John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. Low-back pain is a very common problem, and a variety of treatments have been assessed in Cochrane Reviews. In January 2017, this collection was added to by Susan Wieland from the University of Maryland School of Medicine in the USA and colleagues, when we published their review of the effects of yoga for chronic, non-specific low-back pain. We asked Susan to tell us about the review and the implications of its findings.

Susan: Nonspecific low back pain, or low back pain without a known cause, usually goes away within a few days or weeks. However, some patients find that it continues for 3 months or longer and it’s then considered chronic. This is a serious condition that interferes with the person’s daily activities and lowers their quality of life.
The usual treatments for this type of back pain are over the counter pain relievers and stretching or exercise. One type of exercise that is sometimes used is yoga, a mind-body intervention originating in India that has become very popular in the West, and our review found some evidence that it might be beneficial for chronic non-specific low-back pain, but the research is limited.
We included 12 trials from the US, UK, and India that had compared various types of yoga to a non-exercise intervention such as educational materials, an intervention such as physiotherapy, or a waiting list, in which one group of patients start the yoga straight away while the other group are offered it at the end of the study.
When yoga was compared to not doing exercise, patients reported small to moderate improvements in back function and small improvements in pain at 3 and 6 months. But, those allocated to yoga also had a 5% higher risk of adverse events, primarily transient increases in back pain. There was some information suggesting benefits of yoga over no exercise at 12 months, but the data were so sparse that we are very uncertain about these long-term effects.
When yoga was compared to other forms of exercise, we didn’t see any differences in back function at 3 and 6 months, and only one small trial provided information on pain at 7 months. This general lack of studies comparing yoga versus exercise, and the inconsistencies in the results of the individual trials mean that we cannot be certain about our findings, and they could change with more research evidence.
Finally, there was only one very small trial of the effects of adding yoga to another exercise program, in this case called “back school”, and so we are also very uncertain about the effects of yoga when it is added to an exercise program.
Across all the trials, there was little information on the longer term effects of yoga upon back function and pain, and very little information on its effects on mental health or quality of life.
In summary, therefore, the research to date suggests that patients with chronic, non-specific low-back pain who do yoga may find it more effective than not doing any exercise, and as effective as doing other types of exercise. But it’s important to note that all the yoga interventions in the trials we included were developed specifically to treat low-back pain, and the yoga classes were taught by trained and experienced teachers. These factors may impact on both effectiveness and safety, and decisions about trying a yoga program designed to treat chronic, non-specific low-back pain should depend on the availability of such a program, the cost, and the patient’s individual preference.

John: If you would like to learn more about the yoga programs that have been assessed and the studies that did so, you can find full details in Susan’s Cochrane Review. It’s available online at Cochrane Library dot com, where you can find it with a simple search for ‘yoga for back pain’.