Yoga may benefit some people with chronic low-back pain, although any improvement in either function or pain relief is likely to be modest, according to a new Cochrane review.
The authors of the review also say they were unable to determine whether yoga is more effective than other forms of exercise at relieving low-back pain, due to a lack of research comparing the two approaches.
Yes, these findings are rather underwhelming. But any treatment that offers even modest help in relieving low-back pain and is generally inexpensive and without negative side effects is welcome news, particularly given how many millions of people suffer bouts of low-back pain each year.
As the Cochrane reviewers point out, their findings will help low-back pain sufferers “make more informed choices about their future treatment options.”
A common complaint
Low-back pain is an exceedingly common medical complaint and a leading reason people visit their doctor or call in sick to work. Up to 80 percent of Americans experience significant low-back pain at some point in their lives, and during any three-month period, almost a third of U.S. adults report having at least one day of such pain, according to the Centers for Disease Control and Prevention (CDC).
Although low-back pain is sometimes linked to a specific disease or medical condition, most cases have unknown causes. Treatments for low-back pain typically include over-the-counter medications, physical therapy and, in rare cases, surgery. Research has also shown that cognitive behavioral therapy and mindfulness-based stress reduction can be helpful. A major study published last year concluded that prescription pain medications (opioids) were generally not effective at treating low-back pain.
Many people recover from low-back pain within a few days or weeks, no matter what treatment is used. But often the pain lasts much longer, leading to a diagnosis of non-specific chronic low-back pain (pain that lasts more than three months and for which there is no obvious cause). Such pain can be debilitating.
The new Cochrane review is a meta-analysis. Its authors pooled data collected from 12 randomized controlled trials (considered the “gold standard” for measuring the effects of treatments on humans) that had compared the effectiveness of yoga with other interventions for easing low-back pain. These studies, which were conducted in the United States, India and the United Kingdom, involved 1,080 participants who were mostly between the ages of 34 and 48.
The comparison interventions included non-yoga forms of back-focused exercise, no exercise, and educational programs (such as booklets and/or lectures) that taught self-care. Some of the studies involved more than one non-yoga approach.
The type of yoga used in the studies varied, but the most common was a form of Hatha yoga known as Iyengar. In addition to physical yoga poses (which were specifically chosen for the treatment of low-back pain), the yoga interventions also included meditation, relaxation and/or breathing exercises. Participants attended yoga classes taught by experienced instructors, but were also encouraged to practice yoga at home.
The Cochrane researchers analyzed data regarding several outcomes — but particularly back function and back pain — at follow-up periods of one month to one year. They found “moderate-certainty” evidence that yoga is more effective than nonexercise interventions for reducing pain at three to four months and for improving back-related functioning at six months.
That discovery could be viewed as vindication for yoga advocates, who have long claimed that yoga can help people with chronic low-back pain. However, the meta-analysis also found little clear evidence that yoga was any more beneficial than other forms of back-focused exercises.
Furthermore, the positive effects from yoga on low-back pain were often too small to be clinically important. In other words, the improvements observed in the studies frequently had little impact on the back-pain sufferers’ daily lives.
Nor was the yoga intervention risk-free. About 5 percent of the yoga participants across the 12 studies reported increased back pain, although this risk appears to be similar to that of the people assigned to other back-focused exercise programs. Yoga was not associated with any serious adverse events.
Many questions remain
“It is uncertain whether there is any difference between yoga and other exercise for back-related function or pain, or whether yoga added to exercise is more effective than exercise alone,” the Cochrane reviewers conclude.
Better, larger studies involving more diverse groups of people are needed, they stress, to determine with any confidence the short- and long-term benefits of yoga for people with low-back pain.
In the meantime, “the lesson for consumers is, if you have chronic low back pain and you’re interested in trying yoga, and your doctor agrees, it’s worth a try,” said Susan Wieland, the lead author of the Cochrane review and an assistant professor at the University of Maryland’s Center for Integrative Medicine, in an interview with Reuter’s Health. “But be sure you’re attending a yoga class where the yoga is designed to be helpful and safe for people with back issues. And make sure your teacher is well trained. It will minimize your chances of injury and maximize your chances of seeing a benefit.”
FMI: The study is behind a paywall, but you can read an abstract on the Cochrane Database of Systematic Reviews’ website. You’ll find more information about chronic low-back pain, including a video on “Yoga for Health and WellBeing,” at the National Center for Complementary and Integrative Health’s website.