A twist in pain relief
FORGET the Achilles heel. If there’s a weak spot on the human body, it’s probably the lower back. Pain experts conservatively estimate that more than two-thirds of the U.S. population will wrestle with bouts of back pain at some point, and though most cases are short-lived -- a few days or weeks -- for 5% to 10% of the population, the ache will become chronic, even disabling.
In their quest for relief that’s too often elusive, sufferers turn to painkillers, acupuncture, supplements, pricey ergonomic chairs, exercise and sometimes even surgery.
They might consider adding yoga to the list.
A study appearing in the Dec. 20 issue of the Annals of Internal Medicine reports that yoga is at least as effective, and maybe more so, than traditional exercise in the treatment of lower back pain, and that it is definitely more effective than setting the sufferer loose with a self-help book stuffed with back care tips.
The study, conducted by researchers from Group Health Cooperative, a nonprofit healthcare system in Seattle, examined 101 adults, all of whom had experienced mild to moderate lower back pain for at least three months.
Participants were randomly assigned to one of three treatment plans for 12 weeks. One group attended 12 weekly sessions of 75-minute classes of a gentle form of yoga known as viniyoga. Another had a similar number of 75-minute exercise sessions that included aerobics, strength training and stretching. Both of these groups were encouraged to also do their assigned type of exercise at home.
A third group was mailed a copy of a self-care book on back pain that emphasized adopting a fitness program, recommended lifestyle modifications and provided tips for managing flare-ups.
By the last treatment at week 12, the yoga group reported significantly more pain relief than the group receiving the self-help book, as measured by a standard scale used to assess pain and discomfort. The yoga group also reported slightly more improvement than the exercise group, although that difference was not statistically significant.
The yoga benefits appeared to persist. Fourteen weeks after the final treatment, yoga patients reported a continued downward trend in their pain whereas the effect leveled off in the case of the self-help set. There was no statistical difference between the yoga group and the conventional exercise group.
Yoga practitioners have long suspected that the ancient exercise is helpful in the treatment of back pain, but up till now there’s been little scientific support of the claim. (Funding for the study came from the National Center for Complementary and Alternative Medicine, a branch of the National Institutes of Health that was specifically set up to examine under-studied alternative therapies.)
Dr. Richard Deyo, an internist at the University of Washington in Seattle and a coauthor on the study, says the findings somewhat surprised him. “Based on previous clinical trials of exercise and back pain, I expected that exercise would show some benefit, which it did,” he says. “I was less certain that yoga would show any advantage.”
The yoga improvements could be due to two things: the relaxation that the practice instills, and improved body mechanics -- paying more attention to how one sits, stands and walks, suggests Karen Sherman, the study’s first author and a Group Health researcher. “The people in the yoga group said they became more aware of how they moved,” she says.
Dr. Douglas Lundy, an orthopedic surgeon at Orthopaedic Center of the Rockies who wasn’t involved in the research, found the study intriguing. “If I had a patient who was interested or wanted to try [yoga], I would encourage it,” he says.
Yoga seemed to work well for Karyn Grob of Seattle, who suffered back pain after a 2002 car accident, and had tried muscle relaxants and physical therapy with no relief before enrolling in the study. She was assigned to the yoga group.
“I felt better after the first session. It seemed to relax me and loosen me up,” Grob says. Today she remains much improved and continues with her yoga at home, four times weekly, while her husband (who isn’t into yoga) watches her curiously. “He’s just glad I’m able to walk the dogs,” she says.
Anyone wishing to try yoga for back pain should check with a doctor first to make sure the pain isn’t caused by a serious underlying medical condition such as cancer or kidney problems, or by other conditions that yoga could exacerbate, such as disc problems or sciatica.
They should find an instructor who’s experienced with back pain issues, and make sure they choose a gentle form of yoga. But, says Sherman, bear in mind: Yoga generally isn’t covered by insurance, thus it requires a financial commitment to learn it. It also takes a time commitment to practice it, either in classes or at home.
And as anyone who has wrestled with back pain knows, there’s no magic bullet.
“Chronic back pain,” says Deyo, “is like diabetes or congestive heart failure. Generally they’re lifelong issues. We try to help people stay as functional as possible, but it may be unrealistic to think you’re going to be completely pain-free.”
