April 23, 2018

Yoga, Physical Therapy or Education for Chronic Low Back Pain. Which is better?

By Editor

Spine Community News: Chronic low back (CLBP) affects approximately 10% of U.S. adults.  Recent clinical guidelines have recommended the use of yoga, physical therapy, and meditation as effective therapies.  Questions remain as to whether any of these forms of therapy are superior and are they effective for people of lower socioeconomic status.

Doctors reported on a year-long study of 320 CLBP individuals, non-white, high-school educated, $30,000 or less income, who were assigned to 12 weekly yoga, physical therapy, or education sessions and 40 subsequent maintenance sessions.  Outcomes measured improvement in disability and pain.  Yoga and physical therapy tended to have a greater effect on CLBP than education   In regard to pain, PT was more effective that yoga or education.  However, both yoga and physical therapy individuals had a greater number who were able to stop pain medicines.  There were no side effects from the therapies.

The limitation of the study was the lack of adherence of study subjects as defined as attending 75% of yoga or PT sessions which was 36% and 44%, respectively.  Lower socioeconomic individual have a variety of reasons who missing seasons.  The outcome may be better for those who attend a greater number of sessions.

An accompanying editorial highlighted the very heterogeneous group of diagnoses of the study subjects ranging from herniated discs with sciatica, spinal stenosis, and severe scoliosis.  Non-drug therapy may be more effective with certain CLBP problems compared to others.  A study of a more homogenous group of CLBP patients may have a better outcome.

David Borenstein, MD
Executive Editor TheSpineCommunity.com

Reference:

Saper RB et al: Yoga, physical therapy or education for chronic low back pain. A randomized noninferiority trial. Ann Intern Med 2017;167:85-94

Change DG, Kertesz SG: Yoga and low back pain: No fool’s tool. Ann Intern Med 2017;167:129-130

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