Yoga helps in the treatment of chronic lower back pain to improve both pain and functional ability
Date First Published:
January 22, 2007
Last Updated:
January 23, 2007
Report by:
Mr Kumar Kunasingam & Dr Charlotte E Evans, Clinical Fellow in Orthopaedics, ITU/A&E (Dartford and Gravesham NHS trust, The Royal Melbourne Hospital, Melbourne, Victoria)
Search checked by:
Miss Vivien Shuen, Dartford and Gravesham NHS trust, The Royal Melbourne Hospital, Melbourne, Victoria
Three-Part Question:
In [patients with chronic lower back pain] would [yoga] help in [treatment of pain relief and functional ability?]
Clinical Scenario:
A 40 year old man presents with an acute on chronic exacerbation of lower back pain after lifting. He has no other symptoms. He has suffered minor injuries to his back while playing rugby in his twenties and thirties. He spends most of his working time at a desk. The pain is usually improved with pain relief. He wishes to know if yoga can help to improve the chronic pain.
Search Strategy:
An advanced Medline search (1996 - Jan 2007) using lower back pain and yoga as thesaurus mapped terms via an Athens portal.
Search Details:
{low back pain OR lumbar vertebrae OR intervertebral disk displacement OR pain OR spinal diseases} AND {yoga}
Outcome:
39 articles were found of which only 4 related to the use of yoga in the treatment of lower back pain.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The impact of modified Hatha yoga on chronic lower back pain : a pilot study Galantino M-L. Bzdewka TM. Eissler-Russo JM. Holbrook ML. Mogck EP. Geigle P. Farrar JT. Mar-Apr 2004 USA | Patients with chronic lower back pain presenting between the ages of 30 and 65 | Randomised pilot study | Forward reach and sit reach tests | Improved flexibility | Pilot group not powered to reach statistical significance. There was a high dropout in the control group and large differences in the baseline for the seconday measures ie depression and disability. |
| Oswestery disability index | Decreased disability | ||||
| Beck depression inventory | Decreased depression | ||||
| Clinical enquires. Does yoga speed up healing for patients with lower back pain? Graves N. Krepcho M. Mayo H.G. Hill J. Aug-04 USA | Review article of evidence based literature | Review of articles | Limited studies - overall encourages yoga | Limited evidence based studies | |
| Recommendations from other sources | Poor - some recommendations of exercise but no mention of yoga | ||||
| The effect of Iyengar yoga therapy for chronic low back pain Williams K. A. Petronis J. Smith D. Goodrich D. Wu J. Ravi N. Doyle E.J.Jr Gregory J.R. Munoz K.M. Gross R. Steinberg L. May-05 USA | Patients with lower back pain for 11.2+/-1.54 years with 48% of the group using pain medication. | Randomised control trial. | Functional disability | Improved | 30% drop-out rate from study. |
| Pain intensity | Decreased | ||||
| Pain medication | Requirements decreased | ||||
| Psychological and behavioral outcomes | No significant difference | ||||
| Comparing yoga, exercise and a self-care book for chronic low back pain: a randomised control trial Sherman K.J. Cherkin D.C. Erro J. Miglioretti D.L. Deyo R.A. Dec-05 USA | 101 patients with chronic low back pain aged between 20 and 64 years old who had presented to primary care 3-15 months before the study. | Randomised control study of yoga classes vs exercise vs a self care book | Back related functional status (modified 24 point Roland Disability scale) | yoga group superior improvement to exercise and self care group | Participants were only followed for 26 weeks following randmisation. Only one instructor was used in each intervention. |
| general health status | no significant difference | ||||
| medication use | decreased in the yoga group more than the other 2 groups |
Author Commentary:
The current work on yoga and back pain is limited. However, the aforementioned papers show level 1 evidence in their main primary objectives of improved movement and decreased requirements of pain medication. The studies are all relatively short term and the outcome is patient compliance related.
Bottom Line:
With a well motivated patient regular yoga can show improvement in pain and improve functional movement.
References:
- Galantino M-L. Bzdewka TM. Eissler-Russo JM. Holbrook ML. Mogck EP. Geigle P. Farrar JT.. The impact of modified Hatha yoga on chronic lower back pain : a pilot study
- Graves N. Krepcho M. Mayo H.G. Hill J.. Clinical enquires. Does yoga speed up healing for patients with lower back pain?
- Williams K. A. Petronis J. Smith D. Goodrich D. Wu J. Ravi N. Doyle E.J.Jr Gregory J.R. Munoz K.M. Gross R. Steinberg L.. The effect of Iyengar yoga therapy for chronic low back pain
- Sherman K.J. Cherkin D.C. Erro J. Miglioretti D.L. Deyo R.A.. Comparing yoga, exercise and a self-care book for chronic low back pain: a randomised control trial