Yoga is more effective than either instruction from a self-care book or a traditional exercise program at improving function and reducing medication use among patients with chronic low back pain, according to a randomized controlled trial published in the Annals of Internal Medicine.¹

In 101 adults with chronic low back pain, patients who participated in a 12-week session consisting of weekly 75-minute yoga classes had improved function in daily activities compared with patients given a self-care book or those in a regular exercise group over the 3-month period (P <.001).

The benefits of yoga continued for an additional 14 weeks after the completion of classes, the study showed. In addition, after 6 months patients in the yoga group had less pain and were far less likely to take pain medications than their counterparts in either of the other groups. At 26 weeks, only 21% of yoga participants reported taking pain medication in the past week, compared with half of the patients in the regular exercise group and 59% of those who received the book, according to the new findings.

"Yoga may be beneficial for back pain because it involves physical movement, but it may also exert benefits through its effects on mental focus," conclude the study authors led by Karen J. Sherman, PhD, of the Center for Health Studies at the Group Health Cooperative in Seattle, Washington. The authors note that yoga may strengthen mental acuity, thereby increasing patients' awareness of maladaptive body movements and positioning and of the importance of relaxing muscles and relieving stress.

In the study, primary outcomes were back-related functional status as assessed by the modified 24-point Roland Disability Scale and "bothersomeness" of pain as gauged by an 11-point numerical scale at 12 weeks. Clinically significant change was considered to be 2.5 points on the functional status scale and 1.5 points on the bothersomeness scale. Secondary outcomes were days of restricted activity, general health status, and medication usage.

After adjusting for baseline values, back-related function in the yoga group was superior to the book and exercise groups at 12 weeks. There were no significant differences in symptom bothersomeness found between any two groups at 12 weeks. At 26 weeks, however, the yoga group was superior to the book group with respect to both bothersomeness and back-related function.

Viniyoga chosen as yoga technique

Participants in the yoga group learned viniyoga, a therapeutically oriented style of yoga that emphasizes safety. The classes were taught by a senior teacher of viniyoga who has written a book on its therapeutic uses.  Each class included a question-and-answer period, an initial and final breathing exercise, five to 12 recommended postures ( to be repeated 3 to 6 times each), and guidance on a deep relaxation technique. The authors point out that it is unclear whether a different yoga regimen would have yielded similar benefits.

"This study suggests that viniyoga is a safe and effective treatment for chronic back pain and provides physicians with a rationale for recommending it (and possibly other therapeutically oriented studies of yoga as well) to their patients," Dr. Sherman concludes. "Physicians should encourage their patients to choose instructors who have experience working with individuals who have back pain and who can help then manage that symptoms flare-ups that may occur as a result if the physical activity."

New study validates clinical practice

"This study is validation for what we have been doing and recommending for all these years," says New York City-based sports medicine physician Lewis Maharam, MD, the medical director of the ING New York City marathon. "Patients who have low back pain benefit from a program that includes stretching and strengthening, and we know that yoga is a very good stretching and strengthening program—when supervised by a qualified instructor."

Patients really need a good instructor who doesn't allow them to overstretch or do things that are beyond their ability, says Dr. Maharam, also the author of several books including A Healthy Back: A Sports Medicine Doctor's Back-Care Program for Everybody. As far as rheumatologists recommending yoga to patients with chronic low back pain, "I think they already are recommending this and the new evidence just reinforces the practice."

1. Sherman KJ, Cherkin DC, Erro, J, et al. Comparing yoga, exercise, and a self-care  book for chronic low back pain. Ann Intern Med. 2005;143:849-856.