Chronic back pain is a common and vexing problem. Suggested treatments range from the relatively benign (exercise and OTC anti-inflammatory medications) to more invasive approaches including implanted pain control devices and surgery. In some cases, the type of treatment that is recommended depends on the type of practitioner seen for the pain:
- Chiropractors like to manipulate backs
- Back surgeons like to operate
- Busy primary care docs like to prescribe drugs and physical therapy
- Homeopaths prescribe homeopathy
You get the picture, right? Now there is proof that a more or less do-it-yourself option for treating chronic back pain seems to produce pretty good results: yoga.
Here is what we know about yoga and back pain
Here is what we know about the impact of yoga on chronic back pain from a randomized trial in the UK, published in the Annals of Internal Medicine (Tilbrook et al, vol 155, pp 569-578, 2011). Patients were recruited from 39 general practices. They all had to fill out a questionnaire, the Roland Morris Disability Questionnaire or RMDQ) that helped the researchers to assess the severity and impact of their back pain. They needed a score of at least 4 to be eligible to participate. In addition, they could not have performed yoga in the previous 6 months, had to be able to use stairs and get up off the floor, not be pregnant or have life-threatening conditions. They were also excluded if they had prior spinal surgery, severe psychiatric or substance abuse problems or evidence of neurologic deficits related to their back pain.
Patients were randomized, using a computer-generated program, to either a yoga program or usual care (i.e., whatever GPs usually do for back pain). Everybody in the study got a back pain education booklet, but only the intervention group got the yoga program.
Yoga classes were taught by 20 experienced yoga teachers who attended training sessions so that the classes would be more or less the same. The instructors followed a yoga program “adapted appropriately for low back pain” including asana (poses), pranayama yoga breathing, relaxation techniques, mental focus and yoga philosophy. The program was delivered in twelve 75 minute classes (one class per week) and participants were given a relaxation CD as well as home practice information sheets. They were encouraged to practice yoga 30 minutes a day at least two times per week and to use the CD. Sixty per cent of participants offered the yoga program stuck to it. Of the remaining, 26% attended at least one class and 15% did not attend any classes.
Back function was measured at baseline and at 3, 6 and 12 months using the RMQD. Participants were also administered the physical and mental health Short Form (SF-12) Health Survey, the Aberdeen Back Pain Scale, the Pain Self-Efficacy Questionnaire (PSEQ) and the EuroQol-5D health index at 6 and 12 months. They were also asked to report on the number of days spent in bed, the number of days with restricted activity, and medication and health care use, class attendance, and use of yoga at home.
What the research showed was that the yoga group had better back function at 3, 6, and 12 months compared to the usual care group. Although both groups has a mean baseline RMDQ score of almost 8, at month three the yoga group reduced that score by 2.14 compared to only 0.03 for the usual care group. Differences between the two groups remained to month 12, however the results did not meet statistical significance. The yoga group also showed higher pain self-efficacy scores than the usual care group at 3 and 6months, but not at 12 months. Twelve yoga participants had an adverse event during the study (only one was serious – severe back pain in a person with a history of severe pain after any physical activity) and 2 usual care participants experienced severe adverse events (one injury/accident and one death unrelated to the intervention).
The authors compared their results to those found in other high quality randomized, controlled trials. As a result, they suggest that yoga may improve back pain and function more than exercise, manipulation, or cognitive behavioral treatment, or 6 sessions of the Alexander Technique. Only 24 sessions of Alexander were better than yoga at reducing back pain. These comparisons have to be accepted with caution, however, as they did not involve head-to-head comparisons of the different types of interventions.
So there you have it. This well done, peer-reviewed study documents that yoga is safe and effective for chronic back pain. It can also be accessed by back pain sufferers on their own – no prescription needed. My husband, a former marathon runner had chronic back pain for many years. It was so bad that at one point he required a several day inpatient stay to control the pain. About 10 years ago, we started doing yoga, guided by our personal trainer Elizabeth. Now, it is a regular part of my husband’s exercise routine. He rarely has episodes of back pain anymore and when he does, he immediately applies his yoga therapy. Now this is an anecdote, not a study. But for this “N of 1” it works like a charm.