Almost everyone gets low back pain at some point in life. But for millions of Americans, the pain turns chronic and adversely affects their quality of life.

Unlike many medical conditions, chronic back pain has no one-size-fits-all treatment. The usual approach – a combination of physical therapy and medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) – often fails to relieve pain and can lead to complications such as severe stomach bleeding.

“There aren’t a huge number of treatments that seem to be highly beneficial for people with what we call garden-variety, mild-to-moderate low back pain. So people are always looking for something new,” says Karen Sherman, Ph.D., associate professor of the department of epidemiology at the University of Washington in Seattle.

Sherman is an internationally recognized expert on complementary and alternative (CAM) treatments for musculoskeletal conditions. Among her special interests: yoga for low back pain.

“Yoga is certainly a viable option for people who are willing to practice it,” says Sherman, who has conducted studies to assess the benefits of this ancient Indian practice.

Sherman’s most recent study was published in the Oct. 24, 2011 issue of the Archives of Internal Medicine, an influential peer-reviewed medical journal. For the study, Sherman and her colleagues at the Group Health Research Institute in Seattle recruited 228 adults with longstanding back pain and assigned them to one of three interventions:

• Viniyoga-style yoga, which emphasizes postures, breathing exercises, and guided deep relaxation.
• Conventional stretching exercises.
• Self-care with the assistance of a book that discussed the causes of back pain and offered advice on exercise, lifestyle changes, and managing flare-ups.

During the 12-week study, the yoga and stretching groups participated in weekly classes and were asked to practice 20 minutes per day on the other days of the week. Their progress was assessed by questionnaire at 6, 12, and 26 weeks after the study began.

At the start of the study, all participants rated their daily disability level on a scale of zero to 23, with 23 being the most severe. After 12 weeks, the average score in the yoga group had decreased from 10 to four or five while the average score in the stretching group decreased from nine to four or five. The self-care group experienced a significantly smaller decrease: from nine to seven.
Similar improvements were seen in measures of pain. In the yoga group, 60 percent reported improvements in pain. In the stretching group, reported pain improvement was similarly impressive: 40 percent. But the self-care group reported a significantly smaller improvement: just 16 percent.

As an added benefit, 40 percent of the yoga and stretching groups reported that they were able to cut back on pain medications such as NSAIDs compared to only 20 percent of the self-care group. At the start of the study, about 60 percent of all participants were regularly taking pain medications.

After 26 weeks, the yoga group continued to report significantly greater function compared to the self-care group. But at no point during the study was yoga superior than stretching, suggesting that both interventions are equally effective at relieving pain.

“The yoga classes we taught were designed to progressively teach people how to relax and strengthen their back muscles and stretch the nearby muscles in the hip area, and perform lateral bending and gentle twists,” Sherman says. “Then they learned how to customize things for themselves.”

Viniyoga-style yoga is a gentle practice designed to be incorporated into daily life and increase awareness of activities that relieve or exacerbate pain. “It isn’t power yoga or hot yoga with intensive flows,” Sherman says. “You’re not being violent to your body.”

The stretching class focused solely on stretching. Unlike the yoga class, it did not include relaxation and breathing exercises.

To maintain the benefits, participants probably will need to continue with their yoga or stretching regimens, Sherman says. “But everybody’s pain trajectory is just a little bit different,” she adds. “Some people have pain all the time and they’ll discover empirically that they need to keep on doing this, and they’ll get a sense of how often. Other people might go down to a dull roar with the pain and only need to do it when the pain flares.”

A week after the release of Sherman’s study, a similar study was published by British researchers in the Annals of Internal Medicine. Participants included 313 back-pain patients, most of them middle-aged women who had suffered for an average of 10 years.

All of the participants continued with usual care such as medication, massage therapy, or chiropractic treatment. Half of the participants enrolled in a 12-week class based on the asana and pranayama forms of yoga, which included a variety of relaxation and mental-focus techniques. The other half simply continued with their usual care.

At the end of the study – as well as three and six months thereafter – the yoga group reported significantly better function than the usual care-only group. Although there were no group differences in pain and general-health scores, the yoga group reported greater confidence in their ability to perform usual activities of daily living.
“Their study showed comparable benefits to our study,” Sherman says. “So both studies corroborated smaller, previous studies showing that yoga is an option for people with moderately impairing back pain.”

Tips For Finding a Back-Friendly Yoga Class

Here are some of Dr. Sherman’s recommendations:

• Try a gentle form of yoga that’s appropriate for people with back pain.
• Look for a therapeutically-oriented instructor who has experience working with people who have chronic back pain.
• Check out the class before you sign up for it.
• Talk to people who have participated in the class.
• Avoid classes that could be considered aerobic exercise.

“You could try the viniyoga style we tested,” Sherman says. “Or you could try a lyengar yoga class, a hatha yoga class, or possibly other different types of yoga that are geared for people with back pain.  It’s probably more what you put into the class than what you call it.”

“Hopefully, you want a full-body yoga class which includes components other than body movement such as relaxation and breath awareness,” she adds. “Many people will find that yoga is a more attractive way to stretch than conventional stretching exercises because it has other benefits and makes you feel good in a different kind of way.”

Tell Us What You Think Of This Story.   Share your comments below.

Schedule a Wellness panel

SCHEDULE A SCREENING