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Yoga is as effective as physical therapy for chronic low-back pain, study finds

Both yoga and physical therapy resulted in about 20 percent fewer patients taking pain medications, compared to patients in the control group.

Yoga and physical therapy resulted in about 20 percent fewer patients taking pain medications, compared to patients in the control group.
REUTERS/Mike Segar

Yoga is as effective as physical therapy for treating chronic low-back pain, a study published last week in the Annals of Internal Medicine has found.

In the study, both treatments led patients to report similar improvements in pain intensity and in their ability to be physically active — and in their overall quality of life.

Unfortunately, however, those improvements were not always clinically meaningful. In other words, the people in the study who went to yoga classes or physical therapy sessions did not have much better outcomes than those in the study’s control group, who received neither treatment.

Still, both yoga and physical therapy resulted in about 20 percent fewer patients taking pain medications, compared to patients in the control group.

A common complaint

Chronic low-back pain is a very common medical complaint. When surveyed, about a third of adults in the United States say they have experienced low-back pain within the previous three months. Most people recover from the condition within four to eight weeks, but the pain frequently returns within a year — in up to 80 percent of people, according to some research.

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Doctors typically tell patients with low-back pain to stay active. They also usually prescribe medications and physical therapy. Previous research has shown that yoga — a practice that includes physical poses, breathing exercises and meditation — can help ease the symptoms of low-back pain, but it wasn’t clear how well it compared with standard physical therapy.

Nor was it clear if yoga was effective among the people most impacted by chronic low-back pain — those with low incomes and from racial or ethnic minorities. That’s because participants in previous studies on this topic have been predominantly white and middle class.

Three groups

For the current study, a team of researchers led by Dr. Robert Saper of Boston University, recruited 320 racially diverse and predominantly low-income adults with chronic low-back pain. The participants were randomly assigned to either three months of weekly yoga classes or to 15 physical therapy sessions or to an education-only program, which involved receiving a self-help book and newsletters (mailed regularly during the study) about back pain.

At the start of the study and again at 12 weeks, the participants answered an array of questions, including ones about their level of pain and their physical activity limitations.

After three months, the participants entered a nine-month “maintenance” program.  During this period, the yoga group attended more yoga classes or practiced at home, while the physical therapy group continued sessions with a physical therapist every two months or did physical therapy exercises at home.

The participants were surveyed again at the end of the maintenance program.

Key findings

Here is how the Annals’ editors have summarized the findings for patients:

The yoga and physical therapy groups showed almost the same amount of improvement in pain and activity limitation over time. The improvements in pain and activity limitation in the yoga and physical therapy groups were also found at 1 year and were similar to each other. Yoga did not perform better than education in terms of improvement in pain and activity limitation at 3 months. However, participants in both the yoga and physical therapy groups were less likely to use pain medications at 3 months compared with the education group.

Other measurements (satisfaction and quality of life) were similar between the physical therapy and yoga groups. A similar number of participants in the yoga and physical therapy groups reported mild joint and back pain as side effects of the treatment.

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So, yes, the outcomes for the groups that received the yoga and physical therapy were similar — but only modestly better than those for the nontreatment group. In fact, none of the groups had very impressive outcomes. As an accompanying editorial points out, “half of yoga participants, two thirds of [physical therapy] participants, and three quarters of education participants did not achieve [a clinically meaningful response].”

The findings about yoga echo those of a Cochrane review published earlier this year. That meta-analysis (a study that analyzes the strongest previous research on the topic) also found that any positive effects from yoga on low-back pain were often too small to be clinically important.

That’s discouraging. What was encouraging in the Boston University study, however, was the finding regarding the use of pain medication. At 12 weeks, the yoga participants were 21 percent less likely and the physical therapy participants were 22 percent less likely to be taking pain medications than the education-only group.

Unfortunately, that reduction in pain medications appears to have been primarily in the use of over-the-counter drugs, rather than in the use of prescription opioids.

FMI: An abstract of the study is on the Annals of Internal Medicine’s website, but the full study — and the editorial — are behind a paywall, even though the research was supported with taxpayer money through grants from the National Center for Complementary and Integrative Health (NCCIH), which is part of the National Institutes of Health. The Annals’ summary of the study can be read in full on the website, however. You’ll find more information about chronic low-back pain, including a video on “Yoga for Health and WellBeing,” at the NCCIH’s website.