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Does Yoga eases moderate to severe chronic low back pain?

Low back pain can range from a dull, constant ache to a sudden, sharp sensation that leaves you incapacitated. The pain can begin abruptly as a result of an accident or lifting something heavy, or it can develop over time due to age-related changes of the spine. For many people, low back pain persists longer than 3 months (chronic pain). For about 20%, chronic low back pain persists for more than one year.

Recent studies in people with mild to moderate chronic low back pain suggest that a carefully adapted set of yoga postures may help reduce pain and improve the ability to walk and move. Yoga stems from ancient Indian philosophy. As practiced today, it typically combines physical postures, breathing techniques, and meditation or relaxation. Most studies of yoga have been done with people from middle-class, white backgrounds. However, people who are from economically disadvantaged communities are disproportionally affected by chronic low back pain.

To study whether yoga helps alleviate pain and improve movement for people from underserved communities, a team led by Dr. Robert Saper at Boston University School of Medicine and Boston Medical Center studied 320 predominantly low-income, racially diverse adults with moderate to severe chronic low back pain. The researchers carried out a noninferiority trial, which is designed to assess whether a new treatment (yoga) is as effective as a current treatment (physical therapy). The study was funded by NIH’s National Center for Complementary and Integrative Health (NCCIH). Results were published online on June 20, 2017, in the Annals of Internal Medicine.

The participants were randomly divided into three treatment groups. One group received 12 weekly yoga classes designed specifically for people with chronic back pain; one received 15 physical therapy visits over 12 weeks; and one was given an educational book and newsletters about self-care for chronic low back pain. The researchers then continued to track the participants for an additional 40-week maintenance phase. During this phase, people in the yoga and physical therapy groups were randomly assigned to either continue to practice at home or with a professional—at yoga classes or physical therapy sessions.

The researchers found that all three groups reported improvement in physical function and pain reduction. However, people in the yoga and physical therapy treatment groups were significantly more likely than those in the education-only group to stop taking pain relievers after one year. These findings suggest that a structured yoga program may be a reasonable alternative to physical therapy for people with chronic low back pain.

“There are now a number of studies, including ours, that show that yoga is effective for chronic low back pain, but until ours those studies included mostly white and middle-class individuals,” Saper explains. “Chronic low back pain disproportionately impacts those who are economically disadvantaged. Therefore, we feel that it was important to test whether the yoga would be received well by an underserved population as well as being effective.”

—by Tianna Hicklin, Ph.D.

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