Study Finds Yoga Can Help Back Pain, But Keep It Gentle, With These Poses

Jun 20, 2017
Originally published on June 20, 2017 12:32 pm

If you're tired of popping pain medicine for your lower back pain, yoga may be a good alternative.

New research finds that a yoga class designed specifically for back pain can be as safe and effective as physical therapy in easing pain.

The yoga protocol was developed by researchers at Boston Medical Center with input from yoga teachers, doctors and physical therapists.

During the class, trained instructors guide participants through gentle poses, including cat-cow, triangle pose and child's pose. Simple relaxation techniques are part of the class as well. More difficult poses, such as inversions, are avoided.

A guidebook that details the poses taught during the class is freely available, as is a teacher training manual.

The findings, published Monday in the Annals of Internal Medicine, are in line with new guidelines for treating back pain from the American College of Physicians. The group recommends that people with back pain should avoid pain medicines if possible, and instead opt for alternatives such as tai chi, yoga and massage. As we've reported, those guidelines are aimed at people with run-of-the-mill back pain, rather than pain due to an injury or other diagnosed problem.

Who was in the study? Researchers recruited 320 racially diverse, predominantly low-income participants in the Boston area, all of whom had chronic low back pain. The study lasted one year.

What did participants in the study do? Participants were divided into three groups. One group was assigned to a weekly yoga class for 12 weeks. Another group was assigned 15 physical therapy (PT) visits. The third group received an educational book and newsletters. For the remainder of the year — roughly 40 weeks — participants in the yoga group were assigned to either drop-in classes or home practice. The PT group was assigned to either "PT booster sessions" or home practice.

The skinny: Researchers assessed changes in pain and function using a 23-point questionnaire. The participants in the yoga and physical therapy groups had about the same amount of improvement in pain and functioning over time.

When the study began, about 70 percent of the patients were taking some form of pain medication. At the end of three months, when the yoga classes were wrapping up, the percentage of yoga and PT participants still taking pain medication had dropped to about 50 percent. By comparison, the use of pain medication did not decline among participants in the education group.

"It's a significant reduction," says study author Rob Saper, director of integrative medicine at Boston Medical Center.

"I'm not recommending that people just go to any yoga class," Saper told us. He pointed out that their research has helped nail down poses and relaxation techniques that are helpful and safe.

Saper says he chose to compare the effects of yoga with physical therapy because "PT is the most common referral that physicians make for patients with back pain. It's accepted, it's reimbursed, and it's offered in most hospitals."

Saper says if research shows that yoga can be as effective, "maybe yoga should be considered as a potential therapy that can be more widely disseminated and covered [by insurance]."

An editorial published alongside the study points out that treating low back pain is complicated and improvements documented in the study were modest.

"Any single treatment approach is unlikely to prove helpful to all or even most patients," writes Stefan Kertesz of the University of Alabama at Birmingham School of Medicine and his co-author, Douglas Chang of University of California, San Diego. Nonetheless, as this new study has shown, "yoga offers some persons tangible benefit without much risk," they conclude.

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We're going to talk about back pain now because it afflicts a whole lot of people. About 1 in 4 adults in the U.S. have experienced some form of it. Pain medication is usually the first thing people turn to for relief. But new research says you might want to strike a yoga pose before you reach for the pills. Here's NPR's Allison Aubrey.

ALLISON AUBREY, BYLINE: Back pain can come on all at once with no specific trigger. Floretta Francis (ph) remembers waking up one morning with pain that lingered for months.

FLORETTA FRANCIS: Sometimes it was hard for me to come out of bed. This is no joke.

AUBREY: Francis started taking ibuprofen several times a day, but still the pain nagged at her. When she went to see her doctor, she was recruited to participate in a study to see if yoga could be an effective way to ease the pain. Francis was very skeptical. She thought of yoga as exercise for fit people, not a treatment for back pain.

Rob Saper is a physician at Boston Medical Center and the leader of the new study. He says he's used to the skepticism, which is why he wanted to see how yoga stacked up, in an objective way, against something that's known to help, physical therapy.

ROBERT SAPER: Physical therapy is accepted. It's reimbursed. It's offered in most hospitals. So given my interest in yoga, I wanted to see how it compared in its effectiveness to PT.

AUBREY: Saper worked with a group of yoga and medical experts to design a class specifically for back pain. It's extremely gentle and includes basic stretching poses like cat cow and child's pose. It also includes breathing and relaxation techniques. Floretta Francis says when she walked into the first class, after a hectic day of work and a long commute, this is what greeted her.


FRANCIS: They played very calm and soothing music. You were doing the yoga exercises listening to the sound of the ocean, which was remarkable.

AUBREY: Francis was part of one group of study participants who took the yoga class once a week for three months. Another group received physical therapy. Then, Saper says, all the participants were assessed to see if they felt any better. Not everyone improved, but many did.

SAPER: What we found was in three months, yoga improved as well as physical therapy in terms of pain intensity and also how well people were functioning.

AUBREY: Saper says the findings fit with what a few prior studies have found. And what's significant about this study is that the participants were not the Lululemon set. About 80 percent of them live on low incomes. Some don't have as much access to health care or time to exercise. Now, since this study shows yoga can be as effective as physical therapy, Saper says...

SAPER: Maybe yoga should be considered as a potential therapy that could be more widely disseminated and covered.

AUBREY: At the end of the study, the researchers gave out yoga mats and guidebooks and encouraged participants to keep up the practice at home. Floretta Francis says she feels better these days.

FRANCIS: I'm no longer taking ibuprofen, and I'm very much happy.

AUBREY: Now, she says, when she feels a little tweak in her back, she rolls out her yoga mat. Allison Aubrey, NPR News.

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