Yoga, stretching of equal benefit in patients with chronic low-back pain
MedWire News: Yoga classes are more effective than self-care advice in alleviating chronic low-back pain in primary care patients, but no more so than conventional stretching exercises, show randomized trial findings.
"We found that physical activity involving stretching, regardless of whether it is achieved using yoga or more conventional exercises, has moderate benefits in individuals with moderately impairing low back pain," report study authors Karen Sherman (University of Washington, Seattle, USA) and colleagues in the Archives of Internal Medicine.
"Finding similar effects for both approaches suggests that yoga's benefits were largely attributable to the physical benefits of stretching and strengthening the muscles and not to its mental components," they add.
The team compared the effectiveness of yoga classes, stretching classes of comparable physical exertion, and self-care for the treatment of non-specific low-back pain in 228 patients with chronic (lasting at least 3 months) moderate pain (scoring at least 3 points on a 11-item "bothersomeness" scale of 0-10).
Patients in the yoga (n=92) and stretching (n=91) groups attended 12 weekly, 75-minute classes designed specifically for people with chronic low-back pain who are unaccustomed to either form of exercise. Patients assigned to self-care (n=45) received The Back Pain Helpbook, which provides information on the causes of back pain and advice on exercise, lifestyle modifications, and managing flare-ups.
At 12- and 26-week follow-up interviews, roughly twice as many patients in the yoga and stretching groups as in the self-care group reported decreasing their medication use since the beginning of the study (around 40 vs 20%).
Back-related dysfunction, as measured on the 23-item Roland-Morris Disability Questionnaire, declined over time in all groups. Compared with the self-care group, the yoga group reported significantly better function at 12 (by 2.5 points) and 26 weeks (1.8 points) after adjustment for baseline values, while the stretching group had superior function at 6 (1.7 points), 12 (2.2 points), and 26 weeks (1.5 points). There were no statistically or clinically significant differences between the yoga and stretching groups.
In terms of symptom bothersomeness, there were no differences among groups except at 12 weeks, when the yoga group was significantly less bothered by symptoms than the self-care group.
Thirteen patients in each of the yoga and stretching groups reported a mild or moderate adverse experience possibly related to treatment (mostly increased back pain), and one yoga attendee experienced a herniated disk. Just one of the self-care patients reported increased pain after doing recommended exercises.
"Similar to other kinds of physical movement, harmful outcomes from yoga were mostly temporarily increased back pain," the team remarks.
The authors conclude: "Yoga and stretching are reasonable treatment options for persons who are willing to engage in physical activities to relieve moderately impairing back pain.
"Because yoga classes can vary enormously, clinicians are advised to recommend classes for beginners or classes that are therapeutically oriented with instructors who are comfortable modifying postures for persons with physical limitations. Clinicians recommending stretching classes should ensure that these contain sufficient back- and leg-focused stretching."
By Caroline Price