NHS Choices examines the science behind the newspaper headlines.
This well-conducted randomised controlled trial enrolled a reasonably large sample of people with low back pain, analysed them over one year with validated back pain questionnaires, and used a carefully designed yoga programme provided by qualified yoga practitioners.
The trial found that yoga led to a clear improvement in back function compared to usual care. However, there are some important points to note:
- Though this was a randomised controlled trial, participants were aware of the trial’s purpose. Those who chose to take part in the trial may have been more likely to believe that yoga could work for them than people who declined to participate. This means that the trial population may not have been fully representative of all back pain sufferers.
- Participants were not blindedto the treatment that they received (they knew whether they were doing yoga or not). At the start of the trial when the researchers questioned participants’ beliefs about yoga, roughly equal proportions of both trial arms expected that yoga would work for them (57% of the yoga and 55% of the usual care groups). As the primary outcome was a subjective report (a self-completed disability questionnaire), and as the participants knew whether they had received yoga or not, it is possible that the responses of some of the people in both groups could have been biased (albeit unknowingly).
- As the researchers highlight, 13% of the yoga group and 11% of the usual care group did not complete the assessment at three months (though this could be considered an acceptable drop-out rate that should not reduce the strength of the analysis too much).
- Most of the participants (approximately two-thirds) were women. It is not clear whether the study would have had similar results if there had been equal numbers of men and women.
Usual care was not described in this study. Treatment for this type of non-specific (without disease cause) lower back pain, as currently recommended by NICE, follows a step-by-step approach. The initial focus of lower back pain management tends to be on encouraging the person to remain as active as possible, with the use of short-term painkillers (paracetamol or an anti-inflammatory drug) to control pain if required. If the person does not improve, the GP may then refer them for physical therapy, such as physiotherapy or an exercise programme.
The trial results do not demonstrate that the current standard care approach is ineffective or inappropriate. Rather, they lend support to the fact that physical activity can be beneficial for people with chronic low back pain. However, yoga itself may not necessarily be the most appropriate form of exercise for everyone, and people with back pain should continue to follow the advice given to them by their GP or physical therapist.
Links to the headlines
Yoga better for chronic back pain than standard NHS treatment, according to study. Mirror, November 1 2011
Yoga may work better for lower back pain than conventional treatments. The Guardian, November 1 2011
Yoga can improve your bad back (and get you active more quickly than just having physio). Daily Mail, November 1 2011
Cure back pain the yoga way. Daily Express, November 1 2011
Links to the science
Tilbrook HE, Cox H, Hewitt CE et al. Yoga for Chronic Low Back Pain: A Randomized Trial. Annals of Internal Medicine, November 1 2011