Yoga for chronic low back pain

I often recommend Yoga to my patients as an excellent way to strengthen and relax the body and mind.   I fully believe it is an excellent practice but as a health professional I must ensure the safety and well being of my patients so I have the research to back up my recommendation.

Research into yoga for back pain 

A literature review done in 2007 found three published randomized controlled studies evaluating the effectiveness of yoga for low back pain (LBP) and one feasibility study.   All 3 studies found yoga to be beneficial for low back pain.  

Galantino et al., in 2004 studied the effects of a modified yoga protocol on patients with CLBP (chronic low back pain).  22 subjects were randomized into 2 groups including 11 in the yoga group and 11 in the control group.  The yoga group received 1 hour session twice weekly for 6 weeks and asked to practice as often as possible throughout the week.  Results were not powered for statistical significance (small group sizes) but the potentially important trend appeared of decreased depression and improved flexibility and balance in patients with CLBP undergoing a yoga intervention.

 In 2005 Williams et al., evaluated a lyengar yoga intervention where the yoga group received a 90 min class weekly for 29 weeks and patients were encouraged to practice yoga at home for 30min, 5 days per week.   The control group received periodic educational material as well as two 1-hr lectures. The authors of this study concluded yoga therapy could significantly reduce disability and pain and decrease use of medications in patients with CLBP.

 Sherman et al., conducted an RCT in 2005 to compare yoga classes to conventional exercise and self care books in patients with LBP.  101 Participants were randomly assigned to one of the three interventions including 36 participants to the yoga class, 35 to the conventional exercise class, and 30 to the self-care book.  The authors concluded that yoga was more effective than a self-care book in reducing pain and improving functional status in patients with CLBP. Furthermore, they stated these benefits appeared to persist for at least several months after intervention. On the other hand, while the yoga group consistently reported superior outcomes compared to the exercise group, none of these differences was statistically significant. Finally, the authors noted the yoga intervention was safe and had moderately good adherence. In conclusion, the authors suggested that the Viniyoga style of yoga was an effective and safe treatment for patients with nonspecific CLBP.

 Take home points:

• Yoga can be an effective management tool for people suffering with low back pain
• Yoga can decrease pain, disability, and medication use as well as increase flexibility
• Patients and practionner should understand that differently styles of yoga exist and some may be better suited for low back pain than others.
• Patients should be directed to seek out experienced instructors who have worked with low back pain patients in the past.

 

 

 Sources: 

Sorosky, S., Stilp, S., & Akuthota, V. (2007). Yoga and pilates in the management of low back pain Current Reviews in Musculoskeletal Medicine, 1 (1), 39-47 DOI: 10.1007/s12178-007-9004-1

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