Robert Saper and colleagues at Boston Medical Center are conducting research to assess the likelihood that yoga may be as effective as physical therapy in reducing low back pain. If shown effective, yoga classes are more likely to be reimbursed by insurance as an alternative to more costly physical therapy.
Saper’s research is notable for its inclusion of a broader sociodemographic sampling than the predominantly white, educated, affluent populations that have been used in previous published studies. Chronic low-back pain does not discriminate, affecting 5-10% of the population across all income levels, so including a wider range of incomes in this study further validates its findings.
Saper notes that yoga’s potential to alleviate other conditions that commonly present with back pain (e.g., depression, anxiety, hypertension) may prove particularly important in low-income patient populations.
Saper and colleagues’ 2009 pilot randomized controlled trial compared weekly hatha yoga classes to a standard of care control group. The yoga classes included postures, deep breathing, and meditation. Participants were given a CD and materials for 30 minutes of home practice. Following 12 weeks, the control group reported minimal improvement, while yoga group participants showed 80% reduced usage of pain medications and one-third less pain.
Building on this study, Saper and colleagues received a $2.7 million grant to conduct two additional studies. The first, currently underway, explores “dose” (investigating how much yoga is the optimum amount for symptom reduction) among 96 participants receiving one or two weekly yoga classes for 12 weeks. The second, a 3-armed RCT slated to launch in 2012, is to follow 320 participants over 12 weeks, comparing the effects of yoga treatment to physical therapy and a control group. Half the participants will receive a maintenance program following completion of the treatment to determine whether this improves outcomes.
A recently-published randomized controlled trial by Tilbrook and colleagues replicated Saper et al’s 2009 findings, as did Sherman et al’s investigation of a 3-armed trial comparing yoga to an educational pamphlet and conventional stretching. Conventional stretching did not, however, outperform yoga in this study. It will thus be interesting to see whether yoga boasts equivalent benefit to physical therapy following Saper’s 2012 trial.
Importantly, yoga may not be appropriate for everyone. For those who aren’t drawn to the practice, the same benefits may not be experienced. And yoga may actually exacerbate back pain for a small minority of practitioners; one of the participants in Saper et al’s 2009 study experienced an increase in symptoms during yoga participation which improved upon cessation, a trend reported across studies in a small number of participants.
Do you think yoga is as effective or more effective as physical therapy in reducing low back pain?