Yoga for Back Pain Relief

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Back pain is notoriously difficult to treat. This is the result of a combination of factors, including the difficulty in accurately diagnosing the source of chronic pain in many cases, and the failure of interventions, therapies and pharmaceuticals to address an identified source. Furthermore, normal activities of daily living often aggravate the problem, limiting the ability of any intervention to achieve lasting results. Consequently, chronic back pain is the number one reason Americans turn to complementary and alternative medicine (CAM) [1].

A recent article published by Helen Tilbrook and colleagues in the Annals of Internal Medicine addresses the effectiveness of yoga — a combination of stretching, breathing, and exercise that falls into the CAM purview — in helping to relieve chronic low back pain [2]. The Tilbrook study is not the first of its kind; several studies have suggested that yoga may be effective for chronic back pain relief [see, for example, 3-5]. However, as Tilbrook and colleagues point out, the previous studies contained a variety of limiting factors that make it difficult to draw robust conclusions from their data.

The Tilbrook study was much larger than its predecessors, including a total of 313 participants. The participants were randomly assigned to either traditional back pain treatment or to attend a once-weekly yoga class each week for 3 months. During classes, the participants were taken through a series of poses appropriate to those with low back pain. They were also taught about relaxation and the philosophy of yoga, and were encouraged to practice yoga daily at home. To this end, participants were given a video yoga class to use in home practice.

One of the difficulties in addressing the efficacy of a pain relief technique is that pain can’t be objectively measured; patients must rank their own pain. However, a large back pain relief study previously demonstrated that a decrease in the Roland-Morris Disability Questionnaire (RMDQ, a questionnaire used to objectify the process of ranking pain and its effect on daily life) score of 1.57 points correlated to significantly improved quality of life [6]. The Tilbrook study found that the yoga group had significantly reduced back pain as compared to the group that received usual care. At three months (the end of the yoga program), the yoga group had an adjusted average RMDQ score that was 2.17 points lower than the average of the usual care group. At six and 12 months, the yoga group’s average adjusted RMDQ score was still lower than the average of the usual care group, by 1.48 and 1.57 points respectively.

While the results of the study are somewhat compelling in their support for yoga as a pain relief strategy, perhaps the most important finding of the study was that yoga appears to be quite safe for chronic sufferers of low back pain. Only 8 of the study participants reported adverse events that could potentially be attributed to yoga. As such, the risk-to-benefit analysis suggests that, given the possibility of pain relief and the minimal risk of injury, yoga is worth considering as an adjunct to other therapies in managing chronic low back pain.

References

1. Chronic Pain and CAM: At a Glance [NCCAM Research]. National Center for Complementary and Alternative Medicine. Accessed 2011 Dec 2.
2. Tilbrook et al. Yoga for chronic low back pain: a randomized trial. Ann Intern Med. 2011 Nov 1;155(9):569-78.
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3. Tekur et al. Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: a randomized control study. J Altern Complement Med. 2008 Jul;14(6):637-44.
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4. Sherman et al. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2005 Dec 20;143(12):849-56.
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5. Galantio et al. The impact of modified Hatha yoga on chronic low back pain: a pilot study. Altern Ther Health Med. 2004 Mar-Apr;10(2):56-9.
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6. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ. 2004 Dec 11;329(7479):1377. Epub 2004 Nov 19.
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