Yoga Works as Well as Physical Therapy for Back Pain

Using yoga to treat lower back pain isn't exactly a groundbreaking idea—multiple studies have proven that regularly downward-dogging it can ease pain and increase mobility. But it's always been more of a suggested alternative than an actual prescribed treatment. Now, researchers are working on changing that.

A new study published in the Annals of Internal Medicine found that yoga was noninferior to (basically "works as well as,") physical therapy in improving function and pain symptoms of chronic low back pain. The "noninferior" verbiage is something to note: Researchers conduct noninferiority trials to determine whether a new therapy is statistically as effective as an already accepted treatment, like physical therapy for back pain, in this case. In short, it's the first step in integrating a new therapy into clinical practice.

About 25 percent of US adults report having low back pain in the past three months, according to the study's accompanying editorial, and the costs associated with back pain in the US alone exceed $200 billion annually. When it comes to chronic low back pain—which is when back pain lasts for 12 weeks or longer—about 10 percent of US adults suffer. Low-risk alternative therapies to low back pain are important, as doctors are also focused on de-emphasizing medications and operations for treatment.

For the study, researchers from Boston Medical Center followed 320 predominantly low-income, racially diverse adults with chronic low back pain for an entire year; more than two-thirds of them were using pain medication and 64 percent were women. The participants were split into three groups: one group was assigned to 12 weekly yoga classes designed for low back pain lasting 75 minutes, one group got 15 physical therapy visits lasting 60 minutes, and one group was given educational books and newsletters. Physical therapy has been shown to help with back pain, too, but yoga and PT hadn't been compared to each other thus far.

After 12 weeks, both yoga and PT participants were 21 and 22 percent less likely to use pain medication than education patients were. In fact, yoga was as effective as physical therapy for reducing pain, improving function, and lowering use of pain medication. Those improvements in the yoga and PT groups were maintained for the remaining 40 weeks of the study (aka the maintenance phase when people were supposed to keep up the routine on their own), but people didn't improve any further.

The study's inclusion of low-income people of color is important; pain has a disproportionate impact on people in these communities. According to past research, people of color with back pain receive fewer specialty referrals and experience less-intensive rehab for occupational back injuries. They've also got less access to nonpharmacologic treatments like physical therapy, plus those copays really add up—and that's with health insurance.

But studies of yoga for back pain have included mostly white and middle-class people. The authors felt "it was important to test whether the yoga would be received well by an underserved population as well as being effective," study author Robert Saper, director of integrative medicine at Boston Medical Center, said in a video accompanying a news release.

Yoga's expensive, too; white adults are almost twice as likely as black or hispanic adults to do yoga, and classes are often unavailable in low-income areas. Still, researchers believe yoga may be a reasonable alternative to physical therapy, depending on patient preferences, availability, and cost.

Regarding availability, Saper said: "Many yoga teachers are available in urban areas, however, yoga teachers and yoga classes still are relatively rare in communities of color and disadvantaged areas. Therefore, it's important that we begin to train and build and make yoga more available to diverse communities."

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