Stretching exercises in the form of either yoga or more conventional classes somewhat lessen chronic low-back pain that is moderately impairing, a study published online Oct. 24 in Archives of Internal Medicine has shown.
However, before referring patients to these classes, clinicians should ensure "sufficient back- and leg-focused stretching" is included and that instructors are willing to modify some of the traditional postures for people who have physical limitations, said Karen J. Sherman, Ph.D., of Group Health Research Institute, Seattle, and her associates.
If performed properly, yoga stretches can relieve chronic low-back pain.
The researchers compared the effectiveness of yoga classes, stretching classes, and usual self-care at relieving chronic low-back pain in a randomized controlled trial involving 228 adults residing in six cities in Western Washington. They hypothesized that yoga would prove superior to the other two interventions, because all eight clinical trials of yoga for this indication in the literature have shown it to be effective. However, the eight studies also had "considerable limitations," including small sample sizes, high attrition rates, and inconsistencies in the types of yoga provided, hours of class time, frequency of classes, and types of control situations.
In this trial, both yoga and stretching classes were held weekly for 75 minutes at Group Health facilities, for a total of 12 weeks. Patients were given CDs or DVDs to assist with home practice and were advised to practice 20 minutes on days when they weren’t attending class.
Patients were assessed via telephone interviews at baseline, 6 weeks, 12 weeks, and 26 weeks. The primary end point was self-rating at 26 weeks on the 23-item Roland-Morris Disability Questionnaire and on a scale of the bothersomeness of lower-back symptoms.
The yoga intervention (92 subjects) included breathing exercises, the use of 5-11 postures for 45-50 minutes (with adaptations allowed for patients’ limitations), and guided deep relaxation. Instructors had at least 500 hours of Viniyoga training and 5 years of teaching experience and were briefed by a study consultant who had expertise in low-back pain.
The stretching intervention (91 subjects) included aerobic activity, 10 strengthening exercises and 12 stretches held for 30 seconds each, and 52 minutes of 15 exercises that stretched all the major muscle groups but focused on the trunk and legs. Instructors were licensed physical therapists who had experience teaching classes and had completed a 2-hour training program for the study.
For the usual-care control condition (45 subjects), patients were given "The Back Pain Helpbook," which details the causes of back pain and makes recommendations regarding exercise, modifying lifestyle factors that contribute to back pain, and managing flares of back pain.
Back-related dysfunction declined over time in all three study groups, but the reduction was significantly greater with the yoga intervention and the stretching intervention. Contrary to their hypothesis, yoga classes did not prove superior to conventional stretching classes in this regard, Dr. Sherman and her colleagues said (Arch. Intern. Med. 2011 Oct. 24 [doi:10.1001/archinternmed.2011.524]).
Self-ratings of symptom bothersomeness did not differ significantly among the three groups.
Significantly more patients participating in both classes showed "substantial" (50% or more) clinical improvement from baseline: 52% of the yoga subjects and 56% of the stretching subjects reported this outcome, compared with only 23% of the control subjects.
Compared with the control group, both intervention groups were significantly more likely to describe their back pain as "better," "much better," or "completely gone" at all follow-up assessments, and were more likely to report they were "very satisfied" with their care.
The finding of such similar outcomes between the yoga group and the stretching group "suggests that yoga’s benefits were largely attributable to the physical benefits of stretching and strengthening the muscles and not to its mental components," the investigators said.
Thirteen patients (14%) in each intervention group reported mild or moderate adverse events that were possibly related to treatment, compared with only 1 control subject (0.02%).
Overall, the results of this study indicate that both yoga and stretching exercises are "reasonable treatment options for persons who are willing to engage in physical activities to relieve moderately impairing back pain," the researchers said.
This study was funded by the National Center for Complementary and Alternative Medicine. No relevant financial disclosures were reported by the authors.