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Yoga helps in the treatment of chronic lower back pain to improve both pain and functional ability

Three Part Question

In [patients with chronic lower back pain] would [yoga] help in [treatment of pain relief and functional ability?]

Clinical Scenario

A 40 year old man presents with an acute on chronic exacerbation of lower back pain after lifting. He has no other symptoms. He has suffered minor injuries to his back while playing rugby in his twenties and thirties. He spends most of his working time at a desk. The pain is usually improved with pain relief. He wishes to know if yoga can help to improve the chronic pain.

Search Strategy

An advanced Medline search (1996 - Jan 2007) using lower back pain and yoga as thesaurus mapped terms via an Athens portal.
{low back pain OR lumbar vertebrae OR intervertebral disk displacement OR pain OR spinal diseases} AND {yoga}

Search Outcome

39 articles were found of which only 4 related to the use of yoga in the treatment of lower back pain.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Galantino et al
Mar-Apr 2004
Patients with chronic lower back pain presenting between the ages of 30 and 65Randomised pilot studyForward reach and sit reach testsImproved flexibilityPilot group not powered to reach statistical significance. There was a high dropout in the control group and large differences in the baseline for the seconday measures ie depression and disability.
Oswestery disability indexDecreased disability
Beck depression inventoryDecreased depression
Graves et al
Aug 2004
Review article of evidence based literatureReview of articlesLimited studies - overall encourages yogaLimited evidence based studies
Recommendations from other sourcesPoor - some recommendations of exercise but no mention of yoga
Williams et al
May 2005
Patients with lower back pain for 11.2+/-1.54 years with 48% of the group using pain medication.Randomised control trial.Functional disabilityImproved30% drop-out rate from study.
Pain intensityDecreased
Pain medicationRequirements decreased
Psychological and behavioral outcomesNo significant difference
Sherman et al
Dec 2005
101 patients with chronic low back pain aged between 20 and 64 years old who had presented to primary care 3-15 months before the study.Randomised control study of yoga classes vs exercise vs a self care bookBack related functional status (modified 24 point Roland Disability scale)yoga group superior improvement to exercise and self care groupParticipants were only followed for 26 weeks following randmisation. Only one instructor was used in each intervention.
general health statusno significant difference
medication usedecreased in the yoga group more than the other 2 groups


The current work on yoga and back pain is limited. However, the aforementioned papers show level 1 evidence in their main primary objectives of improved movement and decreased requirements of pain medication. The studies are all relatively short term and the outcome is patient compliance related.

Clinical Bottom Line

With a well motivated patient regular yoga can show improvement in pain and improve functional movement.


  1. Galantino M-L. Bzdewka TM. Eissler-Russo JM. Holbrook ML. Mogck EP. Geigle P. Farrar JT. The impact of modified Hatha yoga on chronic lower back pain : a pilot study Alternative therapies in health and medicine Mar-Apr 2004; vol. 10 no. 2 : p 56-9
  2. Graves N. Krepcho M. Mayo H.G. Hill J. Clinical enquires. Does yoga speed up healing for patients with lower back pain? The Journal of Family Practice Aug 2004, vol. 53, no. 8, p661-2
  3. Williams K. A. Petronis J. Smith D. Goodrich D. Wu J. Ravi N. Doyle E.J.Jr Gregory J.R. Munoz K.M. Gross R. Steinberg L. The effect of Iyengar yoga therapy for chronic low back pain Pain May 2005, vol.115, no. 1-2, p107-17
  4. Sherman K.J. Cherkin D.C. Erro J. Miglioretti D.L. Deyo R.A. Comparing yoga, exercise and a self-care book for chronic low back pain: a randomised control trial Annals of internal medicine 20 Dec 2005, vol. 143, no. 12, p849-56