In the confounding debate over how best to relieve chronic back pain, a recent study published in a top-tier medical journal gives a nod to a gentle form of yoga. But it also acknowledges the benefits of general exercise in alleviating back discomfort and tightness.
So, you ask (shaking those ibuprofen like dice), what strategy is best? First, the recent research:
The study, published in December in the Annals of Internal Medicine, randomly assigned 101 adults (age 20 to 64) with chronic low-back pain to 12 weeks of yoga classes, general exercise classes or self-treatment guided by the book The Back Pain Helpbook (HarperCollins, 1999).
Those in the yoga and exercise groups attended a 75-minute class weekly and were free to practice their assigned disciplines at home. Most did so a few days a week. The book group did exercises — some of them back-specific — at home, but most did not accumulate as much activity as the other participants.
The yoga and exercise teachers crafted the classes to address back pain. Yoga poses included the cobra, the bridge, the warrior, the lunge and the lying twist. Each class was made up of five to 12 postures, each repeated three to six times, plus a period of deep relaxation.
The exercise class included seven aerobic exercises and 10 strengthening moves focusing on leg, hip, abdominal and back muscles.
All participants reported improved back-related function at 12 weeks, but only the yogis showed sustained improvement at 26 weeks: 78 percent of that group improved significantly, compared with 63 percent of exercisers and 47 percent of book readers.
The findings carry significant caveats: Researchers could not “blind” the study, meaning all participants knew what intervention they were getting, a factor that can influence outcome. Also, there was no control group to demonstrate the widely observed phenomenon that most people with back pain get better even if they do nothing. Results were based on self-reports.
“OK,” you’re saying, “research seems to support yoga and exercise. But my sister solved her back problem with a chiropractor, our dad used basic stretches, and my boss’s uncle swears by gravity boots. What gives?”
“There are a lot of structures in the back,” said the lead author of the study, Karen J. Sherman, an associate scientific investigator at the Center for Health Studies at the Group Health Cooperative in Seattle. There is the spine, surrounding nerves, disks, muscles and the fascia overlaying the muscles. “It’s not like the heart, where you can take a picture and see what’s wrong. For most people, it is very hard to figure out what’s causing the (back) pain.”
Thus, Sherman acknowledges, various treatments will work for people in ways that are hard to predict. But “yoga offers some things — like the (focus on) breathing and relaxation” — that could make the difference. But the study did not determine what aspects of yoga practice made it beneficial.
A British study published last year hailed the benefits of exercise that is not back-specific — such as walking — for back pain.
Which leads Sherman to this conclusion: Unless you have acute back pain, “moving your body is always a good thing to do. The (scientific) literature supports that.” And taking a class properly designed to relieve back pain might help more than making a go of it yourself. If you like yoga, or just want to try it, you might do well.