One of yoga’s known benefits is its ability to relieve chronic low back pain. But is it as effective as physical therapy (PT) for underserved populations with more severe levels of pain and disability? New research published in the Annals of Internal Medicine provides the answer.
In this 52-week study, researchers from Boston University randomly assigned 320 ethnically diverse adults (age 18-64) with chronic low back pain receiving treatment at a local hospital or health center to participate in either a yoga group, a physical therapy group, or an educational group. Most participants were non-white, lower-income women with moderate to severe pain and impairment.
To be eligible, participants needed to have moderate levels of low back pain lasting at least 12-weeks. For all groups treatment was divided into an active treatment phase (baseline to 12 weeks), and a 40-week maintenance phase (12-52 weeks).
Yoga intervention members (n=127) were asked to attend weekly, 75-minute classes for 12 weeks. Classes were taught by one of 13 yoga instructors trained to deliver a manualized yoga treatment protocol for low back pain.
Each class started with meditation, relaxation and breathing exercises, and yogic philosophy, followed by simple poses, and concluding with relaxation. Props and modifications were provided to assure that individuals practiced safely. Participants were also provided with a DVD and manual, and asked to engage in 30 minutes of practice per day, and to record their progress daily. “Maintenance phase” classes were also offered at the end of 12 weeks.
Physical therapy group members (n=129) were asked attend 15, individual 60-minute sessions over the course of 12 weeks with one of 8 physical therapists. Each therapist was trained in a manual-based protocol that incorporated assessment, graded exercise, and screening for patient’s fear-avoidance beliefs.
Appointments included one-on-one physical therapy and supervised aerobic exercise, and psychologically-informed guidance for reducing fear avoidance. Participants were also given supplies and written instructions for home practice, and asked to log their activity. A subset of patients was randomly assigned to booster sessions, where they were asked to follow up with their therapist every 2 months up to a year from initiating the program.
The education group (n=64) consisted of receiving The Back Pain Helpbook, which contains information about chronic low back pain, as well as exercises for strengthening and stretching. Instruction also included self-management, and information regarding the role of fear avoidance and emotions as they relate to back pain.
Participants were asked to read the book according to a pre-determined schedule, and received a 1 to 2-page newsletter summarizing the assigned chapters even 3 weeks. They also received a brief (5-10min) check-in call from staff every 3 weeks during the intervention, and every 6 weeks during the maintenance phase.
The research team focused their evaluation on back-related function, pain, use of pain medication, global improvement, intervention satisfaction, and health related quality of life. Participants completed surveys at 6, 12, 26, 40 and 52 weeks, and were paid for successful questionnaire completion.
Attendance in the yoga and PT groups was acceptable, with participants in both groups attending a median of 7 sessions. Approximately 75% of yoga participants and 64% of PT participants reported engaging in some form of home practice. Patients in both groups also attended a comparable amount of booster sessions.
Yoga and PT are similarly effective for chronic low back pain
Results of the study suggested that both yoga and PT participants responded similarly to treatment, with both yoga and PT group participants experiencing clinically significant reductions in low back pain and related disability. Only the PT group demonstrated statistically significant differences in pain compared to the education group.
Patients in the yoga and PT groups were equally satisfied with their programs, and more satisfied that those in the education group. Improvements in yoga and PT group participants were sustained independently of whether or not they attended ongoing classes, booster sessions or had a home practice. What’s more, after 12-weeks, adults in both the yoga and PT groups were less likely to use pain medication than education group members.
In general, all 3 interventions were found to be safe, with only mild joint and back pain being reported among 9 yoga, 14 PT and 1 education group members.
Findings from the study suggest that a manualized yoga program targeting chronic low back pain in a diverse, underserved sample of adults may be as effective as traditional PY for reducing pain and increasing physical functioning. This does not, however, suggest that “non-manualized” community-based yoga programs for low back pain will be equally as beneficial.
Unfortunately, there continue to be barriers for low-income, underserved individuals seeking access to yoga or PT. Many low-income, minority neighborhoods lack local yoga studios, and classes can be prohibitively expensive for those with little expendable income.
PT can often be inaccessible to those covered by Medicaid, or to those with private insurance and expensive co-payments. Further, non-white adults, or those with low incomes continue to be among the minority in yoga studios. Until we address the issue of inclusion and access, it may be difficult for under-served adults to benefit from these programs.
Originally published at YogaU Online
Saper RB, Lemaster C, Delitto A, Sherman KJ, Herman PM et al. (2017). Yoga, physical therapy, or education for chronic low back pain? Annals of Internal Medicine, 167 (2).