Low-back pain is a very common problem, and a variety of treatments have been assessed in Cochrane Reviews. In November 2022, we published an update of the 2017 Cochrane review of the effects of yoga for chronic, non-specific low-back pain. The review was led by Susan Wieland of the Cochrane Complementary Medicine Field in the USA, together with colleagues from Canada, Germany and the UK. Here’s another of the authors on the review, Shireen Harbin from the Institute for Work & Health in Toronto Canada to tell us about the latest findings.
Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Low-back pain is a very common problem, and a variety of treatments have been assessed in Cochrane Reviews. In November 2022, we published an update of the 2017 Cochrane review of the effects of yoga for chronic, non-specific low-back pain. The review was led by Susan Wieland of the Cochrane Complementary Medicine Field in the USA, together with colleagues from Canada, Germany and the UK. Here's another of the authors on the review, Shireen Harbin from the Institute for Work & Health in Toronto Canada to tell us about the latest findings.
Shireen: Nonspecific low back pain, or low back pain without a known cause, usually goes away within a few days or weeks. However, some people find that it continues for 3 months or longer, at which point it is considered chronic. This is a serious condition that interferes with the person's daily activities and lowers their quality of life.
The usual treatments for nonspecific back pain are over the counter pain relievers and exercise or stretching. One type of exercise that is sometimes used is yoga, a mind-body intervention originating in India that has also become very popular in the West. In the previous version of our review, we found some evidence that it might be beneficial, but the research was limited. In this update, we added nine more trials to the 12 that were in in the 2017 review, and were able to make some additional conclusions.
The 21 trials in the update recruited a little over 2200 participants from the US, UK, India, Croatia, Germany, Sweden and Turkey. These trials had compared various types of yoga to usual care, a waiting list (in which one group of people start yoga right away while the other group is offered it at the end of the study), a non-exercise intervention such as educational materials, or a back-focused exercise intervention such as physiotherapy.
When yoga was compared to not doing exercise, people doing yoga had small and clinically unimportant improvements in both pain and back function at 3 and 6 months. At 12 months, there was a small but clinically unimportant improvement in back function, but little or no difference in pain. People doing yoga were more likely to report that their back pain had improved or resolved at 3 and 6 months, but there was no information at 12 months. Those in the yoga group also reported slightly better mental quality of life at 3 and 6 months and slightly better physical quality of life at 3 months. It's also important to note that people allocated to yoga had a 3% higher risk of adverse events, primarily transient increases in back pain.
When yoga was compared to standard back-focused exercise, we saw evidence of little or no differences in back function at 3 and 6 months. Information on back function was unclear at 12 months, and the effects on pain, clinical improvement, and quality of life were unclear or unavailable at each time point.
Finally, in the single trials comparing yoga to qigong (another type of mind-body exercise) and the addition of yoga to another exercise program, in this case called “back school”, the information is so limited that we are uncertain whether there are any differences between yoga and qigong, or its effects when added to an exercise program.
In summary, our updated review suggests that patients with chronic, non-specific low-back pain who do yoga may find it slightly more effective than not doing any exercise, and as effective for back function as doing other types of exercise. While we have better information in this update about similarities between yoga and other exercise for the outcome of back function, we still need additional good-quality trials to understand whether there is a difference between yoga and other forms of exercise for back function at 12 months, and to discover whether there may be differences for pain, clinical improvement, quality of life and depression. When we consider physical outcomes such as back function, it makes sense that yoga and other exercise might have similar effects, since many of the movements used in yoga for back pain are similar to movements used in other exercise treatments for this condition. However, it's important to remember that there are many types of yoga. The yoga interventions in the trials we included were developed specifically to treat low-back pain and provided by trained and experienced teachers. These factors may affect both the effectiveness and safety of yoga, and decisions about trying a yoga program designed to treat low-back pain should depend on the availability of such a program, the cost and the patient's individual preference.
Mike: If you would like to learn more about the yoga programs that have been assessed and the studies that did so, you can find full details in the full Cochrane Review which is available online at Cochrane Library dot com. You can find it with a simple search for 'yoga for back pain'.