Robust evidence is in: yoga helps to ease chronic back pain

    16 January 2017

    Doing yoga can relieve chronic back pain, according to a major review published by the Cochrane Library.

    The ancient practice, which is characterised by gentle exercise, breathing techniques and light meditation, was found to be twice as effective at easing discomfort than doing back exercises.

    Chronic back pain, defined as lasting for more than three months, is resistant to opioid painkillers. Despite this, the painkillers are prescribed in as many as 40 per cent of cases.

    The researchers, from the University of Maryland in the US, looked at data from 12 clinical trials involving 1,080 people. Study participants attended professional yoga classes at least once a week.

    In comparison to those who just did back exercises, those who did yoga were twice as likely to have reduced chronic lower back pain within 12 months. Participants self-reported a 26 per cent improvement in physical quality of life.

    The researchers also found that in five per cent of cases, yoga made back pain worse, which they say is similar to that experienced by those with chronic back pain doing any form of exercise.

    Susan Wieland, the study’s lead author, said: ‘Our findings suggest that yoga exercise may lead to reducing the symptoms of lower back pain by a small amount, but the results have come from studies with a short follow up.

    ‘The yoga exercises practised in the studies were developed for low back pain, and people should also remember that in each of the studies we reviewed, the yoga classes were led by experienced practitioners.’

    Instant analysis
    This was a meta-analysis of randomised controlled trials — the gold standard of evidence. However, any pooling of the results of different trials will only be as good as the quality of trials considered. In this regard the methodology of the different trials was not the most rigorous.

    The trials considered focused on Iyengar, Hatha or Viniyoga and hence the results should only be applicable to those forms of yoga.

    There was significant bias in all the trials as they were mostly non-blinded (a common method of minimising bias) and methodology was far from ideal. Given these flaws it is surprising and worth noting that the rigorous Cochrane researchers found a positive effect.

    Overall, the results suggest that there is a minimal to moderate positive effect of yoga on back pain when compared to non-yoga exercise groups; this effect, however, does not meet clinical criteria of improvement.

    This is an area where there is a notable difference between the sometimes dramatic reports of individual patients and the results obtained from statistical analysis.

    I would argue that, as there is such a huge gap in our knowledge regarding the causes of ‘non-specific back pain’, in cases like this I would listen to patients more than anyone else.

    Pioneering work by Professor Stuart McGill of Waterloo University in Canada has, in many cases, proved that our traditional understanding of back biomechanics and its impact on pain and injury has been woefully inadequate and sometimes plain wrong.

    Apart from the meditative effects, yoga is an excellent way of building core strength, a major issue in many people with back pain. It is also effective in strengthening the body, improving flexibility and mobility, and potentially increasing one’s ability to resist injury.

    Take-home message: there is evidence that yoga may be of benefit for back pain, but always seek out a qualified, experienced instructor and never undertake any posture that causes pain or that seems too advanced.
    Research score: 4/5