Yoga Anyone for Chronic LBP?

A recent RCT published in Annals of Internal Medicine compared the effects of yoga versus an exercise program directed by a physical therapist versus a self-help book. There are many interesting aspects to this study. For the sake of brevity, we can let the comments sort out the implications. Regardless, this study will likely get much press during the 1st quarter of 2006. Have a look at the video news release associated with the paper's publication. They actually interview patients in the study and show detailed video of the yoga program. Much credit goes out to the American College of Physicians. They readily understand the value of using 'push' forms of media such as press releases to disseminate information. This is a great idea.

John

Comments

[Carina Lowry]

John,

I can't say I am biased because I've been practicing Hatha yoga for over 7 years now and it has helped my core stability through the various poses. But then again, maybe I am since my back pain is significantly less when I'm active in my practice. I am not sure why this is so revolutionary: better posture, improved body awareness, improved balance, improved flexibility in the hips, shoulders, UE's, LE's, and spine. Haven't we been doing this for years as PT's? But yet put it in a context of a supportive peer class setting with personal attention and encouragement for activity and decreased fear (Fritz, George et al) with mirrors for immediate feedback and it's all of the sudden different? How long have we known that exercise and core stabilization will decrease recurrence of chronic LBP (O'Sullivan)? Yet we are quick to criticize the mind body connection of yoga, all the while trying to put a finger on why some people are confronters and others are avoiders. When are we really going to start exploring the psychosocial factors that contribute to chronic pain?

Carina

[Louie Puentedura]

One concern I have about this study and the video that goes with it, is the notion that yoga was better than therapeutic exercise. In fact, the researchers themselves state in the first paragraph of their discussion - "The yoga group consistently reported superior outcomes compared with the exercise group, but none of these differences were both statistically and clinically significant."
This is going to be lost in all the hype and many will be misled into reading that yoga was more effective than BOTH the exercise group and exercise booklet, which clearly, was not the case.
Just another example of needing to appraise the literature and not jump to conclusions from what is written in an abstract or shown in a fancy supplemental video clip.

[John Childs]

Louie:

You are correct to point out that although patients in the yoga group had significantly improved function at 12 weeks compared to the exercise group (p=.034), the effect size favoring yoga was small (1.8 points on the Roland disability scale) and may not be clinically meaningful. However, there was significantly less medication use among the yoga group at 26 weeks (21% of patients) compared to the exercise (50%) and book (59%) groups - nothing to scoff at. Bottom line - there is probably a subgroup of patients who benefit from yoga. Of course, the million dollar question always remains - exactly who benefits the most?

John

[Jon Newman]

I'd be interested in which aspects of the yoga seemed to be causal in the observed results. An interesting experiment might be to perform the same exercises (postural/strengthening) in yoga simply as "exercises for the back" and see what the outcomes are in comparison to a yoga group.

[yoga clothes]

yoga is great, but Zumba is so much fun!