National Institutes of Health • National Center for Complementary and Integrative Health
Clinical Guidelines, Scientific Literature, Info for Patients:
Chronic Low-Back Pain
The Evidence Base
- The current evidence base on efficacy of yoga in chronic low back pain includes a systematic review, which supports the ACP/APS clinical practice guidelines (published in 2007), and several subsequently published randomized clinical trials.
- Many studies have examined the effects of yoga for chronic low-back pain.
- A systematic review supporting the 2007 ACP/APS clinical practice guidelines found fair evidence that viniyoga (as well as acupuncture, massage, and functional restoration) are effective for chronic low back pain. The 2007 clinical practice guidelines included them as options physicians should consider when patients with chronic low-back pain do not respond to conventional treatment.
- A subsequent NCCAM-funded study published in 2009 of 90 people with chronic low-back pain found that participants who practiced Iyengar yoga had significantly less disability, pain, and depression after 6 months than patients who received standard medical care.
- In a 2011 study, also funded by NCCAM, researchers compared yoga (a protocol developed using the principles of viniyoga) with conventional stretching exercises or a self-care book in 228 adults with chronic low-back pain. The investigators concluded that yoga classes were more effective than a self-care book, but not more effective than stretching classes, in improving function and reducing symptoms due to chronic low back pain, with benefits lasting at least several months.
- Conclusions from another 2011 study of 313 adults with chronic or recurring low-back pain suggested that 12 weekly yoga classes resulted in better function than usual medical care.
- A 2013 review and meta-analysis of 10 randomized controlled trials in a total of 967 patients concluded that there is strong evidence of modest to moderate benefit of yoga for low-back pain.
The Evidence Base
- The current evidence base on efficacy of yoga for asthma includes several systematic reviews of randomized controlled trials.
- A 2014 systematic review and meta-analysis of fourteen randomized controlled trials in 824 adults with asthma found no evidence of effects of yoga compared with sham yoga or breathing exercises.
- A 2013 Cochrane review of 13 studies involving 906 adults with mild to moderate asthma concluded that no conclusive evidence supports or refutes the efficacy of such intervention in the treatment of adult patients with asthma.
The Evidence Base
- The current evidence base on efficacy of yoga for arthritis consists of systematic reviews of only a few published studies.
- A 2013 systematic review of eight randomized controlled trials in 559 adults with arthritis found very low evidence for effects of yoga on pain and disability in osteoarthritis and very low evidence for effects on pain in rheumatoid arthritis.
- Overall, clinical trial data suggest yoga as taught and practiced in these research studies under the guidance of skilled teacher has a low rate of minor side effects. It is not uncommon for practitioners to have some minor, transient discomfort, like in most physical activity programs.
- However, injuries from yoga, some of them serious, have been reported in the popular press.
- People with health conditions should work with an experienced teacher who can help modify or avoid some yoga poses to prevent side effects.
- Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. (299KB PDF) CDC National Health Statistics Report #12. 2008.
- Birdee GS, Legedza AT, Saper RB, et al. Characteristics of yoga users: results of a national survey. Journal of General Internal Medicine. 2008; 23(10):1653–1658.
- Bower JE, Woolery A, Sternlieb B, et al. Yoga for cancer patients and survivors. Cancer Control. 2005;12(3):165–171.
- Bureau of Labor Statistics. U.S. Department of Labor. Occupational Outlook Handbook, 2010–11 Edition: Fitness Workers. Bureau of Labor Statistics Web site. Accessed at http://www.bls.gov/ooh/personal-care-and-service/fitness-trainers-and-instructors.htm on January 24, 2012.
- Kiecolt-Glaser JK, Christian L, Preston H, et al. Stress, inflammation, and yoga practice. Psychosomatic Medicine. 2010;72(2):113–121.
- Lipton L. Using yoga to treat disease: an evidence-based review. JAAPA. 2008;21(2):34–36, 38, 41.
- Oken BS, Zajdel D, Kishiyama S, et al. Randomized, controlled, six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Alternative Therapies in Health and Medicine. 2006;12(1):40–47.
- Raub, JA. Psychophysiologic effects of hatha yoga on musculoskeletal and cardiopulmonary function: a literature review. The Journal of Alternative and Complementary Medicine. 2002;8(6):797–812.
- Ross A, Thomas S. The health benefits of yoga and exercise: a review of comparison studies. Journal of Alternative and Complementary Medicine. 2010;16(1):3–12.
- Sherman KJ, Cherkin DC, Wellman RD, et al. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Archives of Internal Medicine. 2011;171(22):2019–2026.
- Tilbrook HE, Cox H, Hewitt CE, et al. Yoga for chronic low back pain: a randomized trial. Annals of Internal Medicine. 2011;155(9):569–578.
- Uebelacker LA, Epstein-Lubow G, Gaudiano BA, et al. Hatha yoga for depression: a critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research. Journal of Psychiatric Practice. 2010; 16(1):22–33.
- Williams K, Abildso C, Steinberg L, et al. Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain. Spine. 2009;34(19):2066–2076.
- Wren AA, Wright MA, Carson JW, et al. Yoga for persistent pain: new findings and directions for an ancient practice. Pain. 2011;152(3):477–480.
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