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Yoga, stretching equally and slightly effective for back pain

PainSci » bibliography » Sherman et al 2011
updated
Tags: treatment, back pain, self-treatment, stretch, exercise, yoga, pain problems, spine, anatomy, spine pain, muscle, ancient

Four pages on PainSci cite Sherman 2011: 1. Quite a Stretch 2. The Complete Guide to Low Back Pain 3. The Complete Guide to Neck Pain & Cricks 4. Get in the Pool for Pain 

PainSci notes on Sherman 2011:

This experiment compared the effects of yoga, a normal stretching class, and an educational booklet on chronic low back pain. The primary findings were that both yoga and stretching seemed to be modestly effective, but neither was better than the other. Back in 2005, the same authors got similar results comparing yoga to conventional therapeutic exercise.

The research has been widely reported as “stretching and yoga work,” with a few writers emphasizing that yoga was no better. However, I haven’t seen anyone report that both stretching and yoga are equally damned here with faint praise, and quite possibly illusory praise: the effect size was modest, just 2.5 points on a scale of 11, and some or all that effect may well be attributable to bias and frustrebo (frustrated placebo) caused by a lack of blinding. Subjects deprived of either a lovely stretching or yoga experience may have reported a more negative experience.

I analyze this study in greater detail in my advanced tutorial, The Complete Guide to Low Back Pain

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Chronic low back pain is a common problem lacking highly effective treatment options. Small trials suggest that yoga may have benefits for this condition. This trial was designed to determine whether yoga is more effective than conventional stretching exercises or a self-care book for primary care patients with chronic low back pain.

METHODS: A total of 228 adults with chronic low back pain were randomized to 12 weekly classes of yoga (92 patients) or conventional stretching exercises (91 patients) or a self-care book (45 patients). Back-related functional status (modified Roland Disability Questionnaire, a 23-point scale) and bothersomeness of pain (an 11-point numerical scale) at 12 weeks were the primary outcomes. Outcomes were assessed at baseline, 6, 12, and 26 weeks by interviewers unaware of treatment group.

RESULTS: After adjustment for baseline values, 12-week outcomes for the yoga group were superior to those for the self-care group (mean difference for function, -2.5 [95% CI, -3.7 to -1.3]; P < .001; mean difference for symptoms, -1.1 [95% CI, -1.7 to -0.4]; P < .001). At 26 weeks, function for the yoga group remained superior (mean difference, -1.8 [95% CI, -3.1 to -0.5]; P < .001). Yoga was not superior to conventional stretching exercises at any time point.

CONCLUSION: Yoga classes were more effective than a self-care book, but not more effective than stretching classes, in improving function and reducing symptoms due to chronic low back pain, with benefits lasting at least several months. Trial Registration clinicaltrials.gov Identifier: NCT00447668.

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