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Can Yoga Match Physical Therapy for Back Pain?
Year-long clinical study yields surprising results for a common, debilitating condition

04/05/2018 By Michelle Lee with Craig Weatherby

The Global Burden of Disease Study (GBD) provides comprehensive data on death and illness, worldwide.

And its data shows that while people are living longer, they’re not necessarily living healthier, or with less pain.

All too often, people are living considerably longer than our ancestors, only to suffer more years of illness, discomfort, or debilitating pain.

According to the ongoing GBD study, heart disease is the leading cause of illness, but the leading causes of discomfort are low back pain and neck pain — and rates of back pain are rising.

Why is back pain a growing problem?
People’s increasingly sedentary lifestyles weaken back muscles, leaving us more vulnerable to back injury, even in younger years.

Jobs in service and agriculture have the highest rates of back pain, thanks to standing, sitting, or stooping all day — and the service industry is the fastest-growing sector in the U.S. economy.

Last but not least, because we’re living longer, our bodies undergo extra years of wear and tear, which raises the risk for back injury and pain.

About eight out of 10 Americans will suffer back pain at some point — but you can take steps to reduce your risk:

  • Stay active
  • Practice good posture
  • Sleep on a good mattress
  • Maintain a healthy weight
  • Wear comfortable, supportive shoes
  • Avoid prolonged periods of inactivity
  • Stretch before workouts or activities such as gardening and cleaning

Since you’ll likely face back pain at some time, it’s good to be forearmed with some knowledge about treatment.

And exciting new findings suggest that yoga can match physical therapy (PT) for treating low back pain.

The backdrop of the new clinical trial
Nearly 40 percent of adults who experience back pain don’t see a doctor for relief.

In part, that’s because of the time and cost required by multiple visits to doctors and physical therapists.

Assuming it’s effective, yoga could allow people with cost or time constraints to take control of their recovery, right at home.

Previous studies found that yoga — or stretching exercises — can help with low back pain, as described below (see “Prior research supports the findings”).

But those trials didn’t compare yoga to physical therapy and couldn’t reveal whether it might work well for people with financial or time barriers to doctor visits and physical therapy.

Fortunately, Boston University researchers recently published the results of a clinical trial designed to answer that critical question.

Clinical study finds yoga and PT comparable and interchangeable
A recent, government-funded clinical trial compared yoga to physical therapy for treatment of low back pain (Saper RB et al. 2017).

This year-long study involved racially diverse, low-income adults — possibly the ideal group in which to test the comparative benefits of yoga and physical therapy.

Boston University researchers recruited 320 predominantly low-income, racially diverse adults (18 to 64 years old) with chronic back pain for a year-long, two-phase study.

The researchers recorded the participants’ average, back-related pain intensity and disability at the start of the study, and again after six, 12, 26, 40, and 52 weeks.

The participants were assigned to one of three groups for the first study phase, which lasted three months:

  • Yoga group — weekly 75-minute yoga classes, plus home yoga practice.
  • PT group — Individual one-hour physical therapy sessions, plus at-home PT exercises.
  • Education group — Received materials on self-care for back pain, periodic (every three weeks) newsletters that summarized key points, and periodic check-in calls.

For the “maintenance” phase of the study, the three groups followed new guidelines:

  • Yoga group — either home yoga practice or drop-in yoga classes.
  • PT group — either home practice or five “booster” sessions of physical therapy.
  • Education group — continue reviewing their materials and receiving check-in calls.

After one year, yoga and PT were found similarly effective for improving pain and physical function — and either approach worked better than just receiving educational materials.

The improvements for the yoga and PT groups remained equivalent throughout the year-long study.

Perhaps unsurprisingly, those who attended more yoga classes or PT sessions (or practiced more at home) enjoyed greater pain relief and functional benefits.

The study was funded by the U. S. National Center for Complementary and Integrative Medicine — a division of the National Institutes of Health.

Hopefully, the lower cost and home-centered nature of yoga practice could prompt more people to tackle their back pain and get back to normal life in a timely fashion.

PT or yoga? Some things to consider
Unlike PT sessions, yoga classes aren’t covered by many employer health plans, although relatively few health plans cover the full costs of physical therapy, or of doctor visits, either.

Regardless of which approach you choose, it’s smart to get an expert medical diagnosis beforehand, to eliminate serious issues, get insurance approval, and discover the after-insurance cost of PT versus yoga classes.

If you choose to try yoga, pick a teacher who’s well trained, experienced with back injuries, and knowledgeable about anatomy and injury avoidance. Don’t be afraid to ask hard questions!

And even though they may possess identical degrees, physical therapists vary in quality — some are more experienced, knowledgeable, and attentive than others. Ask your doctor for recommendations and consult friends who’ve been to local PT practitioners.

Prior research supports the new findings
Seven years ago, the Boston University authors of a similar clinical trial also found that yoga improved back pain and function (Sherman KJ et al. 2011).

They assigned 228 adults to 12 weekly, 75-minute classes of either yoga or stretching exercises — or to simply read a back-pain self-care book.

The yoga and stretching groups received instructional videos, were encouraged to practice at home for 20 minutes a day between their weekly classes, and their back function and pain levels were assessed after six weeks, 12 weeks, and 6 months.

According to study leader Karen J. Sherman, PhD, MPH, “We found yoga classes more effective than a self-care book — but no more effective than stretching classes. Our results suggest that both yoga and stretching can be good, safe options for people who are willing to try physical activity to relieve their moderate low back pain.”

An earlier study of yoga for chronic back pain employed Iyengar yoga, which employs props to help practitioners achieve correct positioning (Williams KA et al. 2005).

For that 16-week trial, adults with chronic low back pain either practiced Iyengar yoga or were provided with self-care education.

Compared with the self-care education group, the yoga group enjoyed significant reductions in pain intensity (64%), functional disability (77%) and pain medication use (88%) during the study and at their three-month follow-up.

To learn more about yoga — and meditation — for bone-joint problems and related pain, see Got Creaky Joints? Yoga May Ease the Ache and Ease Back Pain with Your Mind?.


Sources

  • Global Burden of Disease. The Lancet. Accessed at http://www.thelancet.com/gbd.
  • Khazan, Olga. How Back Pain Took Over the World. The Atlantic. Oct. 7, 2016. Web. 14 July 2017.
  • Rubin Dl. Epidemiology and Risk Factors for Spine Pain. Neurol Clin. 2007; May;25(2):353-71.
  • Saper RB, Lemaster C, Delitto A, Sherman KJ, Herman PM, Sadikova E, Stevans J, Keosaian JE, Cerrada CJ, Femia AL, Roseen EJ, Gardiner P, Barnett KG, Faulkner C, Weinberg J. Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial. Ann Intern Med. 2017 Jun 20.
  • Sherman KJ, Cherkin DC, Wellman RD, Cook AJ, Hawkes RJ, Delaney K, Deyo RA. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Arch Intern Med. 2011 Dec 12;171(22):2019-26.
  • Williams KA, Petronis J, Smith D, Goodrich D, Wu J, Ravi N, Doyle EJ Jr, Gregory Juckett R, Munoz Kolar M, Gross R, Steinberg L. Effect of Iyengar yoga therapy for chronic low back pain. Pain. 2005 May;115(1-2):107-17.