiculating or as it is known, pandiculation.

    Animals naturally stretch or so we thought. They are actually contracting their muscles, ie shortening them and then allowing them to release. This partial or entire body act is what we did as children to relax our muscles and nervous system.

    The next time you wakeup in the morning and stretch – pay attention to what it is you are contracting and letting go of. This level of awareness changes your nervous system.

    In 1680, you may recall that Herman Boerhaave, the founder of clinical medicine noted that a pandiculation can relax the muscles.

    Fast forward to 1990, where Thomas Hanna wrote Somatics and showed us a system of exercises, known as somatics exercises which are merely systematized pandiculations to help us re-learn how to move well and mitigate noxious signals.

    When we attempt any exercise or yoga movement… if done with a conscious awareness of what we are doing while we are moving and then backing away… we can cortically inhibit unwanted muscular contractions thus easing & regaining mobility, restoring natural flexibility and feel our pains go away.

    This readjustment of our nervous system means we can modify movements in yoga or any other exercise platform and use pandiculation for the very therapeutic and restorative means it has been reported for the past few hundred years.

    I’m waiting for the brain images to confirm what many people have experienced in moments… back relief made easy and simple by restoring natural movements so we can go to a yoga class or do exercise to our heart’s content.

    Eduardo Barrera
    Hanna Somatic Educator
    Gravity Werks

  8. Anonymous

    Yoga is indeed becoming as one of the most effective management for low back pain. However, one should never overdo it, otherwise back pain might aggravate. Hence, it is safe to seek medical approval before enrolling into a yoga class if back pain is a problem experienced.

  9. adrien olds

    yoga is the best way to keep some one fit . and removing the back pain is like getting back your spinal chord in a new way .which makes you feel free and confident.Master Your Mind, Body, And Spirit with Acteva!

  10. RK Sangha

    Yoga is one of natural means to maintain or regain personal health naturally.
    RK Sangha
    [URL removed by moderator]

  11. Michelle

    I’m a yoga teacher in England, teaching five classes per week to 15 – 20 students per class, as well as working with private clients. I recently asked all of my students for testimonials and feedback, and was amazed to hear how many of them had come to yoga because of injuries from other sports, back pain, shoulder pain and the like. Now, they are able to do things like touch their toes comfortably, bend backwards and move in ways that may have felt impossible at one point. One man had acute sciatica last Christmas, could barely walk, and six months later, with only one class per week, he says his back feels great in a way that he never imagined was possible. Other people in class have overcome their injuries and are playing sports again with increased strength and stamina because of their yoga practice. It’s amazing what yoga can do, aside from what the double-blind studies say. Just ask the people who do yoga, or give it a try yourself. Even if you’re a skeptic.

  12. Anand

    If you want to go for a good program of yoga teacher training than you should know that what they are providing in their course. One should aware in finding the difference in their basic and advanced course. To become a great yoga teacher you should have solid foundation and knowledge about basic skills. Here we are offer training programs for yoga teachers with at least 200 hours. We are having training with Cain Carroll, who is known for his worldwide teachings of yoga, meditation and self-healing.

  13. Mike V

    I never tried yoga before, but I know it works from other people. When I first experienced back pain a friend recommended a massage cane (trigger point therapy tool) called Body Back Buddy and because the tool had a great effect I was never forced to look on other alternatives.

    Mike V
    [URL removed by moderator]

  14. MA

    Yoga is a great way to help reduce or eliminate minor back pain. We have recommended this to our dancers and stunt actors and it seems to be working out great.

    – MA
    [URL removed by moderator]