Research Review – Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial

Recently some research was published about the effects of yoga vs. physical therapy on low back pain and the results have been making quite a splash on social media (see THIS article).

The results claim that yoga is AS GOOD AS (or “non-inferior to” as they put it) physical therapy for low back pain.

Here is the stream of thoughts that went through my head when I read this…

As someone who believes in the benefits of yoga: “that’s awesome!  Finally some research to back up what I already believe!”

As a physical therapy student: “wait, what the hell am I going to physical therapy school for??”

So, seeing as we’ve been learning to critically appraise research in PT school to support our evidence based practice, I figured I’d put my newly acquired research critiquing skills to use and take a closer look at this study!

**I’ll preface this all by saying unfortunately I currently do not have access to the FULL text of the study, but I have several abstracts, news articles and a detailed article from MedScape.  I will be sure to note where I feel that I am possibly missing information that would be found in the full text and I will continue to look for access to the full study to update this post!

Study: Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial

Objective: To determine whether yoga is noninferior to physical therapy for chronic low back pain.

Study Design: 12-week, single-blind, 3-group randomized noninferiority trial and subsequent 40-week maintenance phase.

Study Participants: 320 predominantly low-income, racially diverse adults with nonspecific cLBP.

Intervention: The study divided participants into 3 groups, 1 group received 12 weekly yoga classes, 1 received 15 PT visits and 1 received educational books and newsletters.

Outcome Measures: Roland Morris Disability Questionnaire (RMDQ) and an 11 point pain scale.

Conclusion:  A manualized yoga program for nonspecific cLBP was noninferior to PT for function and pain.

My Thoughts:

The first thing I immediately noticed is that the author’s specify that the yoga sequence “prescribed” to the study participants was specifically designed to address low back pain (what they called a “structured yoga protocol”).  This is important to note because the generalized statement “yoga is as good for low back pain a physical therapy”, which is what much of the media is using, does not address what type of yoga or which poses are good for low back pain (or more importantly, which are NOT good to do!).  Not only are all styles of yoga not going to be appropriate for individuals with low back pain, but not all yoga teachers have the knowledge/ experience to put together a yoga sequence that specifically addresses the needs of someone with low back pain.

One of the researchers, Dr. Saper, Director of Integrative Medicine at Boston Medical Center, addresses this exact point in one of the articles I read, “This was a very structured, standardized yoga program, we don’t know how patients will do if they go to the yoga studio down the street.”

This point alone makes the results of the study a no-brainer to me since A LOT of the exercises that physical therapists would prescribe for a patient with low back pain are already the same as yoga poses!  It’s one of the reason’s I believe yoga and physical therapy are such a great compliment to each other!

Another thing I noticed was who funded the study…the National Center for Complementary and Integrative Health of the National Institutes of Health.  If you’re not familiar with the term “integrative health” it’s often used to refer to not only collaborative care amongst traditional healthcare professionals, but integrating non-traditional/ medical approaches to wellness, such as yoga, meditation, acupuncture, etc. When reading research it’s always good to take a mental note of who’s conducting/ funding the research and if they may benefit from the results coming out a certain way.  (Please note that in no way am I saying that this research was bias due to the funding, just something to note when reading any research!)

Two things to note about the physical therapy group in the study.  First, the limitations of the study point out that the PT group had a disproportionate loss to follow up which could have had an effect on the results and second, in the abstract/ articles I read there is no detail about what the physical therapy sessions entailed**.  The only mention I found was “the PT group had 15 one-on-one 60 minute sessions that included aerobic exercise”.  Without knowing what the PT group was actually doing it’s hard to really compare the results of the different interventions.

**THIS is where having access to the full study may give me more information.  If I am able to find access to the full report I’ll be sure to update this!

Overall:

It’s great that this type of research is starting to be done, but it’s important to look at the details (and not just the news headlines!).

While I believe in the physical and mindful benefits of yoga, I don’t believe it can cure all and I do also firmly believe in the physical therapy profession.

My goal with my future therapy practice is to combine my yoga background and physical therapy knowledge to be able to create these impairment specific type of sequences for my clients, so it’s nice to see there’s at least a start of some positive research behind it.

I also believe different things work for different people – as Dr. Douglas Chang, of the University of California, San Diego, and Dr. Stefan Kertesz of the University of Alabama at Birmingham, wrote in an accompanying editorial “one treatment method won’t help all or even most patients…in the end, however, it represents one tool among many.”

Also, to stick in a personal note, you may or may not know that I suffered with low back pain for years after a diving accident when I was in high school.  It’s been much better in recent years – interested in knowing what I helped me?  Well, let’s just say I never went to PT for my back and I’ve been doing yoga for about 5-6 years…

 

What do you think about this article and my review of it?

I’d love to know!

Also, thanks to my Evidence Based Practice professor Dr. Jette for teaching me to look at research with a critical eye! 

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