Yoga may help people with low back pain more than exercise or self-help education, researchers found in a study published December 20 in the journal Annals of Internal Medicine. Participants were divided into three groups. One learned the gentle Viniyoga, which uses simple poses adapted to individuals. A second group took part in a supervised stretching, strengthening and aerobic exercise program. The third group received a self-help book about low back pain. After 26 weeks, yoga participants reported better back function, less pain and less use of pain drugs than the other two groups.
By Robert H. Shmerling, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Could yoga be the medical breakthrough back pain sufferers have long been looking for? It could be, if the results of a new study are confirmed.
Researchers in Seattle have just published the results of a study in which they randomly assigned 101 people with low back pain to one of three treatment groups:
- Viniyoga -- This type of yoga uses simple, individualized positions and attention to breathing. It was taught during weekly classes over three months.
- Exercise -- This standard aerobic, stretching and strengthening program was taught during weekly classes for three months.
- Information only --Subjects were provided with a self-help book about low back pain.
The study found that after 12 weeks, the group treated with yoga began to improve more than the other groups. By 26 weeks, they reported less pain, less use of pain medications and better back function than the rest of the study subjects.
Why is this important? Consider these facts:
- Back pain can have a significant negative impact on function and quality of life.
- Eighty percent to 90 percent of adults see a doctor at some point in their lives for back pain; for many, the problem is chronic (long-lasting).
- There is a poor understanding of why back pain develops, and no single best way to evaluate or treat it. In fact, back pain experts often give conflicting advice about what to do.
- Currently available treatments for chronic back pain are not terribly effective; even so, Americans spend an estimated $50 billion each year trying to relieve it.
The results of this new study are promising. However, news reports I've read describing this research provide too few details to be sure that yoga is highly effective for low back pain.
What Changes Can I Make Now?
Make sure your back pain is not due to a serious or dangerous condition. Doctors look for "red flag" symptoms, including unexplained weight loss, numbness or weakness in the legs, or fever. If you had recent trauma or have had cancer in the past, a potentially serious cause of back pain may be more likely. For back pain associated with any of these past or current problems, see your doctor promptly for evaluation.
Do the simple things for back pain that are backed by scientific evidence and may provide other health benefits. For example:
- Avoid bed rest. Research during the last decade suggests that bed rest actually may delay recovery.
- Review your daily routine. There may be activities, such as heavy lifting, that are triggering your pain. Simple changes, such as using a dolly or getting another person to help lift, could make a big difference.
- Try to lose excess weight. This is rarely easy, but losing just five pounds can reduce the stress on your back.
- Give it time. Many people with back pain improve within a few days or weeks. While the cause of pain and its relief are often mysterious, patience is often all you need.
If you have low back pain and the measures above aren't effective, consider treatments that might work and are unlikely to make things worse. These include pain relievers (such as acetaminophen), anti-inflammatory medications (such as ibuprofen), muscle relaxants (such as cyclobenzaprine), and exercises that stretch and strengthen the back.
Consider seeing a physical therapist or personal trainer to design an exercise program you can stick with. Yoga, massage, chiropractic care and acupuncture (among other alternative therapies) are other options in this category.
More aggressive treatments, including steroid injections and surgery, may be helpful in certain situations. However, most people with low back pain do not need these treatments.Talk to your doctor about these options and about seeing a specialist if you have low back pain that is not improving.
Be skeptical about testimonials and assurances of quick cures for back pain. It is common to hear about unproven remedies that guarantee success without risk of side effects. Unfortunately, there is no predictably effective, safe and inexpensive treatment for most cases of low back pain.
What Can I Expect Looking to the Future?
You can expect to hear more about yoga and other low-tech treatments for low back pain. Additional study should determine which types of yoga are most effective, which types of back pain are most responsive to it, and whether the benefits of yoga last beyond 26 weeks.
An important question is whether the average person with low back pain will be motivated enough to regularly practice yoga at home even after the hours spent learning how to do it. Success rates may be much lower if yoga is not practiced regularly well after the techniques are mastered.
Low back pain is an important source of misery and, in some cases, disability. So, is yoga the answer? We don't have a final answer yet. Even before we do, however, enthusiasm for this approach may grow, especially given this latest research.
