Yoga, Stretching Ease Chronic Low Back Pain

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FYI. s. fuchs dc‘There were no statistically orclinically significant differences between the yoga and stretching groups.There were no meaningful differences among the treatment groups forbothersomeness of pain on an 11-point numerical scale, except at 12 weeks, when yoga participants weresignificantly less bothered by symptoms than the self-care group.’ Yoga,Stretching Ease Chronic Low Back PainOctober 27, 2011 — Stretching, regardless of whether it isachieved via yoga classes or conventional stretching exercises, has moderatebenefits in adults with moderately impairing chronic low back pain.In a comparativeeffectiveness study, researchers found that yoga classes were more effectivethan a self-help book, but not more effective than stretching classes, inimproving function and reducing symptoms resulting from chronic low back pain,with benefits lasting at least several months. " Findingsimilar effects for both approaches suggests that yoga's benefits were largelyattributable to the physical benefits of stretching and strengthening themuscles, and not to its mental components, " J. Sherman, PhD, MPH,from Group Health Research Institute, Seattle, Washington, and colleaguesreport.The studywas published online October 24 in the Archives of Internal Medicine. " Actionable " Findings Theauthor of a linked commentary says the results from this trial are " actionable " for practice because they reinforce the evidence thatexercise is safe and moderately beneficial for chronic low back pain. " Healthcare providers should feel comfortable referring patients to either yoga or[physical therapy–]led classes; either seems to be helpful, " writes S. Carey, MD, MPH, from the Sheps Center for Health Services Research,University of North Carolina, Chapel Hill.The studyinvolved 228 adults with chronic low back pain that was moderately impairing,as judged by baseline Roland- Disability Questionnaire (RDQ) scoresbetween 8.6 and 9.8 on a 23-point scale. The investigators randomly assignedstudy participants to 3 commonly used treatments for chronic low back pain:A self-care book (The Back Pain Helpbook), whichprovides information on the causes of back pain and advice on exercising,making helpful lifestyle changes, and managing flare-ups.Twelve weekly yoga classes based on theprinciples of viniyoga and including 17 relatively simple postures withvariations and adaptations, as well as breathing exercises and guided deeprelaxation.Twelve weekly stretching classes led by alicensed physical therapist who had completed a 2-hour teacher trainingprogram. The classes included aerobic exercises, 10 strengtheningexercises, and 12 stretches held for 30 seconds each. The stretches weredesigned to stretch the major muscle groups, with a focus on the trunk andlegs.Back-relatedpain and functional status were assessed at baseline and at 6, 12, and 26 weeksafter randomization.Sixty-fivepercent of yoga class participants and 59% of stretching class participantsattended at least 8 classes. The median number of classes attended among thoseattending at least 1 class was similar (10 yoga and 9 stretching); 63% of yogaclass attendees and 82% of stretching class attendees said they practiced athome 3 or more days per week.Less Pain With Fewer Medications Back-relateddysfunction (RDQ score) declined over time in all groups, with significantdifferences in the adjusted analyses among the 3 groups at 6 weeks (P = .04), 12 weeks (P < .001), and 26 weeks (P = .03), the investigators report.Comparedwith self-care, the yoga group reported superior function at 12 and 26 weeks,and the stretching group reported superior function at 6, 12, and 26 weeks.Table 1. Between-Group Differences (95% Confidence Interval)RDQ Week Yoga vs Self-CareYoga vs Stretching6−1.2 (−2.7 to 0.23)−1.7 (−3.0 to −0.4)12−2.5 (−3.7 to −1.3)−2.2 (−3.4 to −1.0)26−1.8 (−3.1 to −0.5)−1.5 (−2.8 to −0.2)Therewere no statistically or clinically significant differences between the yogaand stretching groups. There were no meaningful differences among the treatmentgroups for bothersomeness of pain on an 11-point numerical scale, except at 12weeks, when yoga participants were significantly less bothered by symptoms thanthe self-care group.Table 2. Differences in Bothersomeness of Pain at Week 12(95% Confidence Interval) Outcome Yoga vs Self-CareStretching vs Self-CareYoga vs StretchingBother at 12 weeks− 1.07 (1.75 to −0.41)− 0.59 (−1.30 to 0.11)− 0.49 (−1.06 to 0.08)Participantsin both exercise groups cut back on their medication use over time. Comparedwith self-care, twice as many participants in the yoga and stretching groups(roughly 40% vs 20%) reported using less medication at the 12- and 26-weekfollow-up interviews.Resultsof 2 secondary outcomes (30% and 50% improvement from baseline in RDQ scoresand bothersome scores, representing " substantial improvement " ) alsofavored yoga and stretching over the self-help book. " For example, 52% to56% of participants in the yoga and stretching groups improved by a least 50%on the RDQ compared with only 23% in the self-care group (P < .001), " the authors report.Moreparticipants in the yoga and stretching groups were " very satisfied " with their overall care for back pain.Dr.Sherman and colleagues say their study builds on prior studies of yoga forchronic back pain. They say they identified 8 published clinical trials of yogafor chronic back pain, and that " [d]espite their diversity, all trialsconcluded that yoga improved back-related function, symptoms and/or reducedmedication usage. " Recentmeta-analyses of exercise for chronic low back pain sufferers reported " modest but clinically questionable " effects of exercise comparedwith usual care, the researchers point out. However, further analyses foundthat stretching and strengthening exercises, supervised exercise, andindividual tailoring of the exercises were associated with the best outcomes. " Apart from tailoring, these features were part of our stretchingclasses, " they note. " Excellent " Study In hiscommentary, Dr. Carey notes that the number of adults with chronic low backpain is rising, along with its medical and social costs. A large number oftreatments are available, yet " we have relatively poor informationregarding how these treatments compare with each other. " The studyby Dr. Sherman's team is " an excellent example of a pragmatic comparativeeffectiveness trial, " Dr. Carey writes. He notes that the findings aregeneralizable to patients with no sciatica and mild to moderate impairment.Although direct costs were not reported, " group treatments are relativelyinexpensive. " " Wephysicians should refer our patients for exercise, practitioners should work tostandardize treatments, and payers should encourage these treatments throughminimization of copayments for therapies that have both effectiveness andmodest cost, " Dr. Carey concludes.Theauthors and Dr. Carey agree that future trials testing stretching and yogaclasses in patients with more severe chronic low back pain are needed.Thestudy was funded by the NationalCenter for Complementaryand Alternative Medicine, part of the National Institutes of Health. Theauthors and Dr. Carey have disclosed no relevant financial relationships.ArchIntern Med. 2011. Published online October 24, 2011. Abstract, Editorial MedscapeMedical News © 2011 WebMD, LLCSend comments and news tips to news@....