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Yoga vs Physical Therapy for Chronic Low Back Pain

Ann Intern Med; 2017 Jul 18; Saper, et al

Publish date:

In patients with nonspecific chronic low back pain, a manualized yoga program is noninferior to physical therapy (PT) for function and pain, a recent study found. Participants in the 12-week, single-blind, 3-group randomized noninferiority trial and subsequent 40-week maintenance phase included 320 predominantly low-income, racially diverse adults with nonspecific chronic low back pain (cLBP). Participants received 12 weekly yoga classes, 15 PT visits, or an educational book and newsletters. The maintenance phase of the study compared yoga drop-in classes vs home practice and PT booster sessions vs home practice. Researchers found:

  • Yoga was not superior to physical therapy for back-related function or pain.
  • Yoga was not superior to education for either outcome.
  • Yoga and PT were similar for most secondary outcomes, as was frequency of adverse events.

Citation:

Saper RB, Lemaster C, Delitto A, et al. Yoga, physical therapy, or education for chronic low back pain: A randomized noninferiority trial. Ann Intern Med. 2017;167(2):85-94. doi:10.7326/M16-2579.

Commentary:

Chronic low back pain is common and therapeutic choices include both pharmacologic and non-pharmacologic therapies. NSAIDs, opioids, muscle relaxants, and duloxetine all have efficacy for low back pain, with opioids not being recommended as a first line option.1 It is important to note that systemic corticosteroids do not have evidence of efficacy for either acute or chronic low back pain. Non-pharmacologic treatments include superficial heat, massage, acupuncture, and spinal manipulation.2 This study shows that yoga and physical therapy have about the same effectiveness, with neither being substantially better than back pain education. —Neil Skolnik, MD

  1. Chou R, Deyo R, Friedly J, et al. Systemic pharmacologic therapies for low back pain: A systematic review for an American College of Physicians clinical practice guideline. Ann Intern Med. 2017;166:480-492. doi:10.7326/M16-2458.
  2. Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166:514-530. doi:10.7326/M16-2367.

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