Yoga for low back pain: A systematic review of randomized clinical trials

Complementary Medicine, Peninsula Medical School, 25 Victoria Park Road, Exeter, Devon, UK.
Clinical Rheumatology (Impact Factor: 1.77). 05/2011; 30(9):1257-62. DOI: 10.1007/s10067-011-1764-8
Source: PubMed


It has been suggested that yoga has a positive effect on low back pain and function. The objective of this systematic review was to assess the effectiveness of yoga as a treatment option for low back pain. Seven databases were searched from their inception to March 2011. Randomized clinical trials were considered if they investigated yoga in patients with low back pain and if they assessed pain as an outcome measure. The selection of studies, data extraction and validation were performed independently by two reviewers. Seven randomized controlled clinical trials (RCTs) met the inclusion criteria. Their methodological quality ranged between 2 and 4 on the Jadad scale. Five RCTs suggested that yoga leads to a significantly greater reduction in low back pain than usual care, education or conventional therapeutic exercises. Two RCTs showed no between-group differences. It is concluded that yoga has the potential to alleviate low back pain. However, any definitive claims should be treated with caution.

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Available from: Edzard Ernst, Oct 03, 2015
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    • "It is typically considered that yoga is comprised of physical postures (asanas), breathing techniques (pranayama), and meditation (dhyana) [14]. Recently, it is suggested that improvement of physical function and modulation in pain perception pathway may act synergistically [6, 15] although the underlying mechanisms of the effect of yoga on chronic low back pain still remain unclear [12]. "
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    ABSTRACT: Background. Serotonin and brain-derived neurotrophic factor (BDNF) are known to be modulators of nociception. However, pain-related connection between yoga and those neuromodulators has not been investigated. Therefore, we aimed to evaluate the effect of yoga on pain, BDNF, and serotonin. Methods. Premenopausal women with chronic low back pain practiced yoga three times a week for 12 weeks. At baseline and after 12 weeks, back pain intensity was measured using visual analogue scale (VAS), and serum BDNF and serotonin levels were evaluated. Additionally, back flexibility and level of depression were assessed. Results. After 12-week yoga, VAS decreased in the yoga group (P < 0.001), whereas it increased (P < 0.05) in the control group. Back flexibility was improved in the yoga group (P < 0.01). Serum BDNF increased in the yoga group (P < 0.01), whereas it tended to decrease in the control group (P = 0.05). Serum serotonin maintained in the yoga group, while it reduced (P < 0.01) in the control group. The depression level maintained in the yoga group, whereas it tended to increase in the control group (P = 0.07). Conclusions. We propose that BDNF may be one of the key factors mediating beneficial effects of yoga on chronic low back pain.
    Evidence-based Complementary and Alternative Medicine 07/2014; 2014:203173. DOI:10.1155/2014/203173 · 1.88 Impact Factor
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    • "Our subsequent trial of 95 adults with cLBP recruited from Boston Medical Center (BMC) and five affiliated community health centers showed that both once-weekly and twice-weekly yoga classes for 12 weeks were similarly effective for reducing pain and improving back related function in a mostly low-income diverse population [26]. Reviews and meta-analyses [32-34] and practice guidelines from the American Pain Society and the American College of Physicians [35] support yoga as an evidence-based treatment for cLBP with at least moderate benefit. However, no studies to date have compared yoga’s effectiveness to PT, the most commonly non-pharmacologic reimbursable treatment physicians recommend [36]. "
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    ABSTRACT: Chronic low back pain causes substantial morbidity and cost to society while disproportionately impacting low-income and minority adults. Several randomized controlled trials show yoga is an effective treatment. However, the comparative effectiveness of yoga and physical therapy, a common mainstream treatment for chronic low back pain, is unknown. This is a randomized controlled trial for 320 predominantly low-income minority adults with chronic low back pain, comparing yoga, physical therapy, and education. Inclusion criteria are adults 18-64 years old with non-specific low back pain lasting >=12 weeks and a self-reported average pain intensity of >=4 on a 0-10 scale. Recruitment takes place at Boston Medical Center, an urban academic safety-net hospital and seven federally qualified community health centers located in diverse neighborhoods. The 52-week study has an initial 12-week Treatment Phase where participants are randomized in a 2:2:1 ratio into i) a standardized weekly hatha yoga class supplemented by home practice; ii) a standardized evidence-based exercise therapy protocol adapted from the Treatment Based Classification method, individually delivered by a physical therapist and supplemented by home practice; and iii) education delivered through a self-care book. Co-primary outcome measures are 12-week pain intensity measured on an 11-point numerical rating scale and back-specific function measured using the modified Roland Morris Disability Questionnaire. In the subsequent 40-week Maintenance Phase, yoga participants are re-randomized in a 1:1 ratio to either structured maintenance yoga classes or home practice only. Physical therapy participants are similarly re-randomized to either five booster sessions or home practice only. Education participants continue to follow recommendations of educational materials. We will also assess cost effectiveness from the perspectives of the individual, insurers, and society using claims databases, electronic medical records, self-report cost data, and study records. Qualitative data from interviews will add subjective detail to complement quantitative data.Trial registration: This trial is registered in, with the ID number: NCT01343927.
    Trials 02/2014; 15(1):67. DOI:10.1186/1745-6215-15-67 · 1.73 Impact Factor
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    • "Four large (í µí±› = 90–313) [1] [2] [3] [4] and five smaller randomized controlled trials (RCTs) (í µí±› = 20–80) [5] [6] [7] [8] [9] have demonstrated yoga is an effective treatment for reducing pain and improving function in adults with cLBP. Meta-analyses [10] [11] [12] and practice guidelines from the American Pain Society and American College of Physicians [13] support yoga as an evidence-based treatment for cLBP with at least moderate benefit. "
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    ABSTRACT: Background. Previous studies have demonstrated that once-weekly yoga classes are effective for chronic low back pain (cLBP) in white adults with high socioeconomic status. The comparative effectiveness of twice-weekly classes and generalizability to racially diverse low income populations are unknown. Methods. We conducted a 12-week randomized, parallel-group, dosing trial for 95 adults recruited from an urban safety-net hospital and five community health centers comparing once-weekly (n = 49) versus twice-weekly (n = 46) standardized yoga classes supplemented by home practice. Primary outcomes were change from baseline to 12 weeks in pain (11-point scale) and back-related function (23-point modified Roland-Morris Disability Questionnaire). Results. 82% of participants were nonwhite; 77% had annual household incomes <$40,000. The sample's baseline mean pain intensity [6.9 (SD 1.6)] and function [13.7 (SD 5.0)] reflected moderate to severe back pain and impairment. Pain and back-related function improved within both groups (P < 0.001). However, there were no differences between once-weekly and twice-weekly groups for pain reduction [-2.1 (95% CI -2.9, -1.3) versus -2.4 (95% CI -3.1, -1.8), P = 0.62] or back-related function [-5.1 (95% CI -7.0, -3.2) versus -4.9 (95% CI -6.5, -3.3), P = 0.83]. Conclusions. Twelve weeks of once-weekly or twice-weekly yoga classes were similarly effective for predominantly low income minority adults with moderate to severe chronic low back pain. This trial is registered with NCT01761617.
    Evidence-based Complementary and Alternative Medicine 06/2013; 2013:658030. DOI:10.1155/2013/658030 · 1.88 Impact Factor
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