Thursday, September 17, 2009

Yoga Relieves Low Back Pain, But Use Caution

Posting contributed by Winnie Dawson, MA, RN, BSN
Chronic low back pain (CLBP), a common complaint among adults, has been shown to improve with a program of regular exercise after the acute pain phase has passed. However, choosing an appropriate exercise regimen can be confusing for many people. A study funded by the National Institutes of Health — published in the September 2009 issue of the journal Spine — reported results showing that a series of twice-weekly yoga classes with home practice relieved pain and improved mood [Williams et al. 2009]. Ninety patients with mild to moderate chronic low back pain that persisted for more than 3 months, without evidence of serious pathology, were randomly assigned to a yoga practice group or a control group. Members of the yoga group participated in 24 weeks of twice-weekly, 90-minute yoga classes specifically designed for people with CLBP. The yoga participants were also asked to practice for 30 minutes on non-class days and received yoga props and instructional materials. Control group members received standard medical care.

The outcomes were based on participant questionnaires used to self-report levels of pain, disability, and depression, as well as the amount of medication usage. At 24 weeks, the results showed a statistically significant reduction in functional disability, pain intensity, and depression for the yoga group as compared with the control group. These improvements remained significant for the yoga participants at the 6-month follow-up after the study’s end. An additional benefit reported by study authors was a “clinically important trend” for reduced analgesic use by the yoga group compared with the control group. There were no adverse events reported in the yoga group. The authors concluded that this study provided a more rigorous evaluation (than previous studies) of yoga in this population and resulted in clinically effective symptom relief for people with CLBP.

Commentary: While the participants in this study ranged in age from 23 to 66, study outcomes showed no differences between age and symptom improvement. Yoga can be practiced by persons of any age when cautious consideration is given to personal levels of strength, flexibility, and balance. The yoga classes in this study were led by certified Iyengar yoga instructors but it is important to note that there are many forms of yoga, each with variations in postures and intensity. All styles of yoga focus on flexibility, balance, and breathing, but Hatha yoga and Iyengar yoga may be most appropriate for beginning students with CLBP. Hatha yoga uses a more gentle approach to posture flow and Iyengar yoga is a form that uses props to aid alignment. Some yoga instructors offer a special class — oftentimes called ‘Gentle Yoga’—for people with health concerns. Since some yoga routines may be too challenging for a person with CLBP, it is always appropriate to discuss chronic back conditions with a certified yoga instructor in advance. Patients also should be cautioned to advise their healthcare providers of their participation in any exercise program.

References:
> Williams K, Abildso C, Steinberg L, et al. Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain. Spine. 2009(Sep 1);34(19):2066-2076. PMID: 19701112 [
PubMed citation.]
> Additional information on yoga and health is available at the U.S. National Center for Complementary and Alternative Medicine (
NCCAM-Yoga).