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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Study Finds Yoga as Effective as PT for Pain

Published October 27, 2016 8:58 AM by Katherine Bortz

As the most common cause of long-term disability, chronic pain has become one of the most widespread conditions in America. According to the U.S. Department of Health and Human Services, pain affects more Americans than diabetes, heart disease and cancer combined.

This year, the CDC released new guidelines for the treatment of chronic pain in March 2016 in response to the related rise in opioid addictions. Instead of doctors prescribing drugs like hydrocodone and morphine, they should first have their patients try a non-drug route. The CDC has recommended that physical therapy, weight loss, cognitive behavioral therapy and certain interventional procedures should be attempted first.

A new study has revealed that yoga for lower back pain, the most common cause of short-term and chronic pain in the country, is, according to director of integrative medicine at Boston Medical Center, Mass., Robert B. Saper, MD: “nonferior to physical therapy for a diverse group of low-income patients.” The 320 adults chosen for this study all had chronic back pain “with no obvious anatomic cause, such as spinal stenosis.” Pain levels were high for all participants, with an average pain scale rating reaching 7.

To see the effectiveness of various treatments, the sample group was split into three sections, with one practicing yoga, one receiving physical therapy and one receiving education on their condition. The results of the study were remarkable.

Saper claimed that 48% of those who practiced yoga were able to get some relief from the practice and achieve a clinical response. Physical therapy received a 37% reduction in pain, and education received a 23% reduction.

What does this mean for the future of physical therapists treating chronic lower back pain? Yoga appears to be a more effective, cheaper and reduces the amount of medication taken by patients as effectively as physical therapy.

Since yoga “is actually superior” to physical therapy and “quite a bit” superior to education, according to the researchers, should physical therapists start incorporating the practice of yoga into their work?

The study can be found here

13 comments

well, yoga is the best effective method to remove any pain. well you can take other advice, walk in the morning even add on your remove pain

mayo hair, dermatologist - Surgeon October 19, 2018 8:28 AM
jalandhar

As someone who has practiced a lot of yoga, and am now a graduating PT student, I definitely agree that incorporating yoga into PT practice could be beneficial to certain populations such as patients with chronic pain as you mentioned above. With this said, I think that we as PT's whether we know it or not, do already incorporate some yoga into our practice. For example, child's pose, warrior I (lunge position), planks, etc. are a few common yoga poses that are already incorporated into therapy practice. One thing that yoga does as a whole focus more on, in my opinion, is the mental well being and the practice of calming the mind through breath, meditation, and heat. I am a whole-hearted believer that the mind and body work together and that we as therapists should do a better job at incorporating this mind-body aspect of rehabilitation and well being into our therapy services.  One other thing that does raise some concerns for me as a therapist is a vast amount of variety that exists in types of yoga practice as well and types of yoga instruction.  As with any other field, there are great yoga instructors and there are less knowledgeable yoga instructors and I would think if used for something like chronic pain, the instruction for yoga would need to be focused on proper form and technique throughout the practice. If these things were addressed, I think it could very well be something we could incorporate more of or recommend for patients to use for a more multi-modal approach to their rehabilitation.

Leah Palmer, PT - SPT May 1, 2018 12:05 PM
Greenville NC

I feel that some of the aspects of yoga that contribute to an improved effectiveness over physical therapy likely comes from the usage of the entire core, meaning diaphragm, "typical" core musculature both front, sides, and back, and pelvic floor, that yoga incorporates. There is a larger emphasis on core control in all positions and movements alongside intentional diaphragmatic breathing that are highly beneficial in reducing back pain, and in my opinion, are aspects not often emphasized enough in typical physical therapy practice. People are likely more inclined to practice yoga because of the de-stressing effects it has, plus let's be honest everyone feels fancy when they say "I do yoga." There is definitely a psychosocial aspect to yoga that is not present for physical therapy. The population that typically practices yoga is thought to be wealthy and healthy, whereas the population practicing physical therapy tend to be there due to illness or injury. Say what you will, the psychosocial beliefs and constructs a person has very much influences their participation in an activity. I would be curious to repeat the same study with more control over the frequency of both yoga and physical therapy to explore if there was a consistency bias towards the societally "more fun" activity. Regardless, I believe any an all movement improves health and pain, and distal movement isn't proficient without core stability so including these components into any movement program is beneficial and should be celebrated. It will be helpful to be able to provide patients with a secondary resource that is fun and scientifically proven to improve their back pain.

Mary Sadler, , SPT ECU April 24, 2018 4:32 PM

I agree that chronic pain is a huge problem in our society. This study is very interesting and somewhat surprising that yoga achieved such greater results than physical therapy. It potentially suggests a more economically-friendly treatment for some patients that may not be able to afford PT. We know that general exercise is also an effective strategy for pain relief, I would think yoga would have similar effects on the body to improve pain. I also wonder that since both the yoga and PT groups in this study had a 1:1 ratio of structured vs nonstructured maintenance programs, if this had impact on participant efficacy with either program. Regardless, I would be more willing to incorporate yoga into my PT treatments because of this research.

Courtney April 24, 2018 4:06 PM
NC

I have been practicing yoga for 10 years, having actually gotten into the practice in order to address a hamstring strain per the recommendation of my physician, who did not think that I needed PT at the time. I made a full recovery within a few months, and even though I now know that PT may have been more expeditious, yoga was a much cheaper option and I gained a lifelong appreciation for the skills and mentality it taught me. I did my senior exit project in high school about the various mental and physical benefits of yoga as a result of my experience. The yoga poses emphasize improving flexibility, stability, core control, postural alignment and body awareness, and my teacher always instructed the importance of taking the pose to the individual's limit and not past it. It was only after college that I looked into PT as a career and was surprised at how much similarity there was between yoga and PT when it came to the goals and approach to progressing one's practice. Obviously there is a greater emphasis on function with PT, and therefore I do not think yoga should be used as a substitution for PT in the majority of cases, but I think that utilizing yoga withing PT practice is an excellent way to teach patients about body awareness, particularly core control and postural alignment, as well as a means of progressing tolerance to stretching and strengthening. When it comes to chronic pain, there is one major advantage that yoga offers over PT, and that is the incorporation of relaxation and mindfulness principles. With chronic pain, learning to utilize these techniques, such as controlled breathing, not dwelling on persisting thoughts, etc. can be beneficial with managing symptoms. Additionally, if a patient develops a passion for yoga while using it in PT, that serves as a tool to increase compliance with maintaining physical activity after discharge, which can often be a problem and contribute to symptoms coming back in the future.

Emma Bivens, , SPT ECU April 22, 2018 1:47 PM

Very interesting study. Patients with chronic low back pain often just need to start moving and having research to back up a specific type of exercise for treating low back pain is a great tool. During one of my clinicals, I was happy to see that the VA incorporates yoga into treatment for veterans. In that facility, the yoga classes were lead by a recreational therapist. Yoga has many different options that make it more or less accessible. For patients that prefer social interaction and have the means, classes may best suit them. However, there are so many free yoga resources online that patients could benefit from. My uncle did a series recently using "Yoga With Adriene" on YouTube and loved it. While this still assumes that a patient has the means to have internet connection or viewing device, it may be a better option compared to paying for classes. I think that yoga fits very nicely into PT practice and I currently use some poses with my patients, but I have no qualms about recommending that a patient seek alternative resources. There will still be enough patients to go around even if the chronic low back pain population suddenly drops. I would be very interested to know how a patient responds to all three interventions: yoga, PT, and education. Now if I could just convice my dad to start doing yoga...

Molly Reynolds, PT - SPT, ECU DPT April 22, 2018 11:57 AM
Greenville NC

I believe that yoga should be incorporated into the treatment of patients with chronic low back pain.  Yoga promotes flexibility and core stability, which are often key components of an intervention plan in patients with low back pain.  In my clinical experience, I have witnessed many PTs starting to incorporate more yoga into their interventions and recommending further participation in yoga following discharge to prevent symptom reoccurrence and for health and wellness.  With increased support in the literature for yoga as a treatment for patients with chronic low back pain, I feel the PT profession as a whole will need to do a better job educating providers on yoga and its potential benefit to allow for more widespread implementation into PT practice.  However, all patients with chronic low back pain will present differently and need to be treated as such.  Therefore, as a profession, we need to make sure we are screening for patients to ensure they are appropriate to start yoga-based treatment.  If we start pushing this on patients too early and they do not have adequate neuromuscular control/stability, it may exacerbate patient symptoms or frustrate patients resulting in decreased adherence to PT.

Andrew, , SPT ECU April 18, 2018 7:59 PM
Greenville NC

I think that incorporating yoga into physical therapy treatment sessions is an excellent idea for the right patient. Hamstring flexibility and core strengthening are aspects that a PT may already be planning to implement into the program but if yoga poses are able to do it in a more fun and engaging way for the patient then they will be more likely to continue with the exercises long after discharge. In addition, the PT can provide information on local free yoga classes for patients who are interested following discharge from therapy. This will provide them a cost effective avenue to maintain the gains that they have made in therapy while also incorporating the social aspect into overall health and wellness. It also gives the therapist a chance to educate the patient regarding proper form and the difference between healthy soreness versus pain from doing too much too soon. This will help ensure that the patient is safe when beginning a new program after discharge.

Holly Johnson, , SPT ECU DPT April 18, 2018 2:31 AM
Greenville NC

I agree that the concepts of Yoga should be incorporated into intervention schemes to treat low back pain. A lot of physical therapy protocols already incorporate extensive flexibility training in to address the stiffness that occurs in many of those with chronic low back pain. In addition, the core stabilization that yoga offers is vastly beneficial to help stabilize the lumbar spinal segments. It would be wise of physical therapists to recommend yoga programs to patients suffering from low back pain to improve long term outcomes as well as help the patient implement a prevention program once their signs and symptoms have become manageable. It would also gives those suffering from chronic pain a chance to meet and learn from others who may have dealt with similar conditions. These two programs are a better option in my opinion as an alternate treatment scheme versus traditional management with medications.

Justin, , SPT ECU April 17, 2018 9:19 PM
Greenville NC

I completely agree with this study. As an aspiring pelvic PT, yoga has many beneficial attributes for our patients, especially those with chronic pain. I've even read studies that support yoga as a way to work through emotional issues and trauma as well. Being able to provide our patients with chronic pain tools to help approach their pain and dysfunction on a systemic level and not on a structure level will help provide more long term and effect relief. I do believe that yoga will be most effective for a whole body approach when utilized under a certified instructor and/or a physical therapist.  Ultimately I believe the most effect and best care for our patients (that is cost effective) is, as always, a team approach. I look forward to the day when i can discharge a patient to the care of a safe and established yoga program.

Ariana , SPT April 16, 2018 1:47 PM
greenville NC

Chronic pain is becoming increasingly prevalent in a variety of populations. I completed an outpatient pediatric clinical, and I incorporated yoga poses into treatment. The children were more invested in the yoga exercises for core strengthening than other core exercises. Yoga is also beneficial to adults and encourages increased compliance with the home exercise program, while also aiding in the transition to community activity. Yoga serves as an excellent option for those seeking group exercise, decreased pain, and emotional support. I believe that yoga and similar practices will decrease the need for opioids and increase patient satisfaction and compliance.

Allie Sullivan, PT - SPT, ECU April 16, 2018 1:39 PM
NC

I recently did a continuing education course on the complex aspects of chronic pain and the multifaceted approach required to treat it. One aspect the course discussed was the idea of performing lower levels of activity and slowly progressing as your body becomes more accustomed to the increased demand. I think yoga is a wonderful avenue for patients with chronic pain. It can be relatively low level, and it provides an opportunity to patients to relax and focus on something other than their pain. In addition, yoga is an excellent way to strengthen the core which would be very beneficial for patients with back pain. Perhaps physical therapists could incorporate yoga concepts into treatment in addition to other treatment techniques. This would give the therapist a chance to educate patients on the value and importance of yoga. while ensuring proper form. In addition, patients may be more likely to continue yoga after discharge from physical therapy as opposed to a traditional home exercise program.

Debra, Physical Therapy - SPT, ECU DPT March 27, 2018 11:15 PM
Greenville NC

I completely agree with you Katherine, I definitely feel as though the integration of yoga into our care as physical therapists will greatly improve patient outcomes.  Chronic pain is such a widespread issue currently in our nation and it is imperative that we start to address this problem without prescription drugs being our first line of defense. As a certified yoga instructor and soon to be physical therapist and yoga therapist, I feel as though yoga is an amazing tool for these individuals.  Yoga is a wonderful adjunct to the other interventions and modalities we use as physical therapists.  Yoga not only addresses the physical aspects of increasing flexibility and strength, but also incorporates psychological and emotional factors as well.  Viewing the patient holistically and not just focusing in on the specific joint or impairment is truly what will lead to long term healing.  

Catherine Duncan, physical therapy - SPT, ECU DPT April 1, 2017 10:10 PM
Greenville NC

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