Yoga and physical therapy may help relieve chronic lower back pain, and may also help people with the condition sleep better, according to a study published this week in the Journal of General Internal Medicine.
The study also reports that these benefits can, in some cases, continue for months after the therapies have ended.
The findings suggest that yoga and physical therapy may serve as effective non-drug treatments for chronic lower back pain and the sleep problems associated with it. Medications used for both back pain and sleep problems can have serious side effects, including the risk of opioid addiction and overdose.
“Identifying holistic ways to treat these conditions could help decrease the reliance on these medications as well as keep patients safer and more comfortable,” said Eric Roseen, the study’s lead author and a researcher in the department of family medicine at Boston Medical Center, in a released statement.
A widespread condition
Low-back pain is a common medical complaint in the United States and a leading reason people visit their doctor or call in sick to work. About 80 percent of Americans experience significant low-back pain at some point in their lives, and during any three-month period, more than a quarter of U.S. adults report having at least one day of such pain, according to government data.
Chronic low back pain is defined as pain that lasts more than 12 weeks. About 20 percent of people who experience acute lower back pain go on to develop chronic pain. Sometimes the source of the pain can be linked to a specific medical condition, but more often the cause is unknown.
Sleep problems are common among people with chronic low back pain. One study found that almost 60 percent of people with the condition report that their sleep is regularly disturbed.
How the study was done
For the current study, Roseen and his colleagues conducted a randomized controlled trial. The main purpose of the study was to see if yoga and physical therapy could improve the pain and physical function of people with lower back pain. But the researchers also analyzed the data to see if the two treatments had an effect on quality of sleep.
The study included 320 volunteers, aged 18 to 64, who had sought care for lower back pain at the Boston Medical Center or seven other clinics in the Boston metropolitan area. More than 90 percent of these patients reported poor sleep.
The participants were randomly assigned to one of three treatment groups for the 12-week study. One group attended 75-minute weekly yoga classes. They were also encouraged to practice yoga at home for 30 minutes each day by using a DVD and a home practice manual. Another group received 15 one-on-one sessions with a physical therapist. In addition to physical therapy work, the hourlong sessions included supervised aerobic exercise. Participants were encouraged to practice at home what they learned from the physical therapist, and to log the number of exercises they did daily.
The rest of the participants were assigned to a “control group.” They received a handbook that included information on how to self-manage their back pain, including instructions on stretching, muscle strengthening and other self-care strategies. The handbook also contained a chapter on solutions for sleep problems.
The participants of all three groups filled out three sleep-quality questionnaires: at the start of the study, at 12 weeks (the end of the study) and at 52 weeks. Changes in back-related pain and physical function were also assessed at various points up to a year after the study began.
After all that data was analyzed, the researchers found that all three groups reported modest improvements in the quality of their sleep after 12 weeks, although those in the yoga and physical therapy groups tended to improve more.
These changes in sleep quality weren’t that significant, however. Compared to the control group, about 10 percent more yoga and physical therapy participants experienced a clinically significant improvement in their sleep. But at 52 weeks — months after the study had concluded — the participants in the two interventions groups tended to report significantly greater improvement in sleep than those in the control group. That was particularly true for the people who took the yoga classes.
The study also found that people in any of the groups who experienced improvements in their pain at six weeks were 30 percent more likely to report they were sleeping better at 52 weeks than those whose pain had not lessened at the six-week mark.
Limitations and implications
This study comes with caveats, of course. Most notably, not all the participants reported having sleep problems at the start of the study, a factor that could have affected the results. Also, the participants self-reported the quality of their sleep throughout the study, and such self-reports can be unreliable.
Despite these limitations — and despite the study’s rather modest results — the researchers believe their findings suggest that both yoga and physical therapy show promise for helping people with chronic lower back pain get a better night’s sleep.
“Although the yoga and [physical therapy] interventions were designed to improve back pain rather than sleep quality, our interventions included components thought to be important for improving sleep quality,” specifically modest exercise, meditation and relaxation,” they write in their paper.
“The high prevalence of sleep problems in adults with chronic low back pain can have detrimental effects on a person’s overall health and well-being,” says Roseen.
“This really emphasizes the need for providers to ask patients with chronic low back pain about the quality of their sleep,” he adds. “Given the serious risks of combining pain and sleep medications, nonpharmacologic approaches should be considered for these patients.”
FMI: You’ll find an abstract of the study on the Journal of General Internal Medicine’s website, but — despite being funded by the National Institutes of Health — the full study is behind a paywall.